Breast Cancer Risk Perceptions and Preventive Behaviors in Korean American Immigrant Women

Background: Breast cancer is the most commonly diagnosed cancer among Korean American immigrant women (KAIW). Yet, KAIW have lower rates of mammography use compared to other racial/ethnic groups. Despite increased research on barriers and facilitators of mammography use (Oh et al., 2017; Lee et al., 2018), KAIW’s breast cancer beliefs, specifically the relationship between perceived risk and mammography is understudied. The purpose of this study was to describe influences on KAIW’s breast cancer prevention behaviors and beliefs. Specifically, we explored 1) KAIW’s perceived breast cancer risk and views on breast cancer prevention, 2) KAIW’ attitudes toward using lifestyle behaviors vs. screening behaviors to prevent breast cancer, and 3) How cultural beliefs shape attitudes towards prevention behaviors. Understanding KAIW’s breast cancer prevention beliefs and behaviors can inform the development of culturally tailored interventions to increase mammography usage.

Methods: As part of a larger mixed-method study, semi-structured interviews were conducted with 30 KAIW in Los Angeles, California, in 2016. Participants’ mean age was 54.8 years, average time of residence in the US was 38.7 years, and about 70% had a college education. Women’s breast cancer screening experiences ranged from those who completed regular mammograms to women who never had a mammogram. Participants voiced their perspectives on breast cancer,breast cancer prevention, and their screening experiences. Interviews ranged in length from one to three hours, were digitally recorded, and transcribed verbatim. Thematic analysis (Braun & Clarke, 2006) guided the development of themes.

Findings: Most participants (n=21) viewed breast cancer as a curable and preventable disease if it is detected early. Most women estimated their personal risk for breast cancer as low or average. Attitudes towards prevention varied by perceived risk, with women reporting low perceived risk describing lifestyle behaviors as their main breast cancer prevention strategy (e.g., healthy diets, positive thinking/mind control, and none use of hormone therapy after menopause). Most women practiced breast self-exam. Only a few women had regular mammograms, even though almost all mentioned the importance of early detection of cancer. KAIW’s attitudes toward lifestyle behaviors vs. screening behaviors were influenced by family/social circle experiences (e.g., false-negative mammograms) and accessibility to health care services (e.g., health insurance), and source of health information (e.g., Korean language Youtube programs and local health lectures). Additionally, many women described their central role in their families as a motivating factor to engage in breast cancer prevention behaviors.

Conclusion: Perceptions of breast cancer risk, cultural messages about appropriate prevention behaviors, and breast cancer and breast cancer screening experiences of KAIW and their social circle influenced women’s attitudes towards mammography. KAIW described completing a range of actions to prevent breast cancer, including breast self-exam, which is not a recommended screening practice in the United States. Perceived breast cancer risk and women’s family connections may be important targets to address as part of culturally appropriate educational interventions to increase KAIW’s mammography usage.