Breast Cancer Screening Behavior in Korean American Immigrant Women: Does Patient-Physician Ethnic and Gender Concordance Matter?

Background: Breast cancer is one of the leading causes of death among Korean American women. While regular mammography is essential to early detection and treatment of breast cancer, Korean American women reported some of the lowest screening rates among minority groups in the United (Lee et al., 2018). Research suggests that primary care physicians are a key factor associated with cancer screening behaviors, especially for minority patients (Adulin et al., 2019; Hong et al., 2018). Recent studies have underscored the effects of patient–physician concordance (e.g., ethnicity, gender, language) in reducing cancer screening disparities (Kim et al., 2018; Mendoza‐Grey et al., 2021). Yet, how ethnic and gender concordance between patient and physician is associated with Korean American immigrant women’s breast cancer screening behavior is understudied. As such, this study seeks to further examine the influence of patient-physician ethnic and gender concordance on Korean American immigrant women’s adherence to American Cancer Society (ACS) breast cancer screening guidelines.

Methods: Cross-sectional survey data were collected from 340 Korean American immigrant women in North Carolina in 2019. Participants were recruited at various community-based sites (e.g., churches and grocery stores). The survey was self-administered or conducted via face-to-face interviews. The average age of the study participants 57.4 years old (SD = 8.3). On average, they had lived in the US for 27.4 years (SD = 11.5). Approximately 86% of them completed high school or more and 64.4% reported their income at least $50,000 per year. Logistic regression was conducted using Stata 15 to examine associations between patient-provider concordance and mammogram adherence by ACS screening guidelines.

Results: Overall, around 67.6% of the participants adhered to ACS screening guideline. Approximately 22.2% and 70.5% of the participants reported having a Korean physician and a female physician, respectively. Having a non-Korean physician was associated with an increased likelihood of adherence of ACS screening guideline (OR=0.49, 95% CI 0.26, 0.96), compared to having a Korean physician. Length of stay in the U.S. (OR=1.03, 95% CI 1.01, 1.06) and having a health insurance (OR=6.87, 95% CI 2.10, 22.54) were significantly associated with adherence of ACS guideline. Gender did not affect mammogram adherence.

Conclusion and Implications: This study revealed length of stay in the U.S. and health insurance were predictive of Korean American immigrant women’s breast cancer screening behaviors. Interestingly, women who had seen a non-ethnic Korean physician were more likely to get a mammogram. Our findings align with the prior works of Jo et al. (2009) and Jih et al. (2015) to highlight the need for further research into the cancer screening recommendation behaviors of Korean physicians compared to non-Korean counterparts. As more than one in five women saw Korean physicians as their primary care doctor, identifying and reducing barriers to mammogram access is crucial. Our study also highlights cultural considerations to promote breast cancer screening rates, particularly among newly immigrated and uninsured Korean American immigrant women.