Regional Differences in Breast Cancer Screening Behaviors Among Korean American Immigrant Women

Background and Purpose: Breast cancer is a commonly diagnosed cancer in Korean American immigrant women (KAIW). KAIW have reported lower rates of mammography use compared to other racial/ethnic groups (Lee et al., 2018). Despite increased research on factors promoting or impeding mammography use among KAIW such as accessibility to health care and health beliefs (Lee et al., 2022; Lee & Schwartz, 2021; Oh et al., 2017), less is known about how residing area (e.g., rural vs. urban communities) impacts breast cancer screening behavior. Previous studies have identified women residing in rural areas to be less likely than those in urban areas to get mammograms (Chandak et al., 2019; Tran & Tran, 2019). This purpose of the present study was to determine if there were regional differences in mammogram uptake among KAIW.

Methods: A cross-sectional survey was conducted with a convenience sample of 461 KAIW residing in the Eastern 12-county (eNC-12), Eastern 29-county (eNC-29), and Piedmont (PNC) regions of North Carolina. The survey was either self-administered or conducted face-to-face. The mean age of study participants was 55.38 years old (SD= 9.21). On average they lived in the United States for 23.35 years (SD= 12.15). About 90.39% of the participants completed high school or higher education, and 35.14% reported their income was less than $50,000 per year. Unadjusted and adjusted multivariable logistic regression models were conducted to examine factors associated with KAIW mammography using SAS® statistical software version 9.4.

Results: KAIW who lived in eNC-29 had lower odds of receiving a mammogram in the past 2 years compared to those living in the PNC region (AOR=0.52, 95% CI: <0.27, 0.98). However, KAIW living in eNC-12 had greater odds of mammogram uptake compared to PNC residents (AOR= 1.11, 95% CI: <0.55, 2.22). Women with health insurance (AOR=3.59, 95% CI: <1.77, 7.32) and those aware of free or low-cost screening services (AOR=9.66, 95% CI:4.78, 19.55) also had greater odds of mammogram screening in the past 2 years.

Conclusions and Implications: We found that in the poor rural settings (eNC-29) there is lower odds of screening compared with the PNC region, after adjusting for all other factors. This is aligned with other research findings that rural areas have lower screening rates (Chandak et al., 2019). Unadjusted screening data indicated higher screening in eNC-12, also a rural area. This may have been due to resources available to some KAIW in that area (e.g., military presence and access to insurance). As a novel study examining regional differences in mammography uptake among KAIW in North Carolina, our findings highlight the factors and opportunities for intervention that could be tailored to each region and increase screening.