Barriers to preventive mammography screening among nonadherent Chinese women

A108

Introduction: Breast cancer is the most common cancer and the second cause of cancer death in Chinese-American women who are the largest Asian population in the US and 70% are immigrants. Chinese women, especially recent immigrants have much lower rates of mammography use than the general population; these women also may lack a regular source of care.
 Objectives: This study examined factors affecting Chinese women’s use of mammography and how presence of a regular provider mediated the impact of cultural and attitudinal barriers to screening.
 Methods: Cross-sectional data from a community-based longitudinal intervention study was used to examine the aims of this study. Two hundred and ten Chinese-American women from the Metropolitan DC and NY areas who were over age 40 and non-adherent to the ACS recommended mammography screening guidelines completed a telephone interview. Sociodemographics, acculturation, medical access factors (including health insurance, presence of a regular medical doctor, and physician recommendation), perception of breast cancer risk, and future intention for screening mammography were assessed. Eastern view of health care was measured by a 5-point Likert scale with a reliability of .76.
 Results: Of 210 non-adherent women, only 36% had an intention to obtain a mammogram in the future. Logistic regression results showed that presence of a regular doctor (OR=4.47, p<.001) and culturally-based beliefs (such as beliefs in the role of self care, hot-cold balanced diet, and herb medicine) were independently associated with screening intention (OR =0.93, p<.05), controlling for covariates. In addition, results from stratified analyses showed that compared to women with a regular doctor, women who lacked a regular doctor were more likely to be uninsured (p<.0001) and poor (income ≤$20,000) (p<.0001), have poor English ability (p<.0001), and have lived in the US for less than 10 years (p<.0001). They were also more likely to hold Eastern view of care (p< .05) and perceive lower risk at breast cancer (p<.01). These women are the least likely to have an intention to obtain a mammogram (P < .0001).
 Conclusion: Although these data are cross-sectional, it appears that Chinese women without regular sources of care have more attitudinal and access barriers to screening. Providing a culturally competent healthcare setting for those uninsured and less-acculturated immigrant women may be an effective strategy to reduce ethnic disparities in receipt of breast cancer screening.