Abstract A55: Breast cancer detection and screening mammography in Mexican American women: Findings from the Ella Binational Breast Cancer Study

Purpose: Although breast cancer incidence and mortality rates are lower in Hispanic than non-Hispanic white women, the profile of tumor presentation among Hispanic women is consistent with a more aggressive disease pattern and less favorable prognosis. The Ella Binational Breast Cancer Study is a multi-center collaboration between the United States (US) and Mexico to investigate whether epidemiological and clinical risk factors, as well as tumor markers, differ between women in Mexico and Mexican-American women living in the US; recruitment is ongoing with the goal of enrolling 1,000 participants.

Experimental Procedures: Using data from the U.S. population of the Ella Study, we assessed the relationship between education level, acculturation, and breast cancer screening behaviors. We used questionnaire data on education level and acculturation as assessed by language usage to identify barriers for mammography screening with the overall goal of identifying methods to improve breast cancer screening education and access. Our population comprised 230 breast cancer patients of Mexican descent living in Houston, Texas (N=138) or Arizona (N=92) who were 40 years or older.

Summary of Data: Our results show the most common method of breast cancer detection was self-detection (67%), followed by screening mammography (23%), clinical exam by a health professional (6%), and other methods (3%). Use of mammography screening was strongly associated with country of birth, level of education and acculturation. Among US-born women, 83% reported receiving prior mammography, compared to 62% of non-US born (p<0.001). Participants with a high school degree or higher were more likely to receive prior mammography compared to those with lower levels of education (76% vs. 62%; p = 0.03). Differences in mammography screening were observed between women who had high English-language media exposure, including women who reported frequent exposure to English television and radio programs, compared to women with low exposure (77% vs. 58%; p=0.04). After noticing a change in their breasts, 49% of women reported waiting one month or more to seek medical attention; the most common reasons for prolonging medical care included having no insurance or not being able to afford medical care (36%) and not feeling it was important (27%).

Conclusions: These data suggest despite high rates of mammography screening reported among Hispanics in national surveys (70–80% based on BRFSS), a high percentage of breast cancer in our population is not detected through screening mammography. Since the majority of participants in our population reported high Spanish media exposure (73%), this suggests a medium to improve culturally appropriate breast cancer screening education, including information about free screening programs in these communities. In the future, we hope to propose an intervention model among Spanish-dominant Latina women that addresses the complex issues of breast self-examination, mammography screening, and importance of prompt reporting of findings to health professionals when breast changes are detected. This model must address the many factors, including limited health literacy, English proficiency, and health care access and affordability, that directly affect critical breast cancer-related behavior and environmental barriers.