Background: In two previous studies, we observed that Latina women are unable to comply with recommendations for breast cancer care due in part to psychosocial barriers including inability to understand physicians and fear of recommendations. These are crucial findings, because ten percent of all new cancers are diagnosed in cancer survivors and second cancers are the sixth leading cause of cancer deaths. Breast cancer survivorship brings to the fore concern that survivors are obstructed from obtaining thorough preventive health screening services. Depression may also contribute to noncompliance via its inhibitory effect on vigilance and behavior change. Here we test a hypothesis that similar barriers in addition to depression level restrict breast cancer survivor screening for colorectal and ovarian cancer.
Methods: We conducted a cross-sectional study of 117 Latina breast cancer survivors using self-report data. Proportions of respondents compliant and noncompliant with recommended screening protocols were compared. Reasons were coded “yes”-“no;” depression was measured with the Center for Epidemiologic Studies (CESD) instrument dichotomized at the usual cutoff of 16 points or higher signifying depression. Cancer screening compliance was determined by published NCI guidelines. Associations were determined via chi-squared analysis. Multivariate analysis was conducted using logistic regression.
Results: Only 5 (4.2%) of participants were screened for both cancers, 43 (36.8%) for either cancer, and 69 (59.0%) were screened for neither cancer. Reported barriers to cancer care were generally high overall, but only “cannot understand English” (66% v 53%, p=.05) and “care is too expensive” (84% v 71%, p=.05) were associated with lack of ovarian cancer screening and none were associated significantly with lack of colorectal screening. Thirty-two percent of the sample met CESD criteria for depression, nearly twice the general population rate; it is associated with ovarian but not colorectal screening noncompliance. Factors including unemployment (74% v 57%, p=.03) and no familial history of cancer (75% v 53%, p=.02) are related to non-compliance with ovarian screening, but only unmarried status is related to non-compliance with colorectal screening (54% v 20%, p=.01). Separate multiple logistic regression analyses confirmed the independent significant association of these factors with ovarian and colorectal screening non-compliance, indicating good model fit and significant proportions of variance explained by the models.
Discussion: There are significant impediments to cancer screening among Latina breast cancer survivors. They derive from multiple domains (demographic factors, psychosocial barriers, and affective states). For this reason they require further research to clearly identify them. Moreover we must develop an equally broad-based preventive strategy that addresses each of these domains to promote vigilance and increase healthy behaviors among Latina women.
Acknowledgements: This research was possible by grants from the San Antonio Cancer Institute, San Antonio, Texas (P30-CA54174), the Susan G. Komen Breast Cancer Foundation (POP 2000 704), and the National Cancer Institute, Redes En Acción (U01-CA86117).
Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B51.