Incidence and Prevalence of Breast Cancer in Hispanic/Latina Women

Like non-Hispanic women in the U.S., breast cancer is one of the most common cancers in Hispanic/Latina women, and is the leading cause of death due to cancers. However, in 2004, Hispanic/Latina women in the U.S. were 33% less likely to have breast cancer as non-Hispanic white women, and in addition, had a lower mortality rate from breast cancer (15 versus 27.7 deaths per 100,000) relative to non-Latino white women (1). 

The statistics for the incidence of breast cancer in the WWAMI region are shown in Table 1:
 

In general, the overall incidence of breast cancer in the WWAMI region for Hispanic/Latina women is similar to that seen in the U.S. - that is, the incidence is lower in Hispanic/Latina women in comparison to non-Hispanic women especially in Washington State and Idaho (no data is available on Hispanics for Wyoming, Alaska, or Montana). 

Protective factors that have been suggested to play a role in the lower risk among Latinas include early and multiple pregnancies, and low dietary fat intake (3).  However, despite these protective factors, the 5 year survival rate for breast cancer among Latinas is only 76% compared to 85% for non-Latina white women (1).  Mexicans, Puerto Ricans, and South and Central Americans have been shown to have lower survival rates for breast cancer. Research studies suggest that the differences in survival rates are due to differences in biological factors, socioeconomic status, access to care, lifestyle factors and behavioral characteristics of different cultures (4).

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Differences in Mammography Screening Rates

The American Cancer Society (ACS) currently recommends yearly mammography and clinical breast exam beginning at age 40, and then annually starting at age 50 years (5). The U.S. Preventive Task Force recommends screening mammography, with or without clinical breast examination, every 1-2 years for women age 40 and older (6). Studies have demonstrated that increased use of screening mammography is associated with lower death rates from breast cancer in the U.S. 

However, among Hispanic/Latina women there continues to exist a disparity in adherence to mammography screening. Studies have shown that cancer screening for Hispanic/Latina women is lower than for non-Hispanic White women. 
In 2005, the ACS reported that 65.4% of Hispanic women over 40 years of age reported having had mammography (7).  Foreign-born Hispanic/Latina women had the highest rates of never being screened with mammography and clinical breast exams when compared with U.S. born Hispanic/Latina women and non-Hispanic Whites (8).  Fernandez et al studied Hispanic women who were low income, immigrants with low literacy in Washington DC., and found that 62% reported having had a mammogram, but only 33% were compliant with age recommendations for screening (9). Skaer et al studied Hispanic women from 6 migrant clinics located in Eastern WA and found that 38% had ever received a mammogram, and that only 30% were compliant with age recommendations for screening (10). 
 

Participation rates in mammography by Hispanic/Latina women have increased over the years, but are still lower than those for whites or African Americans (3). Table 2 demonstrates the percentage of non-Hispanic White women living in Washington State who have reported having a mammogram within the last 2 years in 2006. In comparison, the percentage of Hispanic women who have had a mammogram within the last 2 years was similar. 

Hispanic/Latina women tend to seek healthcare services less than do women in other ethnic groups.  Differences in screening rates between Hispanic/Latina women and non-Hispanic White women may be due to a lack of access to or quality of preventative healthcare (1).  Other studies have shown that low rates of mammography screening in Hispanic/Latina women has been attributed to lack of access to health care, lower socioeconomic status and lower education (4).   Fernandez et al showed that fear of cancer, embarrassment, lack of knowledge about cancer, and cost were common barriers to immigrant Hispanic women (9). Previous research has found that many women, particularly Hispanic/Latina women, report that screening mammography is not necessary in the absence of symptoms of breast cancer (4).  Of the three major U.S. Latino subgroups (Cuban, Puerto Rican, Mexican American), Mexican American are the least likely to use preventative services (11).

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Beliefs About Breast Cancer

Beliefs about breast cancer in Hispanic/Latina women differ from those of non-Hispanic White women.  There may be culturally based beliefs that may influence the way Hispanic/Latina women view breast cancer.  Hispanic/Latina women, particularly those with lower acculturation levels, have less knowledge than non-Hispanic White women about risk factors and symptoms of breast cancer and have less desirable attitudes about the disease.  For instance, Hispanic/Latina women are more likely to believe that medically unaccepted factors such as breast trauma, breast fondling, and multiple sexual partners increased the risk of breast cancer and were less likely to know that breast lumps and bloody breast discharge were symptoms.  Hispanic/Latina women are also twice as likely as non-Hispanic White women to believe that they only need a mammogram when they had a breast lump (12). 

Some Hispanic/Latina women often believe that cancer is god’s punishment for improper or immoral behavior.  If sexual practices such as breast fondling or having multiple sex partners increase the risk of breast cancer, then acquiring this disease may justify the consequence of immoral behavior.  Women may therefore be reluctant to learn that they have breast cancer and to inform their husbands about it (12). 

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Late Diagnosis of Breast Cancer

Although Hispanic/Latina women have somewhat lower incidence rates of breast cancer than non-Hispanic White women, they are more likely to have larger tumors or metastatic disease or both at the time of diagnosis (12).  Compared with other racial and ethnic groups, Hispanic/Latina women are more likely to die from breast cancer or to present with a less favorable disease stage.  These findings are attributed to later diagnosis as a result of the under utilization of mammography.  As a group, Hispanic/Latina women are also less likely to receive clinical breast exams and screening mammograms than non-Hispanic Whites and African Americans (13). 

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Prevention Strategies

There is need to increase awareness and education about self-examination, clinical evaluation, mammography, and other forms of cancer prevention in the Hispanic/Latino community (13).  A number of different modes of education have been attempted. For example, media coverage of breast cancer education through local radio broadcasts and television has the potential of reaching more Latinas who listen to Spanish radio and watch Spanish television.  Some of the television studios have taken advantage of the story lines in some of the most commonly viewed "telenovelas" to cover the topic of breast cancer screening and prevention. Shows such as “Cosas De La Vida Real” ior "Cuidando Su Salud" are examples that raise important health issues about Latinas.  The use of radio talk shows in Spanish that discuss breast cancer and the significance of screening are also ways to help increase awareness. <<Click here >> to sample one of these radio talk shows.

Other examples of community outreach include the success of projects that have reached out to Hispanic communities and migrant labor camps where healthcare advocates and/or health educators (known as promotoras) do “Home Health Parties” (14).  In these “Home Health Parties,” a Latina liaison offers her home and is given a grocery store gift certificate to prepare a dinner and invite her friends to hear a healthcare advocate discuss breast cancer and the importance of screening. In Washington State, researchers from the Fred Hutchinson Institute are sponsoring "home health parties" to raise awareness about cancer and encourage people to take advantage of free screenings. The researchers recruit families to host the gatherings in their homes and then send a trained health educator to lead a discussion on a specific cancer topic. Parties last about an hour and may include 5 to 8 family members and friends (sometimes more). The events are informal with lots of time for questions. The information is usually new to the families, and many do not know that they can take steps to prevent cancer. The cancer topic changes every 6 months. Six months after a party, the health educators, or promotoras, follow up to see if a family has questions or would like a refresher course. Preliminary data from the study are encouraging. Nearly a quarter of the 70 individuals who attended recent parties on colon cancer (and were eligible for screening) subsequently underwent screening.

The Washington Breast and Cervical Health Program (WBCHP) in Washington state is designed to provide uninsured and underinsured women aged 40-64 with breast and cervical cancer screenings (15). Women who are at or below 250% of the Federal Poverty Level, ages 40 - 64 years, and are uninsured or underinsured are eligible for Washington’s Breast and Cervical Health Program (WBCHP).  Nearly 60,000 women are eligible for services each year.  Over 10,000 women are enrolled and screened annually. Program services are available statewide and include screening, public education, professional education, quality assurance, tracking/surveillance, and evaluation of service delivery components. The Department of Health provides technical assistance and support to local WBCHP Prime Contractors who administer the program regionally. Clinics, private physicians, hospitals, local health departments, laboratories, and radiology facilities provide the services. Reimbursement is at the Medicare rate and includes routine office visits, clinical breast exams, screening mammograms.  Particular emphasis is placed on high-risk populations, including women ages 50 years and older, Native Americans, African Americans, Hispanics, Asian/Pacific Islanders, and lesbians.

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1. Abraido-Lanza, Chao, and Gammon (2004). Breast and cervical cancer screening among Latinas and Non-Latina Whites.  American Journal of Public Health 94(8): 1393-1398.

2. Henry J. Kaiser Family Foundation, statehealthfacts.org, Breast cancer incidence rate per 100,000 women by race/ethnicity, 2003. Accessed on 12/09/2007 at: http://www.statehealthfacts.org/comparebar.jsp?ind=66&cat=2 .

3. Molina M, Molina CW. Health Issues in the Latino Community. San Francisco: Josey-Bass, 2001; p107-223.

4. Wells and Roetzheim (2007). Health Disparities in Receipt of Screening Mammography in Latinas:  A Critical Review of Recent Literature. Cancer Control 14(4): 369-379.

5. American Cancer Society, Guidelines for Early Detection of Cancer. Accessed on 12/10/07 at:
http://www.cancer.org/docroot/PED/content/PED_2_3X_ACS_Cancer_Detection_Guidelines_36.asp?sitearea=PED

6. Agency for Healthcare Research and Quality. Screening for Breast Cancer. In: The Guide to Clinical Preventive Services 2006: Recommendations of the U.S. Preventive Services Task Force, AHRQ Publications, June, 2006.

7. American Cancer Society, Statistics for 2006. Accessed on 12/10/07 at:
http://www.cancer.org/docroot/STT/stt_0_2006.asp?sitearea=STT&level=1

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8. Rodriguez MA (2005). Breast and Cervical Cancer Screening:  Impact of Health Insurance Status, Ethnicity, and Nativity of Latinas. Annals of Family Medicine 3: 235-241.

9. Fernandez MA, Tortolero-Luna G, Gold RS (1998). Mammography and pap test screening among low-income foreign-born Hispanic women in USA. Cad Saude Publica 14 Suppl 3: 133-147.

10. Skaer TL, Robison LM, Sclar DA, Harding GH (1996). Knowledge, attitude and patterns of cancer screening: a self-report among foreign-born Hispanic women utilizing rural migrant health clinics. J Rural Health 12(3): 169-177.

11. Suarez, L (1994). Pap smear and mammogram screening in Mexican-American women: The effects of acculturation.  American Journal of Public Health 84(5):742-746.

12. Hubbel FA et al (1996). Differing beliefs about breast cancer among Latinas and Anglo women. Western Journal of Medicine  164(5):405-409.

13. Warren, AG et al (2006). Breaking down barriers to breast and cervical cancer ccreening:  A University-based prevention program for Latinas. Journal of Healthcare for the Poor and Underserved 17(3): 512-521.

14. National Cancer Institute (2007). Cancer prevention starts at home (with a party). NCI Cancer Bulletin 4(22):6. Accessed on 12/10/07 at: http://www.cancer.gov/ncicancerbulletin/NCI_Cancer_Bulletin_072407/page6

15. Washington State Department of Health. Breast and Cervical Health Program. Accessed on 12/10/07 at:
http://www.doh.wa.gov/wbchp/default.htm

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