Hispanic women in the United States
have a lower incidence of breast cancer than non-Hispanic white women.1,2
Between 1999 and 2003, the average annual age-adjusted incidence of breast cancer for Hispanic women was 92.6/100,000 compared with 130.8/100,000 for non-Hispanic white women.3
Despite a lower incidence of disease, age-adjusted 5-year relative breast cancer survival rates between 1992 and 2002 suggest that the risk of death is significantly greater for Hispanic vs. non-Hispanic white women.1
Hispanic women tend to be diagnosed with breast cancer at more advanced stages of disease than non-Hispanic white women.4
This ethnic disparity in stage at diagnosis may be explained in part by less frequent receipt of mammography screening among Hispanic women. The U.S. Preventive Services Task Force (USPSTF) currently recommends that all women aged ≥50 receive mammograms every 1–2 years, and that the decision to undergo biennial mammography before the age of 50 should be an individual one, weighing potential benefits and harms, although, prior to November 2009, biennial mammography screening was recommended for all women ≥40.5,6
However, according to the 2003 National Health Interview Survey (NHIS), only 63.3% of Hispanic women reported ever having a mammogram compared with 71.1% of non-Hispanic white women.7
Further, only 58.1% of Hispanic women between the ages of 40 and 64 reported having a mammogram within the last 2 years compared with 68.4% of all white women within the same age range.8
Improvements in regular mammography screening in the United States are needed in light of these less than optimal national screening rates, particularly among Hispanic women.
Hispanic women face a variety of barriers to having their first mammogram and to receiving regular breast cancer screening every 1–2 years. Compared with non-Hispanic white women, Hispanic women may lack access to preventive services,9
given lower income and more limited health insurance coverage.10–15
Additionally, cultural beliefs and lack of knowledge or awareness about cancer risk are likely to influence screening and preventive behaviors and result in disparities in stage at diagnosis and subsequent survival.13,16–20
Fear of pain associated with the mammogram itself as well as fear of finding cancer have also been cited as psychological barriers to breast cancer screening among Hispanic women in the United States.21
The U.S. Task Force on Community Preventive Services has recommended implementation of breast cancer screening interventions involving the use of client reminders, small media materials, one-on-one education, and reduction of structural barriers and out-of-pocket costs, as outlined in their Community Guide.22
It has not been well-established, however, if these types of interventions have the same impact on screening behaviors specifically among Hispanic women, a growing segment of the U.S. population. Further, there is insufficient evidence from the existing literature for the Task Force to determine if client-oriented group educational interventions are effective for improving breast cancer screening rates either for Hispanic women or for others, as study findings have been inconclusive.22
Group educational interventions for cancer screening are defined by the Task Force as interventions that provide information about the reasons for and benefits of cancer screening and ways to overcome barriers to screening. They are delivered in a lecture or interactive format. A trained layperson or health educator uses slide presentations and role modeling to inform, encourage, and motivate participants to receive cancer screening. A broad spectrum of groups, settings, educators, and topics can be included.22
To date, only a limited amount of research has been conducted to explore the effectiveness of group educational mammography interventions specifically targeted toward Hispanic women.23–29
To help address some of the gaps in the current mammography intervention literature with respect to the effectiveness of group educational mammography interventions, specifically those targeted toward Hispanic women, a home-based group educational intervention led by trained health promoters from the community (i.e., promotoras) was implemented among Hispanic women in the Lower Yakima Valley of Washington State in an effort to improve general cancer knowledge and breast cancer screening practices among participants. The intervention met the Task Force's definition of a group educational intervention but was delivered in a unique setting, the home. The breast cancer home health parties were conducted as part of a larger cancer prevention study in this community aimed at evaluating several different culturally appropriate, targeted interventions to promote preventive strategies, enhance knowledge and awareness, and increase cancer screening rates in the community.
Our objectives were to deliver a home-based group educational intervention addressing the topics of general cancer and breast cancer-specific awareness and screening and to measure the impact of the intervention on a target population of Hispanic women between the ages of 40 and 79, as these women were age-eligible to receive mammography. The impact of the intervention was measured by comparing responses to items from surveys administered preintervention and postintervention assessing general cancer knowledge, breast cancer screening practices, and intentions to be screened. We hypothesized that the intervention would lead to improvements in general cancer knowledge, breast cancer screening practices, and intentions to be screened.