The challenge of early breast cancer detection among immigrant and minority women in multicultural societies.

A sociological view of the barriers experienced by women from traditional cultures, both in their native countries and as immigrants and minorities in multicultural western societies, in preventive health care generally and in breast screening specifically, is essential not only to understand patterns of late-stage diagnosis, but also to design successful interventions and programs. Breast cancer is a unique disease, as its name ties together a multisymbolic organ of the female anatomy and a potentially fatal affliction, the treatment of which commonly is a body-mutilating procedure (mastectomy). Because of its special nature, breast cancer is shrouded in fears, myths, and connotations reaching far beyond the objective clinical understanding of the disease. Many women do not use available breast-screening services and present with advanced symptoms. To help women detect and treat breast cancer early, health care providers and policymakers should try to understand their predicaments and the factors influencing their decisions. Structural barriers include such socioeconomic factors as poor health insurance, distance to medical facilities, and inability to take time off from work, while organizational barriers include difficulty in navigating complex health care systems and interacting with medical staff. Psychological and sociocultural barriers include poor health motivation, denial of personal risk, fatalism, mistrust of cancer treatments, and the fear of becoming a burden on family members. These barriers can often preclude proactive breast screening or rapid response to symptoms, even when breast cancer awareness is rather high. Moreover, in many traditional societies, especially Muslim ones, women's decisions and actions are controlled by men, and men may be unaware of or disapprove of breast screening. This article discusses several approaches to lowering the described barriers, including specially tailoring educational programs that dispel cancer myths, involving men in breast cancer detection efforts, implementing cultural competence training for mainstream health care providers, and recruiting minority health care professionals to enable better outreach to their coethnics.