Breast Screening Program in the Hmong American Community

Institution: University of California, Los Angeles
Investigator(s): Marjorie Kagawa-Singer, Ph.D., R.N., M.N., M.A. -
Award Cycle: 1997 (Cycle III) Grant #: 3AB-3200 Award: $74,250
Award Type: CRC Pilot Award
Research Priorities
Detection, Prognosis and Treatment>Imaging, Biomarkers, and Molecular Pathology: improving detection and diagnosis

Initial Award Abstract (1997)
This preliminary research project targets Hmong American women in California. The study is designed to obtain the information needed to develop a culturally appropriate and acceptable intervention program and materials to enable Hmong women to use early breast cancer screening services.

The full project will develop and test a breast screening intervention program based upon the findings from this proposed pilot study. It is anticipated that by involving the perspective and the voice of the Hmong women and their community leaders from the inception of the design of the project that the design will be more culturally appropriate, acceptable, and effective in promoting breast screening and early detection practices for low-income, Hmong women aged 40 years and older in California.

Asian Pacific Islander Americans (APIAs) comprise the fastest growing minority group in the United States. Hmong Americans comprise one of the major subgroups of Southeast Asians refugees in the U.S. About 60% of Hmong live in California and comprise one of the most disadvantaged groups in the APIA population due to their social history in Laos as well as their experiences here in the U.S. The Hmong number about 46,892, but community leaders estimate the number to be around 60,000.

Currently, no Hmong women in the Long Beach community are known to have obtained a mammogram. Recently, however, a few Hmong women in the community have died from breast cancer, and the community has expressed a need for education and service to help them understand this condition and what can possibly be done to reduce mortality from this disease.

The proposed project is the first effort to study the knowledge, attitudes, cultural beliefs, and screening practices of Hmong women about breast cancer. Two hundred Hmong women in Long Beach (100), Fresno (50) and San Diego (50) will be interviewed. This will be the first study to document individual, cultural, and structural barriers to breast cancer screening among these women, and this information will provide a more informed basis and a joint community collaboration upon which to build breast screening education and service programs for this population of women.

Final Report (1999)
Breast cancer is the leading site for cancer incidence and mortality for Asian American and Pacific Islander (MPI) women in the nation. Although (MPI) women, as an aggregate group, have a lower incidence or breast cancer, these aggregated perspectives hide the true burden of breast cancer in many HOPI communities. MPI women have (he lowest rates of screening for cancer of all ethnic groups, and low levels of knowledge about and use of clinical and self-breast examinations. Less-acculturated MPI women are significantly less likely to have ever had mammograms than their more highly educated and acculturated counterparts. This study is the first to document cancer screening behaviors among Hmong women.

Of the S7 MPI groups in the federal AAPI category, Hmong women are among those at the highest risk for health problems due to high rates of poverty, language isolation, and cultural barriers. Approximately 46,892 Hmong live in California, representing 60% of the Hmong population in the U.S. . A total of 201 Hmong women were surveyed in three counties of California: Fresno, San Diego and Long Beach.

Our results show that overall, 51% of respondents had ever performed a self-breast examination, and 54% of women had ever had a clinical breast examination. Only 27% of the women had ever had a mammogram.

This is the first study to assess the breast cancer screening behaviors of Hmong women in the U.S. These results show that Hmong women fall alarmingly short of national guidelines for regular screening, which instruct woman to obtain both clinical breast examinations and mammograms every year after the age of 4O years old (ACS, 1998). Our study identifies some of the factors that appear to affect the low utilization rate of mammograms In this population.

Mary Anne Foo, of the Orange County Asian and Pacific Islander Community Alliance, was a co-investigator on this project.