Beliefs and Risks of Breast Cancer Among African Immigrants

Institution: University of California, San Francisco
Investigator(s): Yewoubdar Beyene, Ph.D. -
Award Cycle: 1999 (Cycle V) Grant #: 5PB-0027 Award: $236,853
Award Type: Request for Applications
Research Priorities
Community Impact of Breast Cancer>Sociocultural, Behavioral, and Psychological Issues: the human side



Initial Award Abstract (1999)
Although there are increasing concerns about addressing the cancer detection needs of ethnic minority groups in California, there are still significant gaps in our knowledge, especially about underserved ethnic populations. This is particularly true of African immigrant women. There are an estimated 603,705 African immigrants in the U.S., of which 244,204 are females, and the majority of whom live in the state of California. The major concern of health professionals is the disparity in breast cancer survival rates among women from minority and low-income populations. The changing demographics across the United States will continue to challenge health care providers to offer relevant and sensitive health care services to members of a variety of diverse groups. Failure to recognize and respond to these differences in beliefs and cultural meanings may create service gaps for significant segments of the population.

Studies show that women diagnosed with breast cancer in African countries seem to be a decade younger than their counterparts in the West, and the disease is most often advanced to stage III or IV at the time of diagnosis. These groups of immigrant women are the most challenging in that they come from societies where a routine checkup is unknown and medical care is the option of last resort. Failure to address what may be unique and a high risk predisposition to advanced breast cancer at diagnosis for this community is a serious oversight in breast cancer early detection in California. Clearly, then, these women are under-served and an urgent need exists to document African immigrants' health beliefs and understanding of breast cancer, and to devise culturally appropriate early detection, and treatment plans.

This anthropological study will explore differences in perceived risk of breast cancer and related cultural factors in a sample of African immigrant women. The overall aims of this anthropological research are to examine: 1) the cultural understanding of risk and the etiology of breast cancer among African immigrant women; 2) knowledge of breast cancer symptoms and screening guidelines; 3) cultural beliefs and attitudes of African immigrant women of body parts such as the breasts and their views on loss of body parts; and 4) using cultural consensus analysis, explore how strongly African immigrants agree or disagree among themselves as well as with other immigrants and underserved groups in California, in their beliefs about breast cancer risk, etiology, knowledge of symptom presentation, and screening guidelines.

The study design will involve focus group interviews with 20 key informants and an in-depth interview with 100 African immigrant women. The major analysis will be qualitative. In so doing, we will identify those culturally specific factors that influence understanding of breast cancer symptom presentation, and barriers to early detection in order to develop a model that will be generalizable to the larger population of African immigrant women in California.

From such a model we can make specific recommendations about what would and what would not be an appropriate mechanism to employ when interacting with African immigrant women about breast cancer risks, and early detection. This will be vital for primary care providers serving these communities, as well as any project development for early detection and treatment services. Finally, the findings from this research will provide vital information specific to the group, and empower these immigrant women to develop culturally appropriate guidelines for community education.


Final Report (2005)
Studies show that women diagnosed with breast cancer in African countries seem to be a decade younger than their counterparts in the West, and the disease is most often advanced to stage III an IV at the time of diagnosis. Over three million African immigrants reside in the United States of which the majority live in the state of California. One-third of this population is made up of women. These African immigrants are under-served and there is a need to document their health beliefs and understanding of breast cancer in order to devise culturally appropriate early detection, and treatment plans.

Cultural beliefs are important determinants in health care behavior, and in understanding of breast cancer symptom presentations and barrier to early detection. Thus, the goals of this qualitative anthropological research was to identify culturally specific factors that influence understanding of breast cancer symptom presentations, perceived risks, and barriers to early detection among African immigrant women in California. The study also addressed the cultural meanings of breasts, and attitudes toward body parts and views on loss of body parts, and examined knowledge and acceptance of breast cancer screening guidelines among these immigrant women.

Using cultural consensus analysis, the study explored how strongly African immigrant women agree or disagree among themselves in their beliefs about breast cancer risks, knowledge of symptom presentation and screening guidelines. The study design involved focus group interviews with 20 key informants and an in-depth interview with 100 African immigrant women.

Qualitative text data from focus groups and in-depth interviews elicited several shared cultural beliefs and potential barriers to early detection of breast cancer symptoms among women in the African immigrant communities in California. The data suggest that African women do not generally feel comfortable with breast self-examination because touching the breast is considered sexual and women stated that they felt uncomfortable to touch their breast even in privacy. All participants interviewed expressed that breast cancer was often associated with death. The women generally did not have much knowledge regarding treatments available when a diagnosis was made early. Mastectomy was most commonly mentioned and feared. Many Africans believe in reincarnation, where one must have one's body intact upon death. Having body parts removed means that one will return with those body parts missing. In addition, disability and disfigurement carry strong stigma and affects the whole family, therefore women with breast cancer are secluded and never disclose their illness to others and have no social support outside of close family members.

Overall the data suggest that the media and current guidelines are not reaching the African immigrant population. Most stated that small group discussions were the best forum for educating their population.


Symposium Abstract (2003)
Cultural beliefs are important determinants in health care behavior, in the understanding of breast cancer symptom presentation, and in understanding barriers to early detection. Thus, the goals of this BCRP funded qualitative anthropological research were to identify culturally specific factors that influence understanding of breast cancer symptom presentation, perceived risks, barriers to early detection, and knowledge and acceptance of breast cancer screening guidelines among African immigrant women in California. The study design involved focus group interviews with 20 key informants and an in-depth interview with 100 African immigrant women in California.

Findings from focus groups and in-depth interviews elicited several shared cultural beliefs and potential barriers to early detection of breast cancer symptoms among women in the African immigrant communities in California. Relevant variables included modesty, relationship between health and body functions and dismissing preventive health messages and behaviors when in the absence of illness or when feeling well. Overall, the data suggest that media messages and current guidelines are not reaching the African immigrant population. The various attempts made to educate the public regarding breast cancer and its treatments through various media and much of the “marketing strategies” are embedded in western cultural values regarding health and the body, and rarely penetrate the barriers of cultural beliefs of immigrant populations. Since media information focuses mainly on breast cancer among American women, most think that it is an American disease and do not see themselves at risk.

Also, health information at times is misaligned and used to validate cultural beliefs congruent with their country of origin, or be perceived as irrelevant to the group itself, a situation that provokes misunderstandings, and may increase risk of advanced cancer at the time of diagnosis. For example, media information such as the association of breast cancer risks and family history is taken out of context to validate the cultural beliefs held by some that breast cancer is inherited, and therefore, reinforces cultural stigmas. African immigrants perceive the occurrence of disease such as breast cancer in ways that are fundamentally different from the mainstream middle class American society and the health care professionals. The most challenging to reach with the early detection message are recent immigrant and refugee women from non-Western countries to whom the concept of prevention in general may be unfamiliar. Findings from this research underscore the need for culturally informed guidelines on breast cancer early detection and education in reaching African immigrant communities.

Supported by: UCOP-BCRP-7KB-0087; NCI-CA69375; NIH-MO1-RR00070, 00079, 00827; Walton Family Foundation.