Study Points

Cancer Screening Among Racial/Ethnic Minority Women

Course #91802 - $20 • 5 Hours/Credits

  • Back to Course Home
  • Participation Instructions
    • Review the course material online or in print.
    • Complete the course evaluation.
    • Review your Transcript to view and print your Certificate of Completion. Your date of completion will be the date (Pacific Time) the course was electronically submitted for credit, with no exceptions. Partial credit is not available.
  1. What differentiates race from culture?

    DEFINITIONS OF CULTURE, RACE, AND ETHNICITY

    Culture refers to the values and knowledge of groups in a society; it consists of approved behaviors, norms of conduct, and value systems [9,10]. Culture involves attitudes and beliefs that are passed from generation to generation within a group. These patterns include language, religious beliefs, institutions, artistic expressions, ways of thinking, and patterns of social and interpersonal relations [11]. Culture can also represent worldviews—encompassing assumptions and perceptions about the world and how it works [12]. Culture helps to elucidate why groups of people act and respond to the environment as they do [13].

    On the other hand, race is linked to biology. Race is partially defined by physical markers, such as skin or hair color [14]. It does not refer to cultural institutions or patterns, but it is generally utilized as a mechanism for classification. In modern history, skin color has been used to classify people and to imply that there are distinct biologic differences within populations [15]. Historically, the census in the United States defined race according to ancestry and blood quantum; today, it is based on self-classification, with some scholars arguing that race is also a social construct, not merely biologic [21]. Racial characteristics are also assigned differential power and privilege, lending to different statuses among groups [16].

    Click to Review
  2. Today, the U.S. Census defines race by

    DEFINITIONS OF CULTURE, RACE, AND ETHNICITY

    On the other hand, race is linked to biology. Race is partially defined by physical markers, such as skin or hair color [14]. It does not refer to cultural institutions or patterns, but it is generally utilized as a mechanism for classification. In modern history, skin color has been used to classify people and to imply that there are distinct biologic differences within populations [15]. Historically, the census in the United States defined race according to ancestry and blood quantum; today, it is based on self-classification, with some scholars arguing that race is also a social construct, not merely biologic [21]. Racial characteristics are also assigned differential power and privilege, lending to different statuses among groups [16].

    Click to Review
  3. Which of the following is NOT one of the four components of ethnicity identified by Alba?

    DEFINITIONS OF CULTURE, RACE, AND ETHNICITY

    Ethnicity is also a complex phenomenon and has been defined in many different ways. Alba identified four components of ethnicity [17]:

    • Social class

    • Political process

    • Traditions

    • Symbolic token

    Click to Review
  4. What state has the largest immigrant population?

    RACIAL AND ETHNIC MINORITY GROUPS IN THE UNITED STATES: DEMOGRAPHIC PATTERNS

    In 2018, 13.5% of the U.S. population was foreign-born [20]. Three states—California (10.7 million), Texas (4.9 million), and New York (4.5 million)—have the largest immigrant populations in the United States [24]. By 2044, the United States is expected to become majority-minority country [27].

    Click to Review
  5. How does the term "African American" connote a sociopolitical meaning?

    RACIAL AND ETHNIC MINORITY GROUPS IN THE UNITED STATES: DEMOGRAPHIC PATTERNS

    "African American" is a classification that serves as a descriptor; it has sociopolitical and self-identification ramifications. The U.S. Census Bureau defines African Americans or blacks as persons "having origins in any of the Black racial groups of Africa" [23]. It includes people who indicate their race as "Black, African American, or Negro," or provide written entries such as "African American, Afro American, Kenyan, Nigerian, or Haitian." As a group, African Americans have struggled for civil rights, liberty, cultural pride, and identity, giving the term sociopolitical weight as well.

    Click to Review
  6. Which of the following is NOT a factor that contributes to the tremendous diversity among Asian Americans?

    RACIAL AND ETHNIC MINORITY GROUPS IN THE UNITED STATES: DEMOGRAPHIC PATTERNS

    Asian American groups have differing levels of acculturation, lengths of residency in the United States, languages, English-speaking proficiency, education attainment, socioeconomic statuses, and religions. For example, there are approximately 32 different languages spoken among Asian Americans, and within each Asian subgroup (e.g., Chinese), multiple dialects may be present [29,30]. The diversity of this group makes generalizations difficult.

    Click to Review
  7. Compared with all other racial groups, which population has the lowest five-year breast cancer survival rate?

    CANCER DIAGNOSES AND FATALITY TRENDS AMONG RACIAL AND ETHNIC MINORITY WOMEN

    Cancer is the second leading cause of death for African Americans [50]. In 2019, it was projected that 202,260 new cancer cases were expected for African Americans, with 104,240 of these cases occurring in women [50]. The leading sites of new cancer cases among African American women are the breast, lung/bronchus, and colorectum [50]. Beginning in the 1980s, the breast cancer incidence rates among African American women increased significantly, in part because of the increased education in early detection. The incidence rates have now stabilized. Between 2006 and 2015, the breast cancer incidence rate for African American women was 0.9%, compared with 0.4% for non-Hispanic white women [50]. The death rate for breast cancer for this group is still 40% higher than for white women [50]. African American women also tend to develop breast cancer younger (e.g., before 40 years of age) [50]. Furthermore, the five-year survival rate for breast cancer is the lowest for African American women compared with all other racial/ethnic minority groups and white women (79% vs. 91% for white women) [51]. Cervical cancer rates are 30% higher among African American women than their non-Hispanic white counterparts [50]. This disproportionate burden is believed to be related primarily to unequal access to health care extending to a lack of screening.

    Click to Review
  8. African American women are more likely to have had a Pap test in the past three years if they

    CANCER DIAGNOSES AND FATALITY TRENDS AMONG RACIAL AND ETHNIC MINORITY WOMEN

    In the past, African American women had lower mammography screening rates than white women, but these rates are now only slightly higher for African American women 40 years of age and older (69% vs. 64%)[50]. Yet, this higher rate may be due to over-reporting [50]. Similarly, Pap test use is slightly higher, at 85% for African American women compared with 83% of white women [50]. In a 2011 study of African American women who frequented beauty salons in North Carolina, several demographic variables were found to predict Pap test and mammography use [53]. African American women who had an annual household income of at least $50,000 had health insurance, were currently working, and reported being in excellent/very good health tended to have had a Pap test in the past three years. For mammography screening, age (i.e., 50 years or older), having health insurance, having had a Pap test, and reporting having excellent/very good health predicted having a mammogram in the past year.

    Click to Review
  9. What factor appears to influence cancer rates for Asian Americans?

    CANCER DIAGNOSES AND FATALITY TRENDS AMONG RACIAL AND ETHNIC MINORITY WOMEN

    It appears that acculturation and years of residing in the United States are variables that affect cancer rates among Asian immigrant women. In a 2019 study, Asian women who have lived half or more of their lives in the United States were almost three times more likely to be diagnosed with breast compared to their U.S.-born counterparts [147]. In another study, for Asian women who immigrate to the United States, their risk of developing breast cancer increases six-fold, and Asian women who have lived in the United States for at least one decade have an 80% higher risk of breast cancer compared with more recent immigrants [51]. It is speculated that this is due to the changes in diet, physical activity, and the environment.

    Click to Review
  10. Which group of women tend to have larger breast tumors when diagnosed with breast cancer compared with other groups?

    CANCER DIAGNOSES AND FATALITY TRENDS AMONG RACIAL AND ETHNIC MINORITY WOMEN

    Data show that breast tumors in Hispanic women tend to be localized and larger at diagnosis compared with their non-Hispanic white counterparts, perhaps explained by lower mammography screening rates among Hispanic women [59,150]. The five-year breast cancer survival rate for Hispanic women is 86%, compared with 91% for white women [51].

    Click to Review
  11. For Native American women, which is NOT a predictor of mammography and/or Pap test screening?

    CANCER DIAGNOSES AND FATALITY TRENDS AMONG RACIAL AND ETHNIC MINORITY WOMEN

    Like other racial and ethnic minority groups, women from Native American populations have low mammography and Pap test rates. Level of education, health insurance status, and access to health providers all impact screening rates. An estimated 16.9% Native American/Alaska Native women have not had a Pap test in the past five years [131]. In 2017, the estimated mammography rate was 55% [155].

    Cancer screening rates also vary based on tribal affiliations and geographic regions. In a study of 559 Hopi Indian women living on reservations, researchers found that although 95% had ever had a Pap test, only 65% reported consistent annual screenings [73]. Younger women (18 to 24 years of age) were more likely to have had an annual Pap test compared with those older than 25 years of age. Furthermore, women with less than high school education and those who refused to be screened by a male physician were less likely to report annual screenings.

    Click to Review
  12. How does the African American concept of "claiming" impact cancer screening behaviors?

    IMPACT OF CULTURAL BELIEFS ON CANCER SCREENING

    Many cultures believe that language has power to shape reality and change the course of life events [157]. For example, some Native American tribes believe that if someone talks about cancer, particularly in the first person, this can bring about cancer [41]. Many Asian cultures also believe that speaking about taboo topics will bring about the feared event. In a study of Chinese Australian women, participants reported that thinking and speaking about cancer would bring it to fruition [75]. In the African American community, this process is referred to as "claiming;" by discussing cancer, one takes ownership of it, and therefore, there is the possibility of it happening. Conversely, if one does not discuss illness, the possibility is significantly reduced [76]. In a survey study of Muslim immigrants, some participants reported being unaware of family history of cancer, in part because information was withheld to prevent family from worrying or because speech was believed to influence health outcomes [158].

    Click to Review
  13. Which of the following is a common cultural misconception about the causes of breast or cervical cancer?

    IMPACT OF CULTURAL BELIEFS ON CANCER SCREENING

    In several studies, ethnic minority immigrant women reported believing that proper hygiene reduced the risk of cervical cancer [83]. In a study of Vietnamese immigrant women, the majority believed that cervical cancer could be prevented by proper hygiene, including cleaning procedures and observances of behaviors during menstruation [5]. A study of Malaysian women revealed similar beliefs, with the women asserting that "dirtiness" in the vagina could lead to cervical cancer and the necessity for cleaning the vulva and vagina area after sex and during menses [84]. Older Chinese immigrant women have reported that unhygienic conditions in China caused germs that then mutated to cervical cancer [83].

    Research involving Latina immigrant women have found that some women believed that improper care of the womb or inadequate feminine hygiene could lead to infections, which could then place one at greater risk for cervical cancer [49,165]. Attributing the development of cervical cancer to sexual activity during menstruation was also adhered to by some Latina women [85].

    Some Asian cultures believe that certain foods, including deep fried foods and preserved foods (e.g., dried fish, canned foods), may cause cervical cancer [84]. In a study of Latina women, sugar substitutes, spicy foods, and foods that have been microwaved were believed to cause breast cancer [85].

    In a focus group study with African American women, some participants expressed fear that a mastectomy could cause cancer to spread [86]. In another study of Haitian immigrant women, participants shared the belief that x-rays from mammography screening could cause breast cancer [74].

    Click to Review
  14. Which of the following is NOT an individual barrier to cancer screening for racial/ethnic minority women?

    BARRIERS TO CANCER SCREENING

    At the individual level, barriers to cancer screening include issues related to access to care and health literacy. Racial and ethnic minorities in the United States are significantly less likely to have health insurance, making it difficult, expensive, and inconvenient for women to obtain regular mammograms and Pap tests [92]. Over the past decade, co-payment requirements have increased with most insurance plans, and this increase is correlated with a decrease in cancer screenings [93]. Less than 70% of women in cost-sharing plans were screened, compared with nearly 80% of fully covered women. This disproportionately affects African American women, women with lower levels of education, and women in lower socioeconomic levels. Those who are uninsured are even less likely to receive screenings [94]. Lack of health insurance and higher co-payment costs emerged as barriers for Hmong women engaging in appropriate breast and cervical cancer screening [124].

    Lack of a regular physician can also reduce screening rates. In one study, recent immigration and lack of a regular physician were the greatest risk factors for not having a recent Pap test among minority women [95]. Another issue is the amount of time and resources that women have to devote to their health care. In one study, Malaysian women reported being stressed by the competing demands of life, which resulted in their health being a low priority [84]. In some cultures, the patriarchal social structure limits women's decision-making authority, which can negatively impact health-seeking decisions [162]. In such cases, the well-being of others may be valued above one's own [167]. In two separate studies, South Asian and Iranian women indicated that familial responsibilities did not allow time for cancer screenings [163,167]. This may be partially the result of stricter adherence to traditional gender roles, with women responsible for all home and child care. Hispanic women in focus groups discussed similar issues regarding relegating their health needs due to their daily struggles with life maintenance issues (e.g., caring for children, cooking) [96]. Even for older women, childcare issues may remain if they are caring for grandchildren. Creating a stable home life for their families is considered more urgent for African American women than preventive health care [96,99,133].

    One qualitative study noted that cancer screening is still costly in terms of time and finances for older women because they often rely on family members for transportation, resulting in absence from work and arrangements for childcare [97]. For many immigrants, family members attend healthcare appointments to serve as interpreters [98]. The perceived inconvenience is exacerbated by the locations of clinics and long waits for appointments [84,96]. Health clinics that are easily accessible or known to immigrant women have been associated with an increased probability of screening [163].

    Being unable to communicate well in English is a barrier in the context of obtaining transportation, locating the clinic or office, and filling out forms [124,163]. Similarly, Native American women have reported wanting information presented verbally or in simple, easily comprehendible written language [137].

    Lack of accurate knowledge about cancer and screenings also contributes to the lower rates of screening in minority populations. Fear and anxiety, stemming from misconceptions, inaccurate information, and the general unknown, often impede women from adhering to screening guidelines [168]. For example, a survey of Latina women found a common belief that breast cancer is incurable and that mammography is only necessary when symptoms emerge [61]. In one qualitative study, some African American participants did not have an understanding of the difference between self-breast exam and a mammogram [159].

    Click to Review
  15. A preference for a female physician or a provider is considered a(n)

    BARRIERS TO CANCER SCREENING

    Some racial and ethnic minority women have a strong preference for a female physician or provider to conduct mammograms and/or Pap tests. Other women prefer a physician from their own racial/ethnic minority group. In one study, Hispanic women stated that they preferred to have a provider who was also Hispanic, but it was more important that the provider could speak Spanish [99]. Asian and Muslim women preferred a female provider due to their feelings of embarrassment and privacy about having a male provider touch them [158]. Some Asian women expressed a preference for physicians with training from prestigious medical schools; this could be partially explained by the emphasis on education in Asian cultures [99].

    Click to Review
  16. Which is of the following is NOT a culturally sensitive cancer screening promotion strategy?

    CULTURALLY SENSITIVE CANCER PREVENTION AND HEALTH PROMOTION MESSAGES

    Developing culturally sensitive and relevant health prevention education for breast and cervical cancer screenings requires active listening. Recommendations for improving cancer knowledge among racial/ethnic minority women include [83]:

    • More information in the relevant language(s) should be offered and dis­seminated through mass media (e.g., radio, television, newspapers) that target the various racial and ethnic minority groups.

    • Cancer community workshops can be offered in local communities.

    • Educational materials about cancer prevention should be available in a variety of non-English languages.

    • Health fairs can be offered in the community and can include free medical services.

    • Health information and announcements in the relevant languages can be posted in public areas (e.g., ethnic grocery stores) and also on public transportation.

    Click to Review
  17. What strategy can be used to make discussions of cancer more palatable for some racial/ethnic minority women?

    CULTURALLY SENSITIVE CANCER PREVENTION AND HEALTH PROMOTION MESSAGES

    When trying to reach racial/ethnic minority women, it is important to consider how mammogram and Pap test screening messages are framed [89]. For example, the word "cancer" can evoke dread and fear for many women, with several cultures attributing the power to cause illness to the word. Similarly, some women may believe that the only "real" cancers are those in the late stages. However, if cancer screening is couched within a discussion about benign tumors, emphasizing the importance of early detection, then the message will be better received [89]. Instead of employing the word "cancer," the terms "tumors" or "lumps" could be employed as a way to start a dialogue.

    Click to Review
  18. In collectivistic cultures, what is important when communicating health messages effectively?

    GENERAL BEST PRACTICE GUIDELINES WHEN WORKING WITH RACIAL AND ETHNIC MINORITY WOMEN

    In collectivist cultures, individuals' roles as part of a larger group are paramount, with an emphasis placed on interdependence [117]. There are three major elements of collectivist orientation: interdependence; familiarity, caring, and trust; and sense of obligation [117]. The family and the church are concrete representations of this cultural norm, and they influence many behaviors, including health decisions. This translates into cancer prevention and education in that the relationship, connection, and trust between the messenger and the recipient have more importance than the message [117]. Therefore, when practitioners deliver a health message in a personal manner that communicates that they can be trusted and that they care, the message will be viewed as more credible and is more likely be acted on. If a patient sees the same practitioner at every (or most) visit, there are more opportunities to establish a therapeutic alliance, ensuring that health behaviors are maintained.

    Click to Review
  19. What attributes characterize communication styles of low-context cultures?

    GENERAL BEST PRACTICE GUIDELINES WHEN WORKING WITH RACIAL AND ETHNIC MINORITY WOMEN

    Styles of communication can be classified from high- to low-context [118]. High-context cultures are those that disseminate information relying on shared experience, implicit messages, nonverbal cues, and the relationship between the two parties [119]. Love and care may not always be verbally expressed but rather demonstrated through concrete actions [175]. Members of these cultural groups tend to listen with their eyes and focus on how something was said or conveyed [118]. On the other hand, low-context cultures rely on verbal communication or what is explicitly stated in a conversation [119]. Consequently, low-context communicators listen with their ears and focus on what is being said [118]. Because of this, the use of narratives or stories in breast and cervical cancer education may be effective for these groups [129]. Stories of cancer survivors' personal experiences bring more credibility and can reinforce adherence to mammogram screening and breast self-examination recommendations [129]. Western culture, including the United States, can be classified as a low-context culture. On the other hand, groups from collectivistic cultures, such as Asian/Pacific Islanders, Hispanics, Native Americans, and African Americans, are from high-context cultures [118].

    Click to Review
  20. Which of the following is an aspect of the direct communication style frequently used by practitioners?

    GENERAL BEST PRACTICE GUIDELINES WHEN WORKING WITH RACIAL AND ETHNIC MINORITY WOMEN

    Most practitioners have been taught and socialized in a Western biomedical environment in which communication styles are direct (i.e., low-context). This is evidenced by the following common behaviors [120]:

    • Asking questions to obtain more information about the medical condition

    • Checking for information (e.g., side-effects, symptoms)

    • Directing and advising (e.g., telling a patient the necessary treatment)

    • Summarizing (e.g., recounts of the patients' accounts of feelings)

    Click to Review

  • Back to Course Home
  • Participation Instructions
    • Review the course material online or in print.
    • Complete the course evaluation.
    • Review your Transcript to view and print your Certificate of Completion. Your date of completion will be the date (Pacific Time) the course was electronically submitted for credit, with no exceptions. Partial credit is not available.