Breast Self Examination (BSE) among Korean American Women: Knowledge, Attitudes and Behaviors

Abstract: Health beliefs and behaviors among ethnic minority groups in America differ widely from those of the general population. This paper describes part of a study on Korean American women's knowledge, attitudes and beliefs about breast health and breast cancer screening. The relationship between frequency of breast self-examination (BSE) and the Health Belief Model (HBM) variables was assessed in a convenience sample of 133 Korean American. Data were collected using Champion's instrument (susceptibility, seriousness, benefits, and barriers) and McCance et al.'s Breast Cancer Knowledge (BCK) test to measure knowledge about BSE and breast cancer screening. Multiple regression demonstrated that perceived barriers were significantly related to frequency of BSE (R = .32, p Key Words: Breast cancer; Breast Self-Examination (BSE); Korean American Women; Perceived Barriers; Knowledge Asian Americans, largely because of immigration, are the fastest growing minority population in the United States. The intercensal 1997 census estimated 9,253,000 Asians, a 160% increase over the 1980 census count of 3,466,847 (U.S. Department of Commerce, Bureau of the Census, 1997). Currently, Asian Americans constitute 3.0% of the population and this number is expected to dramatically increase to 11 % by the year 2050, representing a 300% overall increase in the population size (U.S. Department of commerce, Bureau of the Census, 1993). Among Asian American women, breast cancer risk increased relatively rapidly from double during the period 1973 to 1986 (Stanford, Herrinton, Schwartz, & Weiss, 1995) and to six fold during 1983 to 1987 (Ziegler et al., 1993) and now approaches that of Whites. Furthermore, there is evidence of late stage of diagnosis, high recurrence rates, and poor survival among Asian American women diagnosed with breast cancer (Jenkins & Lkagawa-Singer, 1994; Lin-Fu, 1993). Breast cancer is the most frequently diagnosed cancer among Korean women in the United States with an age-adjusted rate of 28.5 per 100,000, compared with Non-Hispanic White women 111.8 per 100,000 (Parker, Davis, Wingo, Ries, & Heathe 1998). Although the breast cancer rate among Korean women in the United States are approximately four times lower than non-Hispanic white women, Korean women are more likely to be diagnosed at a laterstage. Among women identified as Korean from the SEER (Surveillance, Epidemiology, and End Results) registry from 1988-92, a significantly higher proportion of Korean women were diagnosed at a regional stage compare to White women (National Cancer Institute, 1995). LITERATURE REVIEW Mammography, clinical breast examination (CBE), and breast self--examination (BSE) continue to be the three mayor modalities for early detection of breast cancer. The American Cancer Society (ACS) has developed guidelines for these breast cancer screening practices. Recommendations include monthly BSE by women 20 years old and older, a CBE every 3 years from age 20-40, then every year for those over 40, and mammography every year starting at age 40 (ACS, 1998). About 70%-80% of breast cancer detected by screening may have a good prognosis (Austoker, 1994). Although the efficacy of BSE as a screening method remains controversial, recent research suggests that it is an efficacious method of detecting lesions at an earlier stage and thus improving treatment outcomes (Foster, Worde, Costanza, & Solomon, 1992; Harvey, Miller, Baines, & Corey, 1998; Koibuchi et al., 1998; McKenna et al., 1992). In addition, approximately 49% - 90% of breast cancers are found by the woman herself, either accidentally or through BSE (Benedict, Williams, & Hoomani, 1996), and women who perform BSE are more likely to seek mammograms and CBE at the recommended intervals (Kurtz, Given, & Kurtz, 1993; Salazar & Carter, 1993). …