# Cultural differences in breast cancer diagnosis and treatment

Breast cancer diagnosis and treatment is influenced by different cultural backgrounds. Factors include differences in beliefs, attitudes, and treatment options that impact diverse populations throughout the world.

## Breast cancer and spirituality

A study examining spirituality and breast cancer showed a positive correlation between spirituality and quality of life. Religious practices, a belief in God or higher power, and a support system of family and friends were important among the African-American women studied. In Chile, prayer and perceived dependence on God to intercede and guide them through this time in their life was important for women with breast cancer. They also had social support from their faith communities. Muslim women studied commonly viewed their diagnoses as the will of God. They were also active in getting the medical treatment they needed. These women's quality of life was linked with their spiritual meaning.
Religion or spirituality is often used to help frame the diagnosis in a new way that provides meaning and purpose. Health care providers can benefit by knowing the role spirituality plays in these patients' lives, leading to better awareness of the support networks needed to help cope with the diagnosis, leading to more empathetic care.

## Screening among women with intellectual disabilities

Despite the fact that governments have passed policies and engage in outreach to provide equal access to healthcare and screenings, women who are intellectually disabled have lower rates of mammography than the general population. A study was done to discover reasons why women were still not taking advantage of the screenings that are now available to them.
A group of women in Ireland had recently received a mammography; they were interviewed to see what they knew about breast cancer, signs or symptoms, if they had read any material prior to their screening or how they could help prevent breast cancer from occurring. The sample of women had little knowledge in any of these areas. The women explained that their experience was positive but prior to screening they had feelings of fear, anxiety and stress because they did not know what to expect. A low level of awareness and the fear of the unknown are barriers preventing women from getting screenings. Three suggestions have been given:
* Patients need to have access to resources to inform them about the importance of screenings and basic facts about breast cancer.
* It is important for providers to explain the mammogram procedure and what it means; it cannot be assumed that patients already know.
* Nurses and staff need to provide emotional support before, during and after the procedure to help relieve embarrassment, stress, fear or anxiety.

## Treatment options by region
### China

The topic of breast cancer can be used to highlight the differences in treatment practices between Western countries and China. This is despite the fact that the incidence of breast cancer in China was approximately 215,600 patients in 2011, which compares closely to the incidence in the United States of America. Even with the high incidence, there has been a lack of emphasis on diagnosis and detection of breast cancer in its early stages.
In Western countries, there are many resources available for patient education and awareness of breast cancer detection as well as many therapeutic options. In China, the majority of breast cancer patients are diagnosed with Stage III/IV disease, which contrasts with Western countries, where patients are more likely to be diagnosed in the early stages. Proper diagnosis is not the only limiting factor. Patients with well-defined disease (HER2-positive) struggle with the ability to gain access to traditional chemotherapeutic options that are considered the standard of care for their Western counterparts.
The other issue most often seen in emerging markets is lack of treatment options as patients relapse following first-line therapy. In China, only about 40% of metastatic breast cancer patients who receive first-line therapy will go on to receive a second line of therapy. The situation later becomes dire, where only one-quarter of patients will receive third-line therapy. Fourth- and fifth-line therapies are virtually non-existent in China. These reported frequencies of later lines of chemotherapy among Chinese patients are significantly lower than those in Japan and the United States, where 80% of patients continue to second-line and 65% of those patients continue to third-line. The main reasons for low use of later-line treatments are the lack of good therapeutic options and the financial burden of more expensive drugs. As the disease progresses, patients are more likely to turn to traditional Chinese medicine.