Abstract B03: Cultural beliefs among Latina women: The role of acculturation and impact on timeliness of breast cancer care
Authors: Gallardo Rani I. , Rauscher Garth , Ferrans Carol 
Published: May 2015

Purpose: Certain cultural beliefs related to breast cancer may act as a barrier to a woman seeking breast cancer preventive services or timely follow-up for a breast symptom. In the Breast Cancer Care in Chicago study, Hispanic patients held considerably more cultural beliefs compared to African-American or non-Hispanic White patients. For Hispanics, holding beliefs that are inconsistent with health care seeking behavior may lead to low or delayed utilization of care regardless of access. This study explores factors associated with breast cancer beliefs among Hispanic women and how this might lead to delays in seeking care or receiving treatment for breast cancer.

Methods: Data were obtained from a population-based sample of 181 urban Hispanic women recruited as part of the Breast Cancer Care in Chicago study. Women were ages 30-79 and had been diagnosed with primary in situ or invasive breast cancer. Interviews included a 15 item cultural beliefs scale spanning a range of beliefs regarding the meaning of a breast lump, importance of treatment, and the role of faith – beliefs that could be inconsistent with motivation to seek timely health care. We dichotomized the total number of beliefs at the sample mean, such that patients holding 3 or more beliefs (index) were compared to patients holding fewer than 3 beliefs (referent). Potential demographic, sociocultural, parental, and care utilization factors were examined, as were measures of acculturation and cultural isolation. An acculturation scale was created based on patient country of origin and language, and parents' country of origin and education. Possible scores ranged from 0-6 (low acculturation=0, high acculturation &gt; 1). Prolonged treatment delay was defined as a time from first clinical visit to first breast cancer treatment exceeding 60 days (sample median), and prolonged total delay was defined as a time from initial symptom detection (self-detected or clinically detected) to first treatment exceeding 90 days (sample median). Logistic regression with model-based standardization was used to estimate confounder-adjusted risk differences for prolonged delay by number of beliefs held.

Results: Seventy-five percent of women held 1 or more beliefs. Beliefs most commonly held were: 1) Faith in God can protect you from breast cancer (48%); 2) If a breast lump is touched or pressed often, the lump will turn out to be breast cancer (30%); and 3) If breast cancer is cut open in surgery, it will grow faster (28%). Fifty percent of the sample had an acculturation score of zero (Mean= 1). Lower acculturation was associated with greater beliefs: patients who were older, born outside the US, did not speak English as a primary language, or whose parents were less educated or born outside the US tended to hold more beliefs (p&lt;0.05). Patients with less income, less education, and lacking private health insurance also tended to hold more beliefs (p&lt;0.05). Both treatment delay (57% vs. 43%, p=0.07) and total delay (59% vs. 32%, p=0.0005) were more common for women holding 3 or more beliefs vs. two or less. After adjusting for age, education, income and acculturation, holding 3 or more beliefs was associated with a 30 percentage point increased risk of prolonged total delay (RD=0.29, 95% CI: 0.12, 0.48) and a 13 percentage point increased risk of prolonged treatment delay (RD=0.13, 95% CI: -0.03, 0.32).

Conclusions: Cultural beliefs may predispose certain Hispanic women who are less acculturated and of lower SES to prolong seeking care for breast symptoms and may influence delays in receiving diagnosis and treatment for breast cancer.

Citation Format: Rani I. Gallardo, Garth Rauscher, Carol Ferrans. Cultural beliefs among Latina women: The role of acculturation and impact on timeliness of breast cancer care. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B03. doi:10.1158/1538-7755.DISP13-B03