Abstract B70: Exploring the role of acculturation in breast, colorectal and cervical cancer screening among Hispanic women
Authors: Diaz-Santana Mary Vanellys , Hankinson Susan , Sturgeon Susan , Bigelow Carol , Rosal Milagros , Ockene Judith , Reeves Katherine W. 
Published: March 2017

Abstract
Racial and ethnic disparities exist in cancer screening and management among Hispanics. Although cancer poses a burden among Hispanic women compared to non-Hispanic white women (nHw), screening rates for breast, colorectal and cervical cancer in Hispanic women lag behind nHw. The Hispanic population is heterogeneous and comprises individuals with diverse heritages. Furthermore, considerable variations in health outcomes and practices have been observed across Hispanic subgroups, supporting the relevance of studying each subgroup separately. Since early detection can reduce the burden of cancer, it is important to identify factors that can predict cancer screening within subgroups of Hispanic women. We sought to assess the role of acculturation in adherence to recommended cancer screening practices among Hispanic postmenopausal women, and to assess whether this association varies by Hispanic subgroup using data from the Women's Health Initiative. We included women who identified themselves as Hispanic in the baseline questionnaire (N=3, 263). All women who reported a personal history of cancer other than non-melanoma skin cancer were excluded from the study. Only women without a hysterectomy were included in the cervical cancer screening analysis (N=1,754). Acculturation was measured using self-reported country of birth, language preference and length of residency in the United States (US). Cancer screening adherence was assessed based on the American Cancer Society guidelines in place at the beginning of the study in 1993. The study outcomes were self-reported breast cancer screening (mammography use) and cervical cancer screening (Pap smear use) during the past year and colorectal cancer screening (sigmoidoscopy or colonoscopy use) within five years prior to the interview. Logistic regression was used to estimate the prevalence odds ratio for three types of cancer screening (breast, cervical and colorectal) according to the acculturation level among Hispanic women and within subgroups (Cuban (N=137), Mexican (N=1,151), Puerto Rican (N=289) and Other Hispanic (N=693)), with adjustment for age, alcohol use, family history of cancer, body mass index, physical activity level, and smoking status. Prevalence of breast, colorectal and cervical cancer screening was 68.7%, 55.9% and 47.1%, respectively. Highly acculturated women (US-born, English language preference and living in the US longer than in their country of origin) were more likely to be screened for breast (OR=2.12; 95% CI: 1.57-2.86), cervical (OR=1.46; 95% CI: 0.98-2.18) and colorectal cancer (OR=4.61; 95% CI: 3.27-6.50) within guidelines compared to Hispanic women with low acculturation level. Adjusting for socioeconomic factors attenuated the strength of these associations. For receipt of mammogram, subgroup analysis showed that acculturation mattered in the receipt of a mammogram only for Mexican/Mexican American women (OR=1.35; 95% CI: 1.01-1.82) for high vs. moderate/low acculturation. High acculturation was associated with greater adjusted odds of colorectal cancer screening among Mexican/Mexican American (OR=1.46; 95% CI: 1.10-1.95), Cuban women (OR=18.17; 95% CI: 2.17-152.37), and women from other Hispanic origins (OR=1.50; 95% CI: 1.07-2.11) when compared to women from their same national origin with a moderate/low acculturation level. No significant association between acculturation and cervical cancer screening were observed within the subgroups. These data show important differences in the impact of acculturation on cancer screening uptake among subgroups of Hispanic women. These findings will be useful to develop educational programs, and culturally tailored strategies for each Hispanic subgroup with the end goal of reducing the observed racial and ethnic disparities existent in cancer and promoting colorectal and breast cancer screening.
Citation Format: Mary Vanellys Diaz-Santana, Susan Hankinson, Susan Sturgeon, Carol Bigelow, Milagros Rosal, Judith Ockene, Katherine W. Reeves. Exploring the role of acculturation in breast, colorectal and cervical cancer screening among Hispanic women. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr B70.