Abstract B63: Culturally informed views on cancer screening: Differences and similarities between older and younger Somali women in Minnesota
Authors: O'Brien Jennifer M. , Raymond Nancy C. , Ali Nora , Osman Sirad , Kola Okuyemi 
Published: May 2015

Abstract
Purposes of the Study: Despite literature indicating that Somali women are infrequently screened for breast or cervical cancer, there is a paucity of evidence-based breast and cervical cancer screening interventions for this group. In order to culturally adapt the evidence-based intervention to the Somali community, we needed to know what Somali immigrant women understand about cancer and their attitudes toward and the acceptability of mammogram and Pap smear as screening modalities. Additionally, we examined whether there were differences in response to these topics based on the age of the women.
Methods: Using community engaged research methods and in partnership with a community-based organization, focus groups were conducted to explore the issues described above. Two focus groups were conducted with women ages 20 to 35 and two focus groups were conducted for women ages 36 to 65. The age split allowed for candid expression of opinions, especially by younger women, as they did not have to fear that older women would find their views to be disrespectful. Additionally, breast cancer screening is recommended for women over 40 while cervical cancer screening starts at 18 years of age.
Results: Our findings suggest that Somali women of all ages experience similar challenges in seeking health care, including breast and cervical cancer screening. Both groups faced challenges with language barriers and the difficulties of communication through medical interpreters when seeking health care. Women in both age groups described how cancer is rare in Somalia, and there is considerable stigma surrounding it, including feelings of secrecy and shame. All women expressed concerns about the radiation from mammograms, and the fear that mammograms cause cancer. All women expressed concerns about feelings of shyness and modesty when discussing the Pap test, as well. Both groups of women shared concerns about the logistics of the Pap test as it relates to female circumcision, that it would be physically difficulty and cause pain because of the circumcision.
However, there were some striking differences. Older women tended to say that they only went to the doctor when sick, while younger women illustrated that this attitude is changing over time. Older women were more likely to describe being distrustful of western medicine and medical mistakes than younger women. Many older women emphasized that cancer is caused by Allah's will and that fate plays a large role in developing cancer.
Younger women were more likely to talk about modesty, feelings of shyness, and concerns about the pain involved in obtaining a mammogram. They expressed more concern about the Pap test and how it would affect their circumcision, which in and of itself is physical proof of their highly valued virginity. Younger women continued to express concerns that the Pap test might impact their perceived virginity; i.e. that they might be perceived as non-virgins if others saw them at a clinic where they would receive a Pap test.
Conclusions: In conclusion, Somali women have a culturally informed view of breast and cervical cancer, and this research indicated that there are cultural misperceptions and attitudes which need to be addressed in an adapted version of Friend to Friend in order to improve screening uptake for this group. There are key differences between younger and older Somali women, which indicate a nuanced response is required to address specific barriers for each group. Finally there are culturally informed beliefs which can help with promoting preventative care and screening practices, and these should be integrated into ongoing intervention development.
Citation Format: Jennifer M. O'Brien, Nancy C. Raymond, Nora Ali, Sirad Osman, Okuyemi Kola. Culturally informed views on cancer screening: Differences and similarities between older and younger Somali women in Minnesota. [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 B63. doi:10.1158/1538-7755.DISP13-B63