reducing breast cancer risk among latina women

Reducing Breast Cancer Risk Among Latina Women: Myths and Misconceptions 2004 Minority Women’s Health Summit August 12-15, 2004 Amelie G. Ramírez, DrPH, Principal Investigator Baylor College of Medicine – San Antonio Cancer Institute Co-Principal Investigators José R. Martí, MD Columbia University Edward J. Trapido, ScD NCI Frank J. Penedo, PhD U. of Miami Aida L. Giachello, PhD U. of Illinois, Chicago Martha A. Medrano, MD, MPH U. of TX Health Science Ctr., S.A. Eliseo J. Pérez-Stable, MD U. of California, San Francisco Gregory A. Talavera, MD, MPH San Diego State U. Elena Ríos, MD National Hispanic Medical Assoc. Roland Garcia, PhD, NCI Program Officer Supported by NCI Grant No. UO 1 CA 86117-01 Selected Spanish Settlement Dates in the Americas: Late 1400s - Late 1700s San Diego 1768 Santa Fe 1609 Natchitoches 1713 St. Augustine 1565 Veracruz 1518 Spanish settlements Baracoa 1511 Santo Domingo 1496 Santa Marta 1525 San Juan 1521 Hispanic Population: 1930-2050 (millions) 100 90 80 68.2 70 60 50 40 30 20 9.1 10 0 1930 1940 1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050 First year “Hispanic” used Census Projections 98.2 82.7 55.2 43.7 32.5 22.4 14.6 1.3 1.6 2.3 3.5 Source: U.S. Department of Commerce. (1993) We the American… Hispanic. U.S. Census Bureau.(2000). Projections of the Resident Population by Age, Sex, Race, and Hispanic origin, 1999 to 2100. Percent Distribution of Hispanics by Type: 2002 Central and South American 14.3% Other Hispanic 6.5% Cuban 3.7% Puerto Rican 8.6% Mexican 66.9% Source: U.S. Census Bureau, Current Population Survey, March 2002 Why It’s Important to Study Latinos and Cancer • • • • Fastest growing U.S. population group Cancer: 2nd leading cause of death Breast cancer leading cause of death for Latinas Higher incidence of: cervical, stomach, gallbladder and liver cancer Latino Cultural Values • Family emphasis • Religious/spiritual • emphasis Machismo attitudes Sociodemographic Profile • • • • • • • • • Poor access to health care Poverty Low educational attainment Lack of health insurance Strong family ties Strong religious beliefs Low levels of knowledge about breast cancer Reliance on folk/alternative medicine Lack of orientation toward preventative health behaviors Lack of Latino Health Data • • Lack of cancer reporting among groups other than African Americans Hispanic origin not reported on all state death certificates as late as 1990 • Gaps in SEER data collection • We should: Cancer in Latinos: At the Crossroads  Research the impact of cancer on Latinos  Study factors that may provide protective effect  Plan for population growth, aging, acculturation  Encourage greater participation by Latinos in clinical trials Recent Mammography by Ethno-Regional Group 90 80 70 60 50 40 30 20 10 0 S. Francisco Central Am. Miami Cuban Am. New York P. Ricans San Diego San Antonio Mexican Am. Mexican Am. Houston Mexican Am. Brownsville Mexican Am. Laredo Mexican Am. Ramirez et al. Breast cancer screening in regional Hispanic populations. Health Education Research. 2000. Knowledge of Screening Guidelines – Women 40+ Hispanic Group Never Heard Mamm . Mexican American Central American 4.8 1.7 Heard but no Knowledge Mamm . 36.9 33.9 Knowledge Mamm . 58.3 64.4 Pap 11.7 8.6 Pap 35.8 43.7 Pap 52.5 47.7 Puerto Rican Cuban 2.1 2.9 17.8 4.9 31.8 25.3 41.1 39.8 66.1 71.8 41.1 55.6 Source: Ramirez et al. Hispanic Women’s Breast and Cervical Cancer Knowledge, Attitudes, and Screening Behaviors. Am J Health Promot. 2000; 14(5):292-300 Attitudes Toward Cancer – Women 40+ Hispanic Group Cancer can be cured % Disagree Mexican American Central American Puerto Rican 21.5 17.8 21.2 Little I can do to prevent % Agree 39.5 36.8 33.5 How likely to get cancer % More likely 17.0 12.2 20.1 Cuban 15.2 34.3 11.6 Source: Ramirez et al. Hispanic Women’s Breast and Cervical Cancer Knowledge, Attitudes, and Screening Behaviors. Am J Health Promot. 2000; 14(5):292-300 Latina Breast Cancer Facts • Third highest incidence rates among minorities • Third highest mortality rates among all groups • Mostly commonly diagnosed cancer • Leading cause of cancer death • Diagnosed at a more advanced stage of the disease • Uninsured 2.3 times more likely to be diagnosed at a • later stage Lower 5-year survival rate: 76% vs. 87% Source: American College of Physicians 2000; Healthy People 2010, 1998 Latina Breast Cancer Myths • A bruise on the breast will lead to breast cancer. • If an incision is made during breast cancer surgery, the cancer will spread. • Getting too many mammograms leads to breast cancer. • Mammograms are only used to evaluate breast lumps. Source: Ramirez et al, 2000 American Journal of Public Health Familias en Acción/Familias in Action & Nuestras Historias/Our Stories Latina Breast Cancer Myths • Touching the breasts too often will lead to cancer Talking about cancer causes cancer Using illegal drugs causes cancer Herbs cure breast cancer (uña de gato/cat’s claw) • • • Source: Ramirez et al, 2000 American Journal of Public Health Familias en Acción/Familias in Action & Nuestras Historias/Our Stories Disparities in Clinical Trial Participation NCI study participation: • Latinos and other minority groups: 3% • Non-Hispanic Whites: 88% National PSA Campaign • 4 PSAs (video and audio) produced in Spanish and English • >700 nationwide TV and radio stations receiving PSAs • 2 Telly Awards for PSA excellence Clinical Trials Outreach for Hispanics • Purpose: Increase awareness and intention to participate in clinical trials; coordinate with NCI Cancer Genetics Network to offer enrollment Methods: Clinical Trials Education Series presentation to Hispanic adults in existing groups Results: 40 presentations, 1,000 people, 90% Hispanic, mostly female, desire more information • • Recommendations Patient Education • Increase breast cancer awareness • Work with community organizations to dispel • myths and educate Latinas about breast cancer Promote breast cancer screening behavior (clinical breast exams, mammograms, and BSEs) Recommendations Training • Encourage Latino and minority students to enter health professions in formal education curriculum • Promote cultural competence • Provide professionals with continuing formal and informal cultural competence training Recommendations Patient Contact • Promote cultural competence of office staff • Provide culturally appropriate educational materials • Ask open-ended questions and remain non-judgmental Recommendations Research • Encourage research in Latinos and other minority populations, including immigrant and racial/ethnic groups • Study correlation between culturally competent communication and health outcomes • Fund technology use in cancer care communications among minority populations For more information on cancer control policy recommendations produced by Redes En Acción, visit our web sites at www.redesenaccion.org or www.saludenaccion.org Mil Gracias