Perspectives on preventive health care and barriers to breast cancer screening among immigrant and refugee women

Despite evidence that reductions in breast and cervical cancer morbidity and mortality can be achieved through early detection and treatment, patients continue to present with advanced cancer without prior screening. This is particularly true for thousands of recent immigrants and refugees. The migration experience may have varied impacts on health practices and attitudes of refugees, while the impact of prior trauma and current resettlement makes these among the most vulnerable members in our society. To understand documented disparities in use of preventive cancer care, we studied refugee and immigrant women receiving care in an urban community health center which delivers state funded health assessments for refugees. The three groups selected for study (Serbo-Croatian/Bosnian, Somali and Arabic speakers from Africa and the Middle East), are refugees whose emigration to the United States came as a result of extremely violent conditions in their countries of origin. Women included in the study were 40-79 years of age, self-identified as speaking Serbo-Croatian (Bosnian), Somali, or Arabic, receiving primary care at the health center and overdue for breast cancer screening. We compared their responses to in-depth interviews conducted by native language speakers, as part of a larger study of their participation in health screening patient navigation programs. Responses were coded according to best practices for content and thematic analysis. Comparisons of the three populations showed both similarities and differences in health beliefs and behavior. Our findings emphasize the importance of understanding diverse cultural realities in creating appropriate cancer education and outreach for underserved communities.