Breast cancer worry in immigrant and U.S.-born women: The role of absolute and comparative perceived risk, and health literacy

Worry about the possibility of developing cancer (cancer worry) has been associated with cancer screening behavior, follow-up of abnormal screening tests, and adverse psychosocial health.  Few studies have examined cancer worry in general cancer screening or immigrant populations.  Using multinomial logistic regression, we examined breast cancer worry in 1st-generation immigrants (foreign-born), 2nd-generation (US-born with foreign-born parent(s)), and 3rd-generation women (US-born with US-born parents) undergoing screening mammography, aged 40-65 years, (n=304; 73% Hispanic, 18% African-American, 15% white/other).  There were no differences in the level of worry between 3rd- and 2nd-generation women.  As compared to both US-born groups, foreign-born women had similar levels of moderate worry (worry “sometimes”), but were more likely to report high levels of worry (worry “often/all the time”) than low levels of worry (worry “rarely/never”) (OR=1.8. 95% CI: 1.0-3.5).  Adjustment for health literacy attenuated this association (OR=1.5, 95% CI: 0.8-3.1), while adjusting for educational attainment and objective breast cancer risk did not alter this association.  Accounting for differences in perceived risk strengthened the association between nativity and worry, and comparative risk and absolute risk were each independently associated with high worry after adjustment for nativity and health literacy (OR=3.1, 95% CI: 1.4-7.0 and OR=3.6, 95% CI: 1.8-7.4, respectively).  These findings suggest that foreign-born women may experience elevated levels of breast cancer worry that is not explained by their objective risk of breast cancer.  If confirmed in other studies, the results suggest that addressing health literacy and perceived risk may help to reduce excessive cancer-related distress in foreign-born women.