A systematic review of barriers and enablers to South Asian women’s attendance for asymptomatic screening of breast and cervical cancers in emigrant countries

Abstract

ObjectivesThe aim of this review was to identify the cultural, social, structural and behavioural factors that influence asymptomatic breast and cervical cancer screening attendance in South Asian populations, in order to improve uptake and propose priorities for further research.DesignA systematic review of the literature for inductive, comparative, prospective and intervention studies. We searched the following databases: MEDLINE/In-Process, Web of Science, EMBASE, SCOPUS, CENTRAL, CDSR, CINAHL, PsycINFO and PsycARTICLES from database inception to 23 January 2018. The review included studies on the cultural, social, structural and behavioural factors that influence asymptomatic breast and cervical cancer screening attendance and cervical smear testing (Papanicolaou test) in South Asian populations and those published in the English language. The framework analysis method was used and themes were drawn out following the thematic analysis method.SettingsAsymptomatic breast or cervical screening.ParticipantsSouth Asian women, including Bangladeshi, Indian, Pakistani, Sri Lankan, Bhutanese, Maldivian and Nepali populations.Results51 included studies were published between 1991 and 2018. Sample sizes ranged from 25 to 38 733 and participants had a mean age of 18 to 83 years. Our review showed that South Asian women generally had lower screening rates than host country women. South Asian women had poorer knowledge of cancer and cancer prevention and experienced more barriers to screening. Cultural practices and assumptions influenced understandings of cancer and prevention, emphasising the importance of host country cultures and healthcare systems.ConclusionsHigh-quality research on screening attendance is required using prospective designs, where objectively validated attendance is predicted from cultural understandings, beliefs, norms and practices, thus informing policy on targeting relevant public health messages to the South Asian communities about screening for cancer.PROSPERO registration numberCSD 42015025284.

A Mixed-Method Study Examining Cancer Screening Uptake among South Asian Ethnic Minorities in Hong Kong

“…Consistent with the findings of the past research,[16] our study demonstrated a considerably low cancer screening uptake rate among South Asians, with atmost 36.9% of the population reported to have previously undertaken one particular cancer screening test. Such data demonstrated an urgent need for strategies that can effectively raise the awareness of local South Asians of the importance of screening in cancer prevention.…”

Systematic reviews as a “lens of evidence”: Determinants of participation in breast cancer screening

“…The systematic reviews had a broad geographic perspective (supplementary Appendix C), with some of them aiming to identify an evidence relevant for either specific countries (USA, the UK, France, Canada, or Japan), 13 – 20 geographic regions, 1 or populations by income or ethnicity. 21 – 24 Most of the reviews focused on interventions to improve participation rate (14) or behaviour of screened population and associated factors (12). The majority of reviews were publicly funded and no reviews reported a private source of funding (supplementary Appendix C).…”

Best practice models recommended by Bhutanese refugee women for cervical and breast cancer screening in Australia: A qualitative study

“…This problem is not unique to refugees resettled in Australia, similar patterns of sub‐optimal screening behaviour are also found in other refugee and migrant women, particularly from South Asian populations, in other high‐income countries. Poor knowledge, cultural norms, practices and beliefs inhibit the uptake of cancer screening …”