Beyond language: Motivators and barriers to breast cancer screening among Korean‐speaking women in Sydney Metropolitan, Australia

Background The increasing incidence of breast cancer and disease burden is a significant public health concern. While 30% of breast cancers could be prevented through addressing modifiable risk factors, misconceptions among women about breast cancer risks hamper primary prevention. In the absence of primary prevention, secondary prevention such as mammography increases the early detection of breast cancer and improves health outcomes. However, current population-level screening rates indicate secondary prevention is suboptimal. More effective public health efforts to improve breast cancer prevention are required. Given breast cancer is socially patterned, this work explores how social class impacts women’s breast cancer prevention practices. This study uses the concepts of lay epidemiology and candidacy as a mechanism to understand women’s breast cancer risk perspectives. It engages Bourdieu’s relational social class theory to unpack how women’s social, cultural, and structured life contexts shape these perspectives and their considerations regarding primary and secondary prevention. Methods In this qualitative study 43 Australian midlife women (aged 45–64 years), were interviewed to explore their understandings of breast cancer risks, how they perceived their own risk, and how this shaped their prevention behaviours. A theory-informed thematic analysis applying Bourdieu’s concepts of habitus, capital, and fields to understand how women’s social class positions shapes risk perspectives and prevention practices was conducted. Results This social class analysis showed differences in how women engage in breast cancer discourse, consider risks, and participate in breast cancer prevention. Middle-class women prioritise health promoting practices and were more likely than working-class and affluent women to attend mammography screening. Working-class women experience structural factors, like low income, stress and difficult life circumstances, which hamper primary prevention practices and for some screening is not considered or prioritised, and their decisions not to screen are less active. Affluent women often do not consider themselves at-risk due to their healthier ‘lifestyles. ’They suggest that this, and their knowledge of screening benefits and harms allows them to make informed decisions not to screen. Conclusions Women interpret and understand breast cancer risks differently and enact prevention practices within the parameters afforded by their social class positions. These findings are useful to inform improved public health approaches regarding both modifiable breast cancer risks and increasing mammography screening. To improve equity in breast cancer prevention efforts, such approaches must respond to limitations based on social class and address structural factors that impact prevention practices.

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Enhancing the Breast Cancer Screening Journey: Exploring Women's Perceptions of Traditional Mammography and Emerging AI driven Thermography (Preprint)

Sirka Kacafírková,

Poll,

Jacobs

et al. 2024

Preprint

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BACKGROUND Breast cancer is one of the most frequent causes of mortality among women’s population. Early diagnosis is critical for successful treatment, but underscreening is frequent. Novel screening methods that are more convenient, such as thermography, are being developed. They could help a wider group of screeners and they could contribute to better compliance with screening and thus to a decline in breast cancer mortality. OBJECTIVE The study aims to explore the screeners’ preferences for the screening process, specifically for a novel screening that utilizes artificial intelligence (AI) and thermal imaging. Furthermore, we explore a better understanding of the barriers and facilitators associated with participation in breast cancer screening by currently used mammography. METHODS One online focus group with experts and five focus groups with potential screeners on thermography were carried out. Potential screeners were recruited through an online survey (n=228) focused on addressing barriers and motivations related to screening. Survey data were analyzed using SPSS software. Findings from the focus groups were examined by two researchers utilizing open, axial, and selective coding in MAXQDA software. RESULTS The information obtained in the focus groups showed that small changes during the procedure (tailored adjustments, such as film or music during the procedure, dimmed light) were appreciated, especially by women without any mammography screening experience. Furthermore, the non-invasiveness of the procedure was seen positively by all participants. Among other important factors that influence the perception of the procedure and can therefore affect the decision whether to go or not, was the way they were treated by medical staff and waiting hours. For certain women, how the interaction goes between them, and the clinicians is more important than the technology itself. Results from the online survey complemented these insights on motivation and barriers. Personal belief in breast cancer prevention was the most indicated motivator for women with mammography experience (44%, n=154), followed by an invitation from a screening program (29%, n=154). Barriers indicated by women without experience were mainly: no recommendation from a doctor (53%, n=74), no warning signals (36%, n=74) or no problem related to breasts (28%, n=74) followed by being too young for mammography (23%, n=74). CONCLUSIONS Even though the thermography was perceived mainly positively, rather than the technique itself, women prioritized how they were treated by medical staff. This includes detailed information in understandable language, empathetic communication and adjustments that fit personal preferences. As we also saw in the results from the survey, doctors play the leading role in the decision to go to the screening, so their change in the approach can encourage greater participation in breast cancer screening initiatives.

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Beyond language: Motivators and barriers to breast cancer screening among Korean‐speaking women in Sydney Metropolitan, Australia

Cited by 3 publications

References 22 publications

Equity in breast density notification in Australia: A focus group study exploring the impact and needs amongst culturally and linguistically diverse (CALD) women

Equity in breast density notification in Australia: A focus group study exploring the impact and needs amongst culturally and linguistically diverse (CALD) women

How social class shapes breast cancer risk perspectives and prevention practices of Australian midlife women: a qualitative study using the concept of ‘breast cancer candidacy’

Enhancing the Breast Cancer Screening Journey: Exploring Women's Perceptions of Traditional Mammography and Emerging AI driven Thermography (Preprint)

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