Reducing Breast Cancer Risk Among Latina Women: Myths and Misconceptions2004 Minority Women’s Health SummitAugust 12-15, 2004: 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 Martha A. Medrano, MD, MPH Columbia University U. of TX Health Science Ctr., S.A. Edward J. Trapido, ScD Eliseo J. Pérez-Stable, MD NCI U. of California, San Francisco Frank J. Penedo, PhD Gregory A. Talavera, MD, MPH U. of Miami San Diego State U. Aida L. Giachello, PhD Elena Ríos, MD U. of Illinois, Chicago National Hispanic Medical Assoc. Roland Garcia, PhD, NCI Program Officer Supported by NCI Grant No. UO 1 CA 86117-01


Slide2: Selected Spanish Settlement Dates in the Americas: Late 1400s - Late 1700s San Juan 1521 Baracoa 1511 Veracruz 1518 St. Augustine 1565 Santa Fe 1609 San Diego 1768 Natchitoches 1713 Spanish settlements Santo Domingo 1496 Santa Marta 1525


Slide3: Hispanic Population: 1930-2050 (millions) Census Projections First year “Hispanic” used 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.


Slide4: Percent Distribution of Hispanics by Type: 2002 Source: U.S. Census Bureau, Current Population Survey, March 2002


Why It’s Important to StudyLatinos and Cancer: 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: Latino Cultural Values Family emphasis Religious/spiritual emphasis Machismo attitudes


Sociodemographic Profile: 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 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


Cancer in Latinos:At the Crossroads: Cancer in Latinos: At the Crossroads We should: 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: S. Francisco Central Am. Miami Cuban Am. New York P. Ricans San Diego Mexican Am. San Antonio 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. Recent Mammography by Ethno-Regional Group


Knowledge of Screening Guidelines – Women 40+: Knowledge of Screening Guidelines – Women 40+ 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+: Attitudes Toward Cancer – Women 40+ 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: 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: 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: 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 TrialParticipation: 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 National PSA Campaign


Clinical Trials Outreach for Hispanics: 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


RecommendationsPatient Education: 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)


RecommendationsTraining: Recommendations Training Encourage Latino and minority students to enter health professions Promote cultural competence in formal education curriculum Provide professionals with continuing formal and informal cultural competence training


RecommendationsPatient Contact: Recommendations Patient Contact Promote cultural competence of office staff Provide culturally appropriate educational materials Ask open-ended questions and remain non-judgmental


RecommendationsResearch: 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


Mil Gracias: Mil Gracias ! ! 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