BREAST CANCER SCREENING KNOWLEDGE AND BELIEFS OF NIGERIAN WOMEN LIVING IN THE UNITED STATES

Background

Breast cancer remains a significant global cause of cancer death and disability, and one of the most commonly diagnosed cancers in women, irrespective of race and ethnicity (Hasnain, Menon, Ferrans, & Szalacha, 2013). Early breast cancer detection through screening has been proven to be the key to reducing mortality and morbidity rates caused by this disease (American Cancer Society [ACS], 2017). Although there has been an overall decrease in the mortality rate from breast cancer in the United States, the racial disparity gap continues to widen with a 39% higher breast cancer mortality rate recorded among the African American women than their Caucasian counterparts (ACS, 2017). Underutilization of mammography screening among immigrant women in the United States is reported to be associated with lower breast cancer knowledge, negative cultural beliefs, lower English proficiency, and lack of health insurance (Wallace, Torres, Beltran, & Cohen-Boyar, 2013). Disparities in health services translate into higher breast cancer burden among the African-born women with resultant underutilization of breast health services. Disparities impact access and use of care, socioeconomic status, knowledge, and development of positive attitudes towards preventive breast health services (Smith, Conway-Phillips, & Francois-Blue, 2015).

Furthermore, many U.S studies about breast health tend to lump both the African American and African born immigrant women together, ignoring the important cultural differences that ultimately affect their breast screening practices (Ndukwe, Williams, & Sheppard, 2014). Nigerian women are at risk of being diagnosed with late stages of breast cancer because at baseline, they are more familiar with treating diseased condition than prevention; a practice that is common in their home country (Ogunsiji, Kwok, & Fan 2017). There is a dearth of studies about breast health among African-born immigrant women in the United States, specifically Nigerian women, even though Nigerians are among the fastest-growing populations in the United States (Migration Policy Institute, 2015). Without determining the underlying factors that impact early breast cancer screening utilization among Nigerian women in the United States, breast cancer will continue to be diagnosed in advanced stages with fatal outcomes.

The study employed quantitative inquiry to assess the knowledge level, demographic factors, and health beliefs of Nigerian women, 40 years and older in the United States towards the utilization of mammogram. The goal of this study was to advance a social change by creating awareness of the significance of preventive and timely mammogram screening behaviors among Nigerian communities and other minority women populations in the U.S. Additionally, the study outcome might enlighten health care providers and policy-makers in the U.S. about developing culturally sensitive health policies that would address the immigrant women populations’ breast health needs.

Problem Statement

Most breast cancer mortality occurs in women diagnosed in late stages of the disease due to lack of knowledge, cultural and religious beliefs, and other barriers to regular breast cancer screening (World Health Organization [WHO], 2017). American Cancer Society (2016) estimated that 3.1 million U.S. women survived breast cancer in 2015. Most breast cancer survival was reported among the American born women than the immigrant women populations (Harcourt et al., 2014). Low utilization of breast cancer screening services by African immigrant women in the United States stems from their migrating from countries with limited access to health care services. It is therefore natural for them to not giving priority to preventive breast health and early detection services (Harcourt et al., 2014).

Other barriers such as negative attitudes and cultural values, difficulty in navigating the seemingly complex U.S. health care system, lack of English proficiency, and fatalism have been reported as factors that lead to underutilization of mammographic screening services among the African born immigrants (Gondek et al., 2015; Kwok et al., 2016). It is pertinent to note that African-born immigrants represent one of the fast growing but the most vulnerable populations in the United States because of limited research studies about their health behaviors and breast health care needs (Pinder, Nelson, Eckardt, & Goodman, 2016). Most cancer-specific studies about health behaviors and interventions are generally combined with data from African American women, African born immigrant women, and Caribbean born women populations. Findings from such studies lead to data extrapolation and misleading outcomes that do not inform population specific interventional approaches (Hurtado-de-Mendoza et al., 2014).

Furthermore, the study by Pinder et al (2016) on women from various African regions living in the United States between 2008 to 2012 indicated that Nigerian women had the highest breast cancer incidence rate of 50.4 per 100,000 population due to delay in seeking preventive breast screening services. It was therefore projected by the researchers that by 2030, breast cancer incidence rate among Nigerian women in the United States might double with high mortality rate. The researchers, therefore, recommended further studies and development of strategic interventions to reach out to this population. This present study was necessary to address the gap in the research literature about the underlying factors that drive the Nigerian women in the United States health behaviors about delayed utilization of breast screening services, specifically mammogram. An understanding of such factors could add relevance to research and practice of public health. It could also create awareness of breast cancer and timely screening measures among immigrant women, especially Nigerian women in the United States.

Purpose of the Study

The purpose of this descriptive quantitative study was to determine the knowledge level of breast cancer, demographic factors and health beliefs held by Nigerian women living in the United States towards the utilization of mammographic screening. Addressing the factors that impede optimal utilization of breast cancer screening services, specifically mammogram would inform public health services and primary health care providers on how to reach out to this population and other immigrant groups in the United States with culturally sensitive interventions. Also, the outcome of this study would add knowledge that may inform policymakers on how to develop health policies that promote comprehensive preventable breast health services with improved access for all women in the U.S. Furthermore, the outcome of the study might serve as a tool to enlighten both the Nigerian populace in diaspora and their home government on the significance of preventive breast health care services for early detection of breast cancer. Finally, the knowledge gained from the study would empower and educate women, specifically immigrant women in the United States on how to take personal responsibilities in making informed health decisions that promote optimal health behaviors.