After reviewing 11 published articles on the subject, lead researcher Kerrie-Anne Calder and co-author Janet Olowookere of the University of Liverpool School of Health Sciences found four main reasons for the lower cancer screening rate among these women in the U.K.:
- Religion: Some women said that they could not go against God's will or viewed cancer as a punishment. For some, screening appointments during holy periods such as Ramadan meant that the appointments were missed.
- Culture: Some women felt that even the hint of cancer-related activity may damage their children's marriage prospects, and some felt, for example, that cancer may be contagious.
- Fear: Many women were reluctant to expose their private areas, were worried about family attitudes, or were concerned, for example, after female genital mutilation.
- Language barriers and inadequate targeting of health messages.
"This work shows that there are multiple reasons for BME women's reluctance to participate in screening, including such diverse worries as embarrassment, stigma over testing, worry that cancer may damage their children's marriage prospects, and believing cancer is a punishment from God," Calder noted in a UKIO statement. "It's important that we don't generalize in approaching these women."
This is a critical issue, as research has shown that only 66.7% of South Asian women and 51.1% of Muslim women living in the U.K. accepted invitations for breast cancer screening, compared with 77.7% of non-Asian women. What's more, 12% of these minority women miss out on cervical screening, compared with 8% of white women, according to the researchers. The lower screening rates lead to a higher cancer incidence rate later in life, delayed diagnosis, and higher death rates from cancer, they noted.
It's also vital to avoid the mistake of believing that the reasons for lack of participation are common across all black and minority ethnicity groups, Olowookere stated. For example, concerns over female genital mutilation may apply to some groups but not others, and the month of Ramadan would only influence the Muslim population.
"We need to correlate the reasons with each particular group, and begin to take steps to target each group to encourage screening," she noted in the UKIO statement. "This may mean that health services need to reach out to religious leaders and to interact in different social settings. Healthcare professionals may also need additional training, especially in areas where there is a large BME population. If the NHS [National Health Service] is to function as a service for all, it needs to tailor its messages more effectively."
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