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Journals and articles were searched from search engines like pubmed, scientific journals, Google, Google books, Google scholar, British libraries, Health educator recommendations, and science direct periodic journals from university library. The key words used in searching the documents were barriers of screening, ethnic minority women, breast cancer, promoting uptake of screening, promoting quality of breast cancer through health education, government policies. Demographic statistics, Census reports and population statistics are also included. A total of 39 papers were found through the search engines and the number of articles used in the project is narrowed down to 15 based upon relevance and importance.
The methods used in the research articles include questionnaires, qualitative analysis, extensive literature search, cross sectional studies, observational studies, census reports, mortality reports, statistics, demographic reports and review papers.
All the fifteen articles were researched thoroughly to analyse the primary objectives, methods employed, results obtained and comments over the conclusions pertaining to subject of interest. All these are summarised in the table below:
Author, Year, Location
AK Jain and J Serevitch 2004. The Nightingale Centre and Genesis Prevention Centre,
UHSM NHS Foundation Trust, Manchester.
Breast Cancer Screening-
How do we communicate with women of South Asian origin?
Questionnaires and structured letters listing the objectives of study were sent to office managers and directors of 99 breast screening units in UK requesting them the communication practice with south Asian women of Indian, Bangladeshi, srilankan and Pakistani origin. Communication was also requested with units of larger South Asian women population.
67 of 69 questionnaires were returned to the office with particulars of initial Breast screening invitation procedures across the south Asian women, Mammographic, recall and breast assessment information and means of communication with the south Asian women in local languages like Bengali, Hindi, Telugu, Tamil and Malayalam.
The study reveals that many south Asian women don’t get proper information on breast screening procedures and initiatives due to language and management barriers. Pictorial information and motivation in local languages is not given. Distribution of translated scriptures is poorly taken up.
Conclusions of the research highlight the communication and financial barriers of the BSU. The recommendations of research include increased initiatives in local languages to the women who don’t understand English and increase funding which enables them to improve patient facilities and screening uptake.
Scottish Intercollegiate Guidelines Network 2005 , NHS Scotland.
Management of breast cancer in women-A national clinical guideline
Statistics and Doctor recommendations were collected to design a framework on managing breast cancer in women.
SIGN was prescribed as a collection of guidelines for managing breast cancer patients and it includes surgery, therapy and care.
Treatment procedures like radiotherapy, systemic therapy and physiological care were prescribed as techniques of improving care. Recommendations of care and surgery were include for information. Additional initiatives were mentioned to improve screening uptake among minority women.
Jo Freeman & Douglas Eadie 2007. ISM Institute for Social Marketing.
Breakthrough Breast Cancer Awareness Campaign: ISM Literature Review
Six data bases, grey literature and small archives of data were researched on existing data on awareness programmes, current knowledge and perception of ethnic minority women.
The research revealed that limited or inaccurate knowledge and awareness on screening programmes to be the main cause of poor screening uptake. Gender, cultural differences were influential in predicting attendance at screening centers. Perceiving importance of screening was major approach to be addresses.
Research shed light on the problem areas and risk factors associated with breast cancer screening. Study focuses on multi-strategy interventions like educational packages, Inter-personal support, use of alternative community channels like community groups and ethnic media, Local publicity events like road shows to increase awareness of self examination and screening.
A Szczepura 2005. Ethnic review, Postgrad Med Journal.
Access to health care for ethnic minority populations
Extensive literature search is performed to identify the care process and quality in ethic minority people. Challenges for clinicians, managers and policy makers in ensuring quality care are discussed.
Literature search revealed the primary factors influencing quality to be population diversity, linguistic competence, cultural disparities and lack of orientation and training programs suitable for special needs.
The research focuses on the case study of breast cancer screening through NHS and identifies four reasons fro failure which are lack of knowledge on self examination and screening among ethnic communities, language and cultural barriers, inaccurate register of screening, lack of references and recommendations by health care professionals. The study concludes with highlighting improvement by interventions to increase awareness, improving risk perception and improve breast cancer screening for minority women.
P.T. Straughan and A. Seow 2000. Social Science & Medicine.
Attitudes as barriers in breast screening: a prospective
study among Singapore women
A multistage project was conducted to promote better understanding of Mammographic techniques in Singapore women. The methods included phase-I qualitative analysis, phase-II cross-sectional survey and phase-III prospective study.
Items on FATALISM index, BARRIER index and early cancer DETECT index were studied as a result of the methods.
Apart from the index results, the other important factors influencing screening uptake include social and cultural factors with perception.
Abdullahi et al 2009. Public Health.
Cervical screening: Perceptions and barriers to uptake among Somali women
Qualitative study was performed on seven focus groups and eight in depth interviews.
The study revealed that there was lack of understanding of risk factors and fatalistic attitudes. Culturally specific barriers like embarrassing situation and past experiences accounted for poor screening uptake.
Language barriers and cultural factors account for first stage poor screening. Improvement of language and communication in local language along with continuous support would improve screening uptake .Oral information with explanation about risk factors and advantages of treatment would improve health condition.
Ala Szczepura 2003.
Centre for Health Services Studies,
University of Warwick,
Ethnicity: UK Colorectal Cancer
Colorectal cancer screening pilot tests are performed using records of Faecal Occult blood testing.
The results focus on the disparities of treatment of cancer patients among the ethnic minority people.
The screening uptake studies show the variation in high class areas and the ethnic minority even after equal awareness due to lack of initiation and courage among the ethnic minority.
Teresa et al 2007. Journal Of the national medical association.
Breast Self Examination:
Knowledge Attitudes and
Performance Among Black
A questionnaire was distributed to 180 black women, 18 years
Of age and older in metropolitan areas through the church council developed by the authors. Another group comprises participants above 41 years.
The survey explained that the frequency of breast self examination is associated with knowledge of self examination. Most of the respondents indicated to have practiced BSE from couple of years. 50% indicated to practice regularly and less than half sample had no knowledge on the practice of BSE.
The research revealed that knowledge and practice of BSE is more in the educated class and older people with high income when compared to uneducated lower class women. The study also focussed on attitudinal and demographic variables pertaining to BSE. It also gave a note on confidence and social approval for BSE.
Chee et al 2003. BMC Women’s Health.
Factors related to the practice of breast self examination (BSE) and Pap smear screening among Malaysian women workers in selected electronics factories
A cross sectional survey was conducted among women production workers from ten electronics factories. Self administered questionnaire was collected from 1, 720 women workers. Later statistical analysis was performed by bivariate and multivariate tests like chi square test, odds ratio and binomial regression.
BSE rates were recorded as 24.4% a month and 18.4% for pap smear testing in period of three years. Women over 30 years and older, women with upper secondary education and above, answered the questionnaire on BSE correctly. Proportion of pap smear tests were recorded to be high in older married people bearing kids or couples on contraceptive pills and answered the questionnaires on pap smear tests.
In comparison with national rates, screening practices were recorded as low in the Malaysian women. Health care factors, socio-demographic factors and education were related as barriers for screening. Educational and promotional strategies were directed for better screening rates among Malaysian women.
Cannas et al 2005. Survey methodology for public health researchers, Health education Research.
Factors associated with Mammographic decisions of Chinese-Australian women
Study involved research over sample of population suffering with breast cancer. 20 Chinese-Australian women were recruited for studies from different Chinese organizations like churches, community centres and clubs. Some of the participants discontinued due to discomfort in talking about the disease. Demographic data and open ended questions were used as a part of research
An average of 8 informants among 20 participants has undergone Mammographic testing. Among the eight informants, 3 had it more than twice and the remaining four decided not to have any more. Among other informants who did not have Mammographic testing, 8 informants rejected Mammographic testing while the other four never heard about the term despite publicity.
The study reveals that there are numerous factors responsible for poor screening uptake which includes organizational factors and influence of significant family members. The barriers were accounted to be fear of stigmatisation, fear of mammography and modesty.
Robb et al 2010. . J Med Screen, Pub med central.
Ethnic disparities in knowledge of cancer screening programmes in the UK
Cross sectional study and questionnaires were conducted using data from National health interview in 1998.
The study resulted in enumerating foreign birth place and lack of adjustment to new culture as primary factors for poor screening among ethnic minority.
The study revealed that foreign birth place and socioeconomic factors responsible for poor screening uptake. The study also revealed that foreign blacks are better in screening uptake than the Asians and Chinese.
Mark R D Johnson, May 2001. Mary Seacole Research Centre, De Montfort University
Palliative Care, Cancer and Minority Ethnic Communities
Census reports, hospital episode statistics data (HES), Health of Londoners project analysis, Patient records in hospitals and care centres.
Palliative care defers from region to region and factors influencing difference were accounted as language barriers and lack of access and knowledge of palliative centres across the communities.
The paper defines palliative care in terms of all types of cancer and highlights the maximum usage of this by the local people rather than the ethnic minority people due to lack of access. The paper calls for equality in treatment and increased awareness in relation to this.
Jamesetta Newland, Editors memo, The Nurse Practitioner.
Breast Cancer Awareness
More Than a Monthly Reminder
The study is based on the data available in relation to Susan G. Komen Race for the Cure in developed countries to increase breast cancer awareness.
The letter highlights the improvement of health care through awareness and availability of genetic testing protocol for breast cancer in ethnic minority populations.
The study focuses on the attitude of breast cancer patients and the fear to reveal the disorder. Patient education and support of health care professionals is of concern in the modern day to eliminate barrier of fear.
Wild et al 2006, British Journal of Cancer.
Mortality from all cancers and lung, colorectal, breast and prostate
cancer by country of birth in England and Wales, 2001-2003
The study is based on mortality data of cancer patients from 2001-2003 throughout the country with England and Wales as reference groups. The population data was collected from 2001 census to study rate of mortality.
The number of deaths of women due to breast cancer were recorded as 33, 291. Mortality was recorded high in England and Wales and then women born in North and west Africa. Lower mortality rates were recorded in Eastern Europe and Asian countries.
The data revealed the mortality rate of women due to breast cancer in England and Wales calling emergency actions and research to decrease the number of deaths due to breast cancer.
National Cancer Intelligence Network, NHS, National Cancer action team.
Evidence to March 2010 on
cancer inequalities in England
The Cancer registries are researched extensively for the data on all individuals
Diagnosed with cancer. The information includes age, gender, postcode of residence and hospital of treatment. Survey of population samples are also studied simultaneously.
Cancer treatment inequalities are analysed to be based on these factors:
Incidence and mortality, prevalence and survival of the patients, Awareness of the patient on treatment procedure and stage of diagnosis of the patient, Screening and patient experience during end of life care.
The study focuses on inequalities of treating cancer on the basis of religion, culture and race. Numerous case studies are analysed to draw series of conclusions. Activities against the inequalities of treatment could improve the health condition of patients.
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