Increasing Breast and Cervical Cancer Screening Among Filipino American Women

Asian-American women fall short of the HHS year 2010 goal of regularly screening 70% of age-eligible women for breast cancer and 90% of women for cervical cancer. Among Filipino women, specifically, rates are as low as 48% and only as high as 63% for breast and cervical cancer screening, respectively. Further, among Filipino women, breast cancer is the leading cause of cancer death (incidence rate of 73.1 per 100,000). Albeit cervical cancer is not a leading cause of death, it is one of the few cancers for which an effective screening test is available. Filipino women are one of the fastest growing segments of the population. Nonetheless, few studies have been specifically developed for Filipino women.

The program aims to increase breast and cervical cancer screening among Filipino women by combining elements from the Health Belief Model, the Theory of Reasoned Action/Planned Behavior, and the Precede Model. Women are made aware of screening guidelines for breast and cervical cancer, that age and length of stay in the United States are risks factors for developing cancer, and that screening procedures are critical to early detection and successful treatment. Individual barriers, such as cost, fear of radiation and of finding cancer, and embarrassment are discussed and women who have undergone cancer screening provide peer support and peer norms. Drawing on the cultural values of collectivism, inter-dependence, and community -- common among many Asian groups -- the importance of staying healthy to enjoy life and take care of family members and friends is emphasized.

The group sessions last between 60 and 90 minutes.

Participants were Filipino women over 40 years of age from nine community based organizations and six churches in Los Angeles County.

This intervention is suitable for implementation in community-based organizations, churches, or private homes.

The curriculum for the intervention session is required, as are delivery agents who are fluent in both English and Tagalog. Take-home packets, in English and Tagalog, should include a list of local facilities where free mammograms and Pap smears are available. No cost information is available.

For the study, participants were given tote bags with the study's logo, personalized certificates of completion, and traditional Filipino snacks.

Two brochures were used in the intervention that can be acquired from the publishers:

• "A Mammogram Saved My Life" from Education Programs Associates, Inc., 1 West Campbell Avenue, Suite 40, Campbell, CA 95008, (408) 374-3720.
• "What You Need To Know About Your Pap Exam" from Krames Health and Safety Education, www.staywell.com.

A total of 530 Filipino women over 40 years of age were randomly assigned to either the intervention group (a cancer screening module) or the control group (a physical activity module). Delivered by two physicians and three nurses, participants received a culturally tailored, cancer screening session that reviewed risks of developing cancer, advantages of early detection, and solutions to individual barriers, among other things. Practical advice on how to get ready for a mammogram and a Pap test and how to remember to get tested on a yearly basis was also provided. Numerous attempts were made to ensure cultural appropriateness: data collectors and delivery agents were born and raised in the Philippines and fluent in English and Tagalog; sessions were delivered in Taglish, a combination of English and Tagalog; and traditional snacks were also served. Information packets were provided in English and Tagalog and included a list of local facilities where free mammogram and Pap smears were available and the telephone number of the Cancer Information Service (CIS).

Results indicated:

• No intervention effects were found in breast and cervical cancer screening rates between the intervention and the control group at 12 month follow-up.
• However, the intervention was effective among relatively recent immigrants who had spent less than 10 years in the United States. In this subgroup, mammography screening rates increased more from baseline to follow-up in the intervention group compared to the control group (27% vs 6%, p<0.05).