Journal of Immigrant and Minority Health

, Volume 14, Issue 4, pp 570–582 | Cite as

The Demographic, System, and Psychosocial Origins of Mammographic Screening Disparities: Prediction of Initiation Versus Maintenance Screening Among Immigrant and Non-Immigrant Women

Original Paper


Disparities in breast screening are well documented. Less clear are differences within groups of immigrant and non-immigrant minority women or differences in adherence to mammography guidelines over time. A sample of 1,364 immigrant and non-immigrant women (African American, English Caribbean, Haitian, Dominican, Eastern European, and European American) were recruited using a stratified cluster-sampling plan. In addition to measuring established predictors of screening, women reported mammography frequency in the last 10 years and were (per ACS guidelines at the time) categorized as never, sub-optimal (<1 screen/year), or adherent (1+ screens/year) screeners. Multinomial logistic regression showed that while ethnicity infrequently predicted the never versus sub-optimal comparison, English Caribbean, Haitian, and Eastern European women were less likely to screen systematically over time. Demographics did not predict the never versus sub-optimal distinction; only regular physician, annual exam, physician recommendation, and cancer worry showed effects. However, the adherent categorization was predicted by demographics, was less likely among women without insurance, a regular physician, or an annual exam, and more likely among women reporting certain patterns of emotion (low embarrassment and greater worry). Because regular screening is crucial to breast health, there is a clear need to consider patterns of screening among immigrant and non-immigrant women as well as whether the variables predicting the initiation of screening are distinct from those predicting systematic screening over time.


Mammography Ethnic disparities Immigrant health Minority health Psychosocial factors 



This research was supported by funding from the National Institutes of Health General Medical Science (2SO6 GM54650) and the National Cancer Institute (1P20 CA 91372 and 1 U54 CA 101388).


  1. 1.
    ACS. Cancer facts and figures, 2010. Atlanta: American Cancer Society; 2010.Google Scholar
  2. 2.
    de Koning HJ. Mammographic screening: evidence from randomized controlled trials. Ann Oncol. 2003;14:1185–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Humphrey LL, Helfand M, Chan BKS, Woolf SH. Breast cancer screening: a summary of the evidence for the US preventive task force. Ann Intern Med. 2002;137(1):347–60.PubMedGoogle Scholar
  4. 4.
    Clark MA, Rakowski W, Bonacore LB. Repeat mammography: prevalence estimates and considerations for assessment. Ann Behav Med. 2003;26(3):201–11.PubMedCrossRefGoogle Scholar
  5. 5.
    Rosenberg L, Wise LA, Palmer JR, Horton NJ, Adams-Campbell LL. A multilevel study of socioeconomic predictors of regular mammography use among African-American women. Cancer Epidemiol Biomarkers Prev. 2005;14(11):2628–33.PubMedCrossRefGoogle Scholar
  6. 6.
    Rakowski W, Breen N, Meissner H, Rimer BK, Vernon SW, Clark MA, et al. Prevalence and correlates of repeat mammography among women aged 55–79 in the Year 2000 National Health Interview Survey. Prev Med. 2004;39(1):1–10.PubMedCrossRefGoogle Scholar
  7. 7.
    Rakowski W, Meissner H, Vernon SW, Breen N, Rimer B, Clark MA. Correlates of repeat and recent mammography for women ages 45 to 75 in the 2002 to 2003 Health Information National Trends Survey (HINTS 2003). Cancer Epidemiol Biomarkers Prev. 2006;15(11):2093–101.PubMedCrossRefGoogle Scholar
  8. 8.
    Boudreau DM, Luce CL, Ludman E, Bonomi AE, Fishman PA. Concordance of population-based estimates of mammography screening. Prev Med. 2007;45(4):262–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Bobo JK, Shapiro JA, Schulman J, Wolters CL. On-schedule mammography rescreening in the National Breast and Cervical Cancer Early Detection Program. Cancer Epidemiol Biomarkers Prev. 2004;3:620–30.Google Scholar
  10. 10.
    Hansen JP, Knapp PA, Newcomb PA. Mammography in a health maintenance organization. Am J Public Health. 1991;81(11):1489–90.PubMedCrossRefGoogle Scholar
  11. 11.
    Michielutte R, Diseker RA. Racial differences in knowledge of cancer: a pilot study. Soc Sci Med. 1982;16:245–52.PubMedCrossRefGoogle Scholar
  12. 12.
    Miller LY, Hailey BJ. Cancer anxiety and breast cancer screening in African American women: a preliminary study. Women’s Health Int. 1994;4(3):170–4.CrossRefGoogle Scholar
  13. 13.
    Trontell AE, Franey EW. Use of mammography services by women aged great-than-or-equal-to-65-years enrolled in Medicare—United States, 1991–1993. J Am Med Assoc. 1995;274(18):1420.CrossRefGoogle Scholar
  14. 14.
    Burns RB, McCarthy EP, Freund KM, Marwill SL, Schwartz M, Ash A, et al. Black women receive less mammography even with similar use of primary care. Ann Intern Med. 1996;125:173–82.PubMedGoogle Scholar
  15. 15.
    Anderson LM, May DS. Has the use of cervical, breast, and colorectal cancer screening increased in the United States? Am J Public Health. 1995;85(6):840–2.PubMedCrossRefGoogle Scholar
  16. 16.
    Breen N, Kessler L. Changes in the use of screening mammography: evidence from the 1987 and 1990 National Health Interview Surveys. Am J Public Health. 1994;84:62–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Glanz K, Resch N, Lerman C, Rimer BK. Black-white differences in factors influencing mammography use among employed female health maintenance organization members. Ethn Health. 1996;1(3):207–20.PubMedCrossRefGoogle Scholar
  18. 18.
    Breen N, Waegner KK, Brown MI, Davis William W, Ballard-Barbash R. Progress in cancer screening from the 1987, 1992, and 1998 National Health Interview Surveys. J Natl Cancer Inst. 2001;93:1704–13.PubMedCrossRefGoogle Scholar
  19. 19.
    Jones BA, Patterson EA, Calvocoressi L. Mammography screening in African American women: evaluating the research. Cancer. 2003;97(1):258–72.PubMedCrossRefGoogle Scholar
  20. 20.
    Swan J, Breen N, Coates RJ, Rimer BK, Lee NC. Progress in cancer screening practices in the United States: results from the 2000 National Health Interview Survey. Cancer. 2003;97:1528–40.PubMedCrossRefGoogle Scholar
  21. 21.
    Mandelblatt JS, Gold K, O’Malley AS, Taylor K, Cagney K, Hopkins JS, et al. Breast and cervix cancer screening among multiethnic women: role of age, health and source of care. Prev Med. 1999;28:418–25.PubMedCrossRefGoogle Scholar
  22. 22.
    O’Malley AS, Kerner JF, Johnson L. Are we getting the message out to all? Health information sources and ethnicity. Am J Prev Med. 1999;17(3):198–202.PubMedCrossRefGoogle Scholar
  23. 23.
    Frazier EL, Jiles RB, Mayberry R. Use of screening mammography and clinical breast examination among Black, Hispanic, and White women. Prev Med. 1996;25:118–25.PubMedCrossRefGoogle Scholar
  24. 24.
    Alvidrez J, Azocar F, Miranda J. Demystifying the concept of ethnicity for psychotherapy researchers. J Consult Clin Psychol. 1996;64:903–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Kaplan JB, Bennett T. Use of race and ethnicity in biomedical publication. J Am Med Assoc. 2003;289:2709–16.CrossRefGoogle Scholar
  26. 26.
    Thomas NM. Revisiting race/ethnicity as a variable in health research. Am J Public Health. 2002;92(2):156.PubMedCrossRefGoogle Scholar
  27. 27.
    Magai C, Consedine NS, Conway F, Neugut AI, Culver C. Diversity matters: unique populations of older women and breast cancer screening. Cancer. 2004;100(11):2300–7.PubMedCrossRefGoogle Scholar
  28. 28.
    Consedine NS, Magai C, Conway F. Predicting ethnic variation in adaptation to later life: styles of socioemotional functioning and constrained heterotypy. J Cross Cult Gerontol. 2004;19:95–129.CrossRefGoogle Scholar
  29. 29.
    Williams DR, Lavizzo-Mourey R, Warren RC. The concept of race and health status in America. Public Health Rep. 1994;109:26–41.PubMedGoogle Scholar
  30. 30.
    Phillips AA, Jacobson JS, Magai C, Consedine NS, Horowitz-Mehler NC, Neugut AI. Cancer incidence and mortality in the Caribbean. Cancer Investig. 2007;25(6):476–83.CrossRefGoogle Scholar
  31. 31.
    Schmidley AD, Gordon C. Profile of the foreign-born population in the United States: 1997. Washington: US Government Printing Office; 1999.Google Scholar
  32. 32.
    Yee BWK, Castro FG, Hammond WR, John R, Wyatt GE. Panel IV: risk-taking and abusive behaviors among ethnic minorities. Health Psychol. 1995;14:622–31.PubMedCrossRefGoogle Scholar
  33. 33.
    Brown N, Naman P, Homel P, Fraser-White M, Clare R, Browne R. Assessment of preventive health knowledge and behaviors of African-American and Afro-Caribbean women in urban settings. J Natl Med Assoc. 2006;98(10):1644–51.PubMedGoogle Scholar
  34. 34.
    Garbers S, Chiasson MA. Breast cancer screening and health behaviors among African American and Caribbean women in New York City. J Health Care Poor Underserved. 2006;17(1):37–46.PubMedCrossRefGoogle Scholar
  35. 35.
    David MM, Ko L, Prudent N, Green EH, Posner MA, Freund KM. Mammography use. J Natl Med Assoc. 2005;97(2):253–61.PubMedGoogle Scholar
  36. 36.
    Gorin SS, Heck JE. Cancer screening among Latino subgroups in the United States. Prev Med. 2005;40(5):515–26.PubMedCrossRefGoogle Scholar
  37. 37.
    Soares D, Waters N, Frankson M, Kirlew K, Reid M. Sociocultural deterrents to mammographic screening in Jamaica. West Indian Med J. 2009;58(1):28–32.PubMedGoogle Scholar
  38. 38.
    Reyes-Ortiz CA, Freeman JL, Peláez M, Markides KS, Goodwin JS. Mammography use among older women of seven Latin American and Caribbean Cities. Prev Med. 2006;42(5):375–80.PubMedCrossRefGoogle Scholar
  39. 39.
    Juon H-S, Kim M, Shankar S, Han W. Predictors of adherence to screening mammography among Korean American women. Prev Med. 2004;39(3):474–81.PubMedCrossRefGoogle Scholar
  40. 40.
    Roetzheim RG, Pal N, Tennant C, Voti L, Ayanian JZ, Schwabe A, et al. Effects of health insurance and race on early detection of cancer. J Natl Cancer Inst. 1999;91(16):1409–15.PubMedCrossRefGoogle Scholar
  41. 41.
    May DS, Kiefe CI, Funkhouser E, Fouad MN. Compliance with mammography guidelines: physician recommendation and patient adherence. Prev Med. 1999;28(4):386–94.PubMedCrossRefGoogle Scholar
  42. 42.
    Russell KM, Champion VL, Skinner CS. Psychosocial factors related to repeat mammography screening over 5 years in African American women. Cancer Nurs. 2006;29(3):236–43.PubMedCrossRefGoogle Scholar
  43. 43.
    Consedine NS, Magai C, Neugut AI. The contribution of emotional characteristics to breast cancer screening among women from six ethnic groups. Prev Med. 2004;38(1):64–77.PubMedCrossRefGoogle Scholar
  44. 44.
    Consedine NS, Magai C, Horton D, Neugut AI, Gillespie M. Health belief model factors in mammography screening: testing for interactions among subpopulations of Caribbean women. Ethn Dis. 2005;15(3):444–52.PubMedGoogle Scholar
  45. 45.
    Consedine NS, Ladwig I, Reddig MK, Broadbent EA. The many faeces of colorectal cancer screening embarrassment: preliminary psychometric development and links to screening outcome. Br J Health Psychol. 2011;16:559–79.PubMedCrossRefGoogle Scholar
  46. 46.
    Consedine NS, Magai C, Krivoshekova YS, Ryzewicz L, Neugut AI. Fear, anxiety, worry, and breast cancer screening behavior: a critical review. Cancer Epidemiology. Biomarkers Prev. 2004;13(4):501–10.Google Scholar
  47. 47.
    Gierisch JM, O’Neill SC, Rimer BK, DeFrank JT, Bowling JM, Skinner CS. Factors associated with annual-interval mammography for women in their 40s. Cancer Epidemiol. 2009;33(1):72–8.Google Scholar
  48. 48.
    Powe BD. Fatalism among elderly African Americans. Cancer Nurs. 1995;18:385–92.PubMedCrossRefGoogle Scholar
  49. 49.
    Powe BD, Finnie R. Cancer fatalism—the state of the science. Cancer Nurs. 2003;26(6):454–65.PubMedCrossRefGoogle Scholar
  50. 50.
    Consedine NS, Christie MA, Neugut AI. Physician, affective, and cognitive variables differentially predict “initiation” versus “maintenance” PSA screening profiles in diverse groups of men. Br J Health Psychol. 2009;14(2):303–22.PubMedCrossRefGoogle Scholar
  51. 51.
    Gonzalez J, Consedine NS, McKiernan JM, Spencer BA. Barriers to initiation and maintenance of PSA screening among African American and Afro-Caribbean men. Urology. 2008;180(6):2403–8.CrossRefGoogle Scholar
  52. 52.
    Drossaert CHC, Boer H, Seydel ER. Monitoring women’s experiences during three rounds of breast cancer screening: results from a longitudinal study. J Med Screen. 2002;9(4):168–75.PubMedCrossRefGoogle Scholar
  53. 53.
    Drossaert CHC, Boer H, Seydel ER. Prospective study of the determinants of repeat attending and attendance patterns in breast cancer screening using the theory of planned behavior. Psychol Health. 2003;18:551–65.CrossRefGoogle Scholar
  54. 54.
    Sandin B, Chorot P, Valiente RM, Lostao L, Santed MA. Adverse psychological effects in women attending a second-stage breast cancer screening. J Psychosom Res. 2002;52(5):303–9.PubMedCrossRefGoogle Scholar
  55. 55.
    Margonoff PP, Folwarski J. Russian/Ukrainian families: an overview. In: McGoldrick M, Giordano J, Pearce JK, editors. Ethnicity and family therapy. 2nd ed. New York: Guilford; 1996. p. 672–85.Google Scholar
  56. 56.
    Cohen SS, Palmieri RT, Nyante SJ, Koralek DO, Kim S, Bradshaw P, et al. A review: obesity and screening for breast, cervical, and colorectal cancer in women. Cancer. 2008;112(9):1892–904.PubMedCrossRefGoogle Scholar
  57. 57.
    Deurenberg P, Yap M, van Staveren WA. Body mass index and percent body fat: a meta-analysis among different ethnic groups. Int J Obes. 1998;22:1164–71.CrossRefGoogle Scholar
  58. 58.
    Golden RR, Teresi JA, Gurland BJ. Development of indicator scales for the Comprehensive Assessment and Referral Evaluation (CARE). J Gerontol. 1984;39:138–46.PubMedGoogle Scholar
  59. 59.
    Teresi JA, Golden RR, Gurland BJ. Concurrent and predictive validity of indicator scales developed for the Comprehensive Assessment and Referral Evaluation interview schedule. J Gerontol. 1984;39:158–65.PubMedGoogle Scholar
  60. 60.
    Teresi JA, Golden RR, Gurland BJ, Wilder DE, Bennett RG. Construct validity of indicator scales developed from the Comprehensive Assessment and Referral Evaluation interview schedule. J Gerontol. 1984;39:147–57.PubMedGoogle Scholar
  61. 61.
    Gordon NP, Hiatt RA, Lampert DI. Concordance of self-reported data and medical records audit for six cancer screening procedures. J Natl Cancer Inst. 1993;85:566–70.PubMedCrossRefGoogle Scholar
  62. 62.
    Force USPST. Screening for breast cancer: U.S. preventive services task force recommendation statement. Ann Intern Med. 2009;151(10):716–26.Google Scholar
  63. 63.
    Leitch AM, Dodd GD, Costanza M, Linver M, Pressman P, McGinnis L, et al. American Cancer Society guidelines for the early detection of breast cancer: update 1997. CA: Cancer J Clin. 1997;47(3):150–3.CrossRefGoogle Scholar
  64. 64.
    Calvocoressi L, Sun A, Kasl SV, Claus EB, Jones BA. Mammography screening of women in their 40 s: impact of changes in screening guidelines. Cancer. 2008;112(3):473–80.PubMedCrossRefGoogle Scholar
  65. 65.
    O’Malley AS, Kerner J, Johnson AE, Mandelblatt JS. Acculturation and breast cancer screening among Hispanic women in New York City. Am J Public Health. 1999;89(2):219–27.PubMedCrossRefGoogle Scholar
  66. 66.
    Kudadjie-Gyamfi EK, Magai C. The influence of coping styles on mammography screening in a multiethnic sample. Cultur Divers Ethnic Minor Psychol. 2008;14(3):183–92.PubMedCrossRefGoogle Scholar
  67. 67.
    Consedine NS, Krivoshekova YS, Harris CR. Bodily embarrassment and judgment concern as separable factors in the measurement of medical embarrassment: psychometric development and links to treatment-seeking outcomes. Br J Health Psychol. 2007;12(3):439–62.PubMedCrossRefGoogle Scholar
  68. 68.
    Martin LL, Calle E, Wingo P, Heath C. Comparison of mammography and Pap test use from the 1987 and 1992 National Health Interview Surveys: are we closing the gaps? Am J Prev Med. 1996;12:82–90.PubMedGoogle Scholar
  69. 69.
    Edwards NI, Jones DA. Uptake of breast cancer screening in older women. Age Aging. 2000;29:131–5.CrossRefGoogle Scholar
  70. 70.
    Davies HTO, Crombie IK, Tavakoli M. When can odds ratios mislead? Br Med J. 1998;316:989–91.CrossRefGoogle Scholar
  71. 71.
    Peipins LA, Shapiro JA, Bobo JK, Berkowitz Z. Impact of women’s experiences during mammography on adherence to rescreening (United States). Cancer Causes Control. 2006;17(4):439–47.PubMedCrossRefGoogle Scholar
  72. 72.
    Lerman C, Rimer BK, Trock B, Balshem A, Engstrom PF. Factors associated with repeat adherence to breast cancer screening. Prev Med. 1990;19:279–90.PubMedCrossRefGoogle Scholar
  73. 73.
    Brown WM, Consedine NS, Magai C. Time spent in the United States and breast cancer screening behaviors among ethnically diverse immigrant women: evidence for acculturation? J Immigr Minor Health. 2006;8(4):347–58.PubMedCrossRefGoogle Scholar

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© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of Psychological MedicineUniversity of AucklandAucklandNew Zealand

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