Skip to main content
SpringerLink
Log in

Intrinsic Factors of Non-adherence to Breast and Cervical Cancer Screenings Among Latinas

  • Published:
Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

Abstract

Although adhering to regular screenings can improve timely diagnosis and survivorship, Latinas continue to exhibit the lowest breast and cervical cancer screening rates in the country. Initiatives have generally addressed extrinsic factors to combat disparities. However, the answer to increasing screening adherence among Latina women might lie in equally addressing intrinsic factors as well extrinsic factors. Social Cognitive Theory provided the foundation for the design of Esperanza y Vida, a culturally tailored outreach program that educated Latinas on breast and cervical cancer. Non-adherent participants were offered navigation and followed-up to reassess screening behavior. The objective of this manuscript is to outline the salient culture-related intrinsic factors reported by a sample of Latina women from New York and Arkansas in response to open-ended questions asked at 8 months post-educational intervention and navigation services. In turn, the findings are incorporated in an effort to recommend future steps for effective interventions. Content analysis was used to guide the qualitative data analysis. The most salient barriers reported were related to Systems, Organization and Logistics, Time, being Decidedly Unscreened, and Contrary Beliefs or Confusion.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Houston TP, Elster AB, Davis RM, Deitchman SD. The U.S. Preventive Services Task Force Guide to Clinical Preventive Services, second edition. AMA Council on Scientific Affairs. Am J Prev Med. 1998;14(4):374–6.

    Article  CAS  PubMed  Google Scholar 

  2. U.S. Department of Health and Human Services. Healthy people 2010 Conference Edition 2000.

  3. Tabar L, Fagerberg CJ, Gad A, Baldetorp L, Holmberg LH, Grontoft O, et al. Reduction in mortality from breast cancer after mass screening with mammography. Randomised trial from the Breast Cancer Screening Working Group of the Swedish National Board of Health and Welfare. Lancet. 1985;1(8433):829–32.

    Article  CAS  PubMed  Google Scholar 

  4. Kerlikowske K, Grady D, Rubin SM, Sandrock C, Ernster VL. Efficacy of screening mammography. A meta-analysis. JAMA. 1995;273(2):149–54.

    Article  CAS  PubMed  Google Scholar 

  5. American Cancer Society. Cancer facts & figures for Hispanics/Latinos 2012-2014. 2012.

  6. Kang-Kim M, Betancourt JR, Ayanian JZ, Zaslavsky AM, Yucel RM, Weissman JS. Access to care and use of preventive services by Hispanics: state-based variations from 1991 to 2004. Med Care. 2008;46(5):507–15.

    Article  PubMed  Google Scholar 

  7. Joslyn SA, Foote ML, Nasseri K, Coughlin SS, Howe HL. Racial and ethnic disparities in breast cancer rates by age: NAACCR Breast Cancer Project. Breast Cancer Res Treat. 2005;92(2):97–105.

    Article  PubMed  Google Scholar 

  8. Li CI, Malone KE, Daling JR. Differences in breast cancer stage, treatment, and survival by race and ethnicity. Arch Intern Med. 2003;163(1):49–56.

    Article  PubMed  Google Scholar 

  9. Smith-Bindman R, Miglioretti DL, Lurie N, Abraham L, Barbash RB, Strzelczyk J, et al. Does utilization of screening mammography explain racial and ethnic differences in breast cancer? Ann Intern Med. 2006;144(8):541–53.

    Article  PubMed  Google Scholar 

  10. American Cancer Society. Cancer prevention & early detection facts & figures 2012. 2012.

  11. Press R, Carrasquillo O, Sciacca RR, Giardina EG. Racial/ethnic disparities in time to follow-up after an abnormal mammogram. J Womens Health (Larchmt). 2008;17(6):923–30.

    Article  Google Scholar 

  12. Stuver SO, Zhu J, Simchowitz B, Hassett MJ, Shulman LN, Weingart SN. Identifying women at risk of delayed breast cancer diagnosis. Jt Comm J Qual Patient Saf. 2011;37(12):568–75.

    PubMed  Google Scholar 

  13. Otero-Sabogal R, Owens D, Canchola J, Golding JM, Tabnak F, Fox P. Mammography rescreening among women of diverse ethnicities: patient, provider, and health care system factors. J Health Care Poor Underserved. 2004;15(3):390–412.

    Article  PubMed  Google Scholar 

  14. Agency for Healthcare Research and Quality. Cancer screening and treatment in women: recent findings. Agency for Healthcare Research and Quality. 2008.

  15. Gauss JW, Mabiso A, Williams KP. Pap screening goals and perceptions of pain among black, Latina, and Arab women: steps toward breaking down psychological barriers. J Cancer Educ. 2013;28(2):367–74.

    Article  PubMed  PubMed Central  Google Scholar 

  16. U.S. Preventative Services Task Force. Screening for cervical cancer: recommendations and rationale. 2012.

  17. Reynolds D Cervical cancer in Hispanic/Latino women. Clin J Oncol Nurs. 2004;8(2):146–50.

    Article  PubMed  Google Scholar 

  18. National Center for Health Statistics (US). Health, United States, chartbook on trends in the health of Americans, 2010. Hyattsville: Centers for Disease Control and Prevention, National Center for Health Statistics; 2010.

    Google Scholar 

  19. Smith RA, Cokkinides V, Brooks D, Saslow D, Shah M, Brawley OW. Cancer screening in the United States, 2011. CA Cancer J Clin. 2011;61(1):8–30.

    Article  PubMed  Google Scholar 

  20. Otero-Sabogal R, Stewart S, Sabogal F, Brown BA, Perez-Stable EJ. Access and attitudinal factors related to breast and cervical cancer rescreening: why are Latinas still underscreened? Health Educ Behav. 2003;30(3):337–59.

    Article  PubMed  Google Scholar 

  21. Fernandez ME, Gonzales A, Tortolero-Luna G, Williams J, Saavedra-Embesi M, Chan W, et al. Effectiveness of Cultivando la Salud: a breast and cervical cancer screening promotion program for low-income Hispanic women. Am J Public Health. 2009;99(5):936–43.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Fernandez ME, Gonzales A, Tortolero-Luna G, Partida S, Bartholomew LK. Using intervention mapping to develop a breast and cervical cancer screening program for Hispanic farmworkers: Cultivando La Salud. Health Promot Pract. 2005;6(4):394–404.

    Article  PubMed  Google Scholar 

  23. Mack KP, Pavao J, Tabnak F, Knutson K, Kimerling R. Adherence to recent screening mammography among Latinas: findings from the California Women’s Health Survey. J Womens Health (Larchmt). 2009;18(3):347–54.

    Article  Google Scholar 

  24. Carrasquillo O, Pati S. The role of health insurance on Pap smear and mammography utilization by immigrants living in the United States. Prev Med. 2004;39(5):943–50.

    Article  PubMed  Google Scholar 

  25. Watson-Johnson LC, DeGroff A, Steele CB, Revels M, Smith JL, Justen E, et al. Mammography adherence: a qualitative study. J Womens Health (Larchmt). 2011;20(12):1887–94.

    Article  Google Scholar 

  26. Williams KP, Reiter P, Mabiso A, Maurer J, Paskett E. Family history of cancer predicts Papanicolaou screening behavior for African American and white women. Cancer. 2009;115(1):179–89.

    Article  PubMed  Google Scholar 

  27. 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(4):418–25.

    Article  CAS  PubMed  Google Scholar 

  28. Harlan LC, Bernstein AB, Kessler LG. Cervical cancer screening: who is not screened and why? Am J Public Health. 1991;81(7):885–90.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Gorin SS, Heck JE. Cancer screening among Latino subgroups in the United States. Prev Med. 2005;40(5):515–26.

    Article  PubMed  Google Scholar 

  30. McMullin JM, De Alba I, Chavez LR, Hubbell FA. Influence of beliefs about cervical cancer etiology on Pap smear use among Latina immigrants. Ethn Health. 2005;10(1):3–18.

    Article  PubMed  Google Scholar 

  31. Scarinci IC, Beech BM, Kovach KW, Bailey TL. An examination of sociocultural factors associated with cervical cancer screening among low-income Latina immigrants of reproductive age. J Immigr Health. 2003;5(3):119–28.

    Article  PubMed  Google Scholar 

  32. Abraido-Lanza AE, Viladrich A, Florez KR, Cespedes A, Aguirre AN, De La Cruz AA. Commentary: fatalismo reconsidered: a cautionary note for health-related research and practice with Latino populations. Ethn Dis. 2007;17(1):153–8.

    PubMed  PubMed Central  Google Scholar 

  33. Powe BD, Finnie R. Cancer fatalism: the state of the science. Cancer Nurs. 2003;26(6):454,65 quiz 466-7.

    Article  Google Scholar 

  34. Schwab T, Meyer J, Merrell R. Measuring attitudes and health beliefs among Mexican Americans with diabetes. Diabetes Educ. 1994;20(3):221–7.

    Article  CAS  PubMed  Google Scholar 

  35. Perez-Stable EJ, Sabogal F, Otero-Sabogal R, Hiatt RA, McPhee SJ. Misconceptions about cancer among Latinos and Anglos. JAMA. 1992;268(22):3219–23.

    Article  CAS  PubMed  Google Scholar 

  36. Behbakht K, Lynch A, Teal S, Degeest K, Massad S. Social and cultural barriers to Papanicolaou test screening in an urban population. Obstet Gynecol. 2004;104(6):1355–61.

    Article  PubMed  Google Scholar 

  37. Paskett E, Tatum C, Rushing J, Michielutte R, Bell R, Long Foley K, et al. Randomized trial of an intervention to improve mammography utilization among a triracial rural population of women. J Natl Cancer Inst. 2006;98(17):1226–37.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Institute of Medicine. Unequal treatment: confronting racial and ethnic disparities in healthcare. 2002.

  39. Coronado GD, Thompson B, Koepsell TD, Schwartz SM, McLerran D. Use of Pap test among Hispanics and non-Hispanic whites in a rural setting. Prev Med. 2004;38(6):713–22.

    Article  PubMed  Google Scholar 

  40. Suarez L, Roche RA, Nichols D, Simpson DM. Knowledge, behavior, and fears concerning breast and cervical cancer among older low-income Mexican-American women. Am J Prev Med. 1997;13(2):137–42.

    CAS  PubMed  Google Scholar 

  41. Garces IC, Scarinci IC, Harrison L. An examination of sociocultural factors associated with health and health care seeking among Latina immigrants. J Immigr Minor Health. 2006;8(4):377–85.

    Article  PubMed  Google Scholar 

  42. Byrd TL, Chavez R, Wilson KM. Barriers and facilitators of cervical cancer screening among Hispanic women. Ethn Dis. 2007;17(1):129–34.

    PubMed  Google Scholar 

  43. Centers for Disease Control and Prevention (CDC). Cancer screening–United States, 2010. MMWR Morb Mortal Wkly Rep. 2012;61(3):41–5.

    Google Scholar 

  44. Watson M, Saraiya M, Benard V, Coughlin SS, Flowers L, Cokkinides V, et al. Burden of cervical cancer in the United States, 1998–2003. Cancer. 2008;113(10 Suppl):2855–64.

    Article  PubMed  Google Scholar 

  45. National Cancer Institute. SEER cancer statistics review 1975-2007. 2009.

  46. Jennings-Dozier K Predicting intentions to obtain a Pap smear among African American and Latina women: testing the theory of planned behavior. Nurs Res. 1999;48(4):198–205.

    Article  CAS  PubMed  Google Scholar 

  47. Percac-Lima S, Aldrich LS, Gamba GB, Bearse AM, Atlas SJ. Barriers to follow-up of an abnormal Pap smear in Latina women referred for colposcopy. J Gen Intern Med. 2010;25(11):1198–204.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Elder JP, Castro FG, de Moor C, Mayer J, Candelaria JI, Campbell N, et al. Differences in cancer-risk-related behaviors in Latino and Anglo adults. Prev Med. 1991;20(6):751–63.

    Article  CAS  PubMed  Google Scholar 

  49. Solis JM, Marks G, Garcia M, Shelton D. Acculturation, access to care, and use of preventive services by Hispanics: findings from HHANES 1982-84. Am J Public Health. 1990;80(Suppl):11–9.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Harmon MP, Castro FG, Coe K. Acculturation and cervical cancer: knowledge, beliefs, and behaviors of Hispanic women. Women Health. 1996;24(3):37–57.

    Article  CAS  PubMed  Google Scholar 

  51. Bazargan M, Bazargan SH, Farooq M, Baker RS. Correlates of cervical cancer screening among underserved Hispanic and African-American women. Prev Med. 2004;39(3):465–73.

    Article  PubMed  Google Scholar 

  52. Boyer LE, Williams M, Callister LC, Marshall ES. Hispanic women’s perceptions regarding cervical cancer screening. J Obstet Gynecol Neonatal Nurs. 2001;30(2):240–5.

    Article  CAS  PubMed  Google Scholar 

  53. Hiatt RA, Pasick RJ, Stewart S, Bloom J, Davis P, Gardiner P, et al. Community-based cancer screening for underserved women: design and baseline findings from the Breast and Cervical Cancer Intervention Study. Prev Med. 2001;33(3):190–203.

    Article  CAS  PubMed  Google Scholar 

  54. American Cancer Society. Cancer prevention & early detection facts & figures 2015–2016. Atlanta: American Cancer Society; 2015.

    Google Scholar 

  55. Larkey L Las mujeres saludables: reaching Latinas for breast, cervical and colorectal cancer prevention and screening. J Community Health. 2006;31(1):69–77.

    Article  PubMed  Google Scholar 

  56. Jandorf L, Bursac Z, Pulley L, Trevino M, Castillo A, Erwin DO. Breast and cervical cancer screening among Latinas attending culturally specific educational programs. Prog Community Health Partnersh. 2008;2(3):195–204.

    Article  PubMed  Google Scholar 

  57. Jandorf L, Ellison J, Shelton R, Thelemaque L, Castillo A, Mendez EI, et al. Esperanza y Vida: a culturally and linguistically customized breast and cervical education program for diverse Latinas at three different United States sites. J Health Commun. 2012;17(2):160–76.

    Article  PubMed  Google Scholar 

  58. Bandura A Social foundations of thought and action: a social cognitive theory. Englewood Cliffs, New Jersey: Prentice-Hall, Inc.; 1986.

    Google Scholar 

  59. Jandorf L, Hecht MF, Winkel G, Thélémaque LD, Saad-Harfouche FG, Bursac Z, et al. Increasing cancer screening for Latinas: examining the impact of health messages and navigation in a cluster-randomized study. J Racial Ethn Health Disparities. 2014;1(2):85–100.

    Article  Google Scholar 

  60. Humes K, Jones N, Ramirez R. Overview of Race and Hispanic Origin: 2010. 2010 Census Briefs. 2011. Accessed April 2014. Available from http://www.census.gov/prod/cen2010/briefs/c2010br-02.pdf.

  61. United States Census Bureau State & country quick facts. 2015. Accessed April 2014. Available from http://quickfacts.census.gov/qfd/states/00000.html.

  62. American Cancer Society. Chronological history of ACS recommendations for the early detection of cancer in people without cancer symptoms. 2014. Accessed October 2015.  Available from http://www.cancer.org/healthy/findcancerearly/cancerscreeningguidelines/chronological-history-of-acs-recommendations.

  63. Mayring P. Qualitative content analysis. Forum qualitative Sozialforschung/forum: qualitative social research. 2000;1(2).

  64. Erwin DO, Trevino M, Saad-Harfouche FG, Rodriguez EM, Gage E, Jandorf L. Contextualizing diversity and culture within cancer control interventions for Latinas: changing interventions, not cultures. Soc Sci Med. 2010;71(4):693–701.

    Article  PubMed  Google Scholar 

  65. Carter J, Park ER, Moadel A, Cleary SD, Morgan C. Cancer knowledge, attitudes, beliefs, and practices (KABP) of disadvantaged women in the South Bronx. J Cancer Educ. 2002;17(3):142–9.

    PubMed  Google Scholar 

  66. Sambamoorthi U, McAlpine DD. Racial, ethnic, socioeconomic, and access disparities in the use of preventive services among women. Prev Med. 2003;37(5):475–84.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported by the American Cancer Society grant: RSGT-07-021- 01-CPPB, the John R. Oishei Foundation of Western New York, and Susan G. Komen Western New York. The authors acknowledge the assistance of Anabella Castillo, Jomary Colon, Frances Saad-Harfouche, Michelle Trevino, Susy Hannigan, Elvira Aguillar, Elsa Iris Mendez, and the Latino community members in the conduct of this study. The authos also thank Maria Carina Rodriguez and Caitlyn Braschi with the assistance of data analysis and development of this manuscript.

Author information

Authors and Affiliations

  1. Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Karent Zorogastua, Linda Thelemaque & Lina Jandorf

  2. Roswell Park Cancer Institute, Buffalo, NY, USA

    Deborah Erwin

  3. University of Arkansas for Medical Sciences, Little Rock, AR, USA

    LeaVonne Pulley

Authors
  1. Karent Zorogastua
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Deborah Erwin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Linda Thelemaque
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. LeaVonne Pulley
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lina Jandorf
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Karent Zorogastua.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zorogastua, K., Erwin, D., Thelemaque, L. et al. Intrinsic Factors of Non-adherence to Breast and Cervical Cancer Screenings Among Latinas. J. Racial and Ethnic Health Disparities 3, 658–666 (2016). https://doi.org/10.1007/s40615-015-0184-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40615-015-0184-x

Keywords

Search

Navigation