Reducing Breast Cancer Risk Among Latina Women: Myths and Misconceptions 2004 Minority Women’s Health Summit August 12-1

1. Reducing Breast Cancer Risk Among Latina Women: Myths and Misconceptions2004 Minority Women’s Health SummitAugust 12-15, 2004 Amelie G. Ramírez, DrPH, Principal Investigator Baylor College of Medicine – San Antonio Cancer Institute Co-Principal Investigators José R. Martí, MD Martha A. Medrano, MD, MPH Columbia University U. of TX Health Science Ctr., S.A. Edward J. Trapido, ScD Eliseo J. Pérez-Stable, MD NCI U. of California, San Francisco Frank J. Penedo, PhD Gregory A. Talavera, MD, MPH U. of Miami San Diego State U. Aida L. Giachello, PhD Elena Ríos, MD U. of Illinois, Chicago National Hispanic Medical Assoc. Roland Garcia, PhD, NCI Program Officer Supported by NCI Grant No. UO 1 CA 86117-01

2. Selected Spanish Settlement Dates in the Americas: Late 1400s - Late 1700s Santa Fe 1609 San Diego 1768 Natchitoches 1713 St. Augustine 1565 Veracruz 1518 Baracoa 1511 San Juan 1521 Santo Domingo 1496 Spanish settlements Santa Marta 1525

3. Hispanic Population: 1930-2050 (millions) First year “Hispanic” used Census Projections Source: U.S. Department of Commerce. (1993) We the American… Hispanic. U.S. Census Bureau.(2000). Projections of the Resident Population by Age, Sex, Race, and Hispanic origin, 1999 to 2100.

4. Percent Distribution of Hispanics by Type: 2002 Source: U.S. Census Bureau, Current Population Survey, March 2002

5. Why It’s Important to StudyLatinos and Cancer • Fastest growing U.S. population group • Cancer: 2nd leading cause of death • Breast cancer leading cause of death for Latinas • Higher incidence of:cervical, stomach, gallbladder and liver cancer

6. Latino Cultural Values • Family emphasis • Religious/spiritual emphasis • Machismo attitudes

7. Sociodemographic Profile • Poor access to health care • Poverty • Low educational attainment • Lack of health insurance • Strong family ties • Strong religious beliefs • Low levels of knowledge about breast cancer • Reliance on folk/alternative medicine • Lack of orientation toward preventative health behaviors

8. Lack of Latino Health Data • Lack of cancer reporting among groups otherthan African Americans • Hispanic origin not reported on all statedeath certificates as late as 1990 • Gaps in SEER data collection

9. Cancer in Latinos:At the Crossroads • We should: • Research the impact of cancer on Latinos • Study factors that may provide protective effect • Plan for population growth, aging, acculturation • Encourage greater participation by Latinos in clinical trials

10. Recent Mammography by Ethno-Regional Group S. Francisco Central Am. Miami Cuban Am. New York P. Ricans San Diego Mexican Am. San Antonio Mexican Am. Houston Mexican Am. Brownsville Mexican Am. Laredo Mexican Am. Ramirez et al. Breast cancer screening in regional Hispanic populations. Health Education Research. 2000.

11. Heard but no Knowledge Hispanic Group Never Heard Knowledge Mamm. Pap Mamm. Pap Mamm. Pap Mexican American 4.8 11.7 36.9 35.8 58.3 52.5 Central American 1.7 8.6 33.9 43.7 64.4 47.7 Puerto Rican 2.1 17.8 31.8 41.1 66.1 41.1 Cuban 2.9 4.9 25.3 39.8 71.8 55.6 Knowledge of Screening Guidelines – Women 40+ Source: Ramirez et al. Hispanic Women’s Breast and Cervical Cancer Knowledge, Attitudes, and Screening Behaviors. Am J Health Promot. 2000; 14(5):292-300

12. Cancer can be cured Little I can do to prevent How likely to get cancer Hispanic Group % Disagree % Agree % More likely Mexican American 21.5 39.5 17.0 Central American 17.8 36.8 12.2 Puerto Rican 21.2 33.5 20.1 Cuban 15.2 34.3 11.6 Attitudes Toward Cancer – Women 40+ Source: Ramirez et al. Hispanic Women’s Breast and Cervical Cancer Knowledge, Attitudes, and Screening Behaviors. Am J Health Promot. 2000; 14(5):292-300

13. Latina Breast Cancer Facts • Third highest incidence rates among minorities • Third highest mortality rates among all groups • Mostly commonly diagnosed cancer • Leading cause of cancer death • Diagnosed at a more advanced stage of the disease • Uninsured 2.3 times more likely to be diagnosed at a later stage • Lower 5-year survival rate: 76% vs. 87% Source: American College of Physicians 2000; Healthy People 2010, 1998

14. Latina Breast Cancer Myths • A bruise on the breast will lead to breast cancer. • If an incision is made during breast cancer surgery,the cancer will spread. • Getting too many mammograms leads tobreast cancer. • Mammograms are only used to evaluatebreast lumps. Source: Ramirez et al, 2000 American Journal of Public Health Familias en Acción/Familias in Action & Nuestras Historias/Our Stories

15. Latina Breast Cancer Myths • Touching the breasts too often will lead to cancer • Talking about cancer causes cancer • Using illegal drugs causes cancer • Herbs cure breast cancer(uña de gato/cat’s claw) Source: Ramirez et al, 2000 American Journal of Public Health Familias en Acción/Familias in Action & Nuestras Historias/Our Stories

16. Disparities in Clinical TrialParticipation NCI study participation: • Latinos and other minority groups: 3% • Non-Hispanic Whites: 88%

17. National PSA Campaign • 4 PSAs (video and audio) produced in Spanish and English • >700 nationwide TV and radio stations receiving PSAs • 2 Telly Awards for PSA excellence

18. Clinical Trials Outreach for Hispanics • Purpose: Increase awarenessand intention to participatein clinical trials; coordinate withNCI Cancer Genetics Networkto offer enrollment • Methods: Clinical Trials Education Series presentation to Hispanic adults in existing groups • Results: 40 presentations, 1,000 people, 90% Hispanic, mostly female, desire more information

19. RecommendationsPatient Education • Increase breast cancer awareness • Work with community organizations to dispel myths and educate Latinas about breast cancer • Promote breast cancerscreening behavior(clinical breast exams,mammograms, and BSEs)

20. RecommendationsTraining • Encourage Latino and minoritystudents to enter health professions • Promote cultural competencein formal education curriculum • Provide professionals with continuing formal and informal cultural competence training

21. RecommendationsPatient Contact • Promote cultural competence of office staff • Provide culturally appropriate educational materials • Ask open-ended questions and remain non-judgmental

22. RecommendationsResearch • Encourage research in Latinos and other minority populations, including immigrant and racial/ethnic groups • Study correlation between culturally competent communication and health outcomes • Fund technology use in cancer care communications among minority populations

23. Mil Gracias For more information on cancer control policy recommendations produced by Redes En Acción, visit our web sites at www.redesenaccion.org or www.saludenaccion.org ! !