Journal of Immigrant and Minority Health

, Volume 15, Issue 1, pp 149–158 | Cite as

Increasing Screening Mammography Among Immigrant and Minority Women in Canada: A Review of Past Interventions

  • Nour Schoueri-Mychasiw
  • Sharon Campbell
  • Verna Mai
Original Paper


Screening mammograms are important to detect breast cancer at earlier and more treatable stages. Immigrant and minority women report low participation rates due to barriers related to cultural beliefs and norms, privacy/modesty, and language. This review examines whether screening mammogram interventions in Canada and other countries with comparable health-care systems have addressed the needs of these women. Our systematic literature search identified studies that focused on increasing screening mammogram participation among immigrant and/or minority women. We used the Health Belief Model and the PRECEDE-PROCEED Model to guide our critical synthesis of the reviewed interventions and the recommendations for the future. Eight studies met the search criteria. Overall, interventions showed some increase in mammogram participation rates. The barriers targeted were relatively similar across studies and there was a focus on increasing cues to screening. This review illustrates that it is essential to develop and implement programs to overcome the unique barriers to screening mammography if we are to increase participation among immigrants and minority women. We suggest other potentially effective health promotion strategies as a starting point for discussion and future research.


Screening mammogram Immigrant and minority health Barriers to screening Women’s health 



A version of this paper was awarded the Best Doctoral Paper in 2010 by the Justice Emmett Hall Memorial Foundation. We would like to acknowledge Dr. Sandra L. Bullock and Dr. Paul McDonald for their assistance in developing the topic for this paper, and Ashley Johns, MSc, for her help with editing. Partial work on this paper was supported by a Social Science and Humanities Research Council (SSHRC) Doctoral Award and a University of Waterloo President’s Graduate Scholarship.


  1. 1.
    WHO. Breast cancer: prevention and control. Retrieved on April 11, 2011 from:
  2. 2.
    Canadian Cancer Society’s Steering Committee on Cancer Statistics. Canadian cancer statistics 2011. In. Toronto, ON: Canadian Cancer Society; 2011.Google Scholar
  3. 3.
    Canadian Cancer Society. Breast cancer stats. Retrieved on August 28, 2009 from:
  4. 4.
    PHAC. Breast cancer. Retrieved on April 11, 2011 from:
  5. 5.
    PHAC. Progress report on cancer control in Canada. Retrieved on October 22, 2008 from:
  6. 6.
    de Waard F, Collette HJ, Rombach JJ, Baanders-van Halewijn EA, Honing C. The DOM project for the early detection of breast cancer, Utrecht, The Netherlands. J Chronic Dis. 1984;37:1–44.PubMedCrossRefGoogle Scholar
  7. 7.
    Sarkeala T, Heinavaara S, Anttila A. Organised mammography screening reduces breast cancer mortality: a cohort study from Finland. Int J Cancer. 2008;122:614–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Taylor R, Morrell S, Estoesta J, Brassil A. Mammography screening and breast cancer mortality in New South Wales, Australia. Cancer Causes Control. 2004;15:543–50.PubMedCrossRefGoogle Scholar
  9. 9.
    Shapiro S, Venet W, Strax P, Venet L. Current results of the breast cancer screening randomized trial: The Health Insurance Plan (HIP) of Greater New York Study. In: Day NE, editor. Miller AB: screening for breast cancer. Toronto: Hans Huber Publishers; 1988. p. 3–15.Google Scholar
  10. 10.
    Maxwell CJ, Bancej CM, Snider J. Predictors of mammography use among Canadian women aged 50–69: findings from the 1996/97 National Population Health Survey. CMAJ. 2001;164:329–34.PubMedGoogle Scholar
  11. 11.
    Kwok C, Sullivan G. The concepts of health and preventive health practices of Chinese Australian women in relation to cancer screening. J Transcult Nurs. 2007;18:118–26.PubMedCrossRefGoogle Scholar
  12. 12.
    Maxwell CJ, Kozak JF, Desjardins-Denault SD, Parboosingh J. Factors important in promoting mammography screening among Canadian women. Can J Public Health. 1997;88:346–50.PubMedGoogle Scholar
  13. 13.
    Fox SA, Siu AL, Stein JA. The importance of physician communication on breast cancer screening of older women. Arch Intern Med. 1994;154:2058–68.PubMedCrossRefGoogle Scholar
  14. 14.
    Aroian KJ. Immigrant women and their health. Annu Rev Nurs Res. 2001;19:179–226.PubMedGoogle Scholar
  15. 15.
    Fowler N. Providing primary health care to immigrants and refugees: The North Hamilton experience. CMAJ. 1998;159:388–91.PubMedGoogle Scholar
  16. 16.
    Gentleman JF, Lee J. Who doesn’t get a mammogram? Health Rep. 1997;9:19–28.Google Scholar
  17. 17.
    Shields M, Wilkins K. An update on mammography use in Canada. Health Rep. 2009;20:7–19.Google Scholar
  18. 18.
    Kliewer EV, Smith KR. Breast cancer mortality among immigrants in Australia and Canada. JNCI. 1995;87:1154–61.PubMedCrossRefGoogle Scholar
  19. 19.
    Luo W, Birkett NJ, Ugnat AM, Mao Y. Cancer incidence patterns among Chinese immigrant populations in Alberta. J Immigr Health. 2004;6:41–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Tatla RK, Paszat LF, Bondy SJ, Chen Z, Chiarelli AM, Mai V. Socioeconomic status & returning for a second screen in the Ontario breast screening program. Breast. 2003;12:237–46.PubMedCrossRefGoogle Scholar
  21. 21.
    Donnelly TT, McKellin W, Hislop G, Long B. Socioeconomic influences on Vietnamese-Canadian women’s breast and cervical cancer prevention practices: a social determinant’s perspective. Soc Work Public Health. 2009;24:454–76.PubMedCrossRefGoogle Scholar
  22. 22.
    Stamler LL, Thomas B, Lafreniere K. Working women identify influences and obstacles to breast health practices. Oncol Nurs Forum. 2000;27:835–42.PubMedGoogle Scholar
  23. 23.
    Achat H, Close G, Taylor R. Who has regular mammograms? Effects of knowledge, beliefs, socioeconomic status, and health-related factors. Prev Med. 2005;41:312–20.PubMedCrossRefGoogle Scholar
  24. 24.
    Schofield PE, Cockburn J, Hill DJ, Reading D. Encouraging attendance at a screening mammography programme: determinants of response to different recruitment strategies. J Med Screen. 1994;1:144–9.PubMedGoogle Scholar
  25. 25.
    Hammond JA, Stewart M. Female patients’ attitudes to mammography screening. Can Fam Physician. 1994;40:451–5.PubMedGoogle Scholar
  26. 26.
    Kung EYL, Chan A, Chong Y, Pham T, Hsu-Hage BHH. Promoting breast screen to Melbourne Chinese women using ethnic-specific health promotion strategies. Retrieved on November 6, 2008 from:
  27. 27.
    Raja-Jones H. Breast screening and ethnic minority women: a literature review. Br J Nurs. 1999;8:1284–8.PubMedGoogle Scholar
  28. 28.
    Chiu LF. Straight talking: communicating breast screening information in primary care. Leeds: Nuffield Institute for Health; 2002.Google Scholar
  29. 29.
    Choudhry UK, Srivastava R, Fitch MI. Breast cancer detection practices of South Asian women: knowledge, attitudes, and beliefs. Oncol Nurs Forum. 1998;25:1693–701.PubMedGoogle Scholar
  30. 30.
    Munn EM. Nonparticipation in mammography screening: apathy, anxiety or cost? N Z Med J. 1993;106:284–6.PubMedGoogle Scholar
  31. 31.
    Bottorff JL, Johnson JL, Bhagat R, Grewal S, Balneaves LG, Clarke H, et al. Beliefs related to breast health practices: the perceptions of South Asian women living in Canada. Soc Sci Med. 1998;47:2075–85.PubMedCrossRefGoogle Scholar
  32. 32.
    Hoare TA, Johnson CM, Gorton R, Alberg C. Reasons for non-attendance for breast screening by Asian women. Health Educ J. 1992;51:157–61.CrossRefGoogle Scholar
  33. 33.
    McAllister G, Bowling A. Attitudes to mammography among women in ethnic minority groups in three areas of England. Health Educ J. 1993;52:217–20.CrossRefGoogle Scholar
  34. 34.
    Meana M, Bunston T, George U, Wells L, Rosser W. Influences on breast cancer screening behaviors in Tamil immigrant women 50 years old and over. Ethn Health. 2001;6:179–88.PubMedCrossRefGoogle Scholar
  35. 35.
    Austin LT, Ahmad F, McNally MJ, Stewart DE. Breast and cervical cancer screening in Hispanic women: a literature review using the health belief model. WHI. 2002;12:122–8.PubMedGoogle Scholar
  36. 36.
    Barter-Godfrey S, Taket A. Understanding women’s breast screening behaviour: a study carried out in South East London, with women aged 50–64 years. Health Educ J. 2007;66:335–46.CrossRefGoogle Scholar
  37. 37.
    Bell TS, Branston LK, Newcombe RG, Barton GR. Interventions to improve uptake of breast screening in inner city Cardiff general practices with ethnic minority lists. Ethn Health. 1999;4:277–84.PubMedCrossRefGoogle Scholar
  38. 38.
    Jackson SL, Hislop TG, Teh C, Yasui Y, Tu SP, Kuniyuki A, et al. Screening mammography among Chinese Canadian women. Can J Public Health. 2003;94:275–80.PubMedGoogle Scholar
  39. 39.
    Qi V, Phillips SP, Hopman WM. Determinants of a healthy lifestyle and use of preventive screening in Canada. BMC Public Health. 2006;6:275–82.PubMedCrossRefGoogle Scholar
  40. 40.
    Maclean U, Sinfield D, Klein S, Harnden B. Women who decline breast screening. J Epidemiol Community Health. 1984;38:278–83.PubMedCrossRefGoogle Scholar
  41. 41.
    Donnelly TT. Challenges in providing breast and cervical cancer screening services to Vietnamese Canadian women: the healthcare providers’ perspective. Nurs Inq. 2008;15:158–68.PubMedCrossRefGoogle Scholar
  42. 42.
    Remennick L. The challenge of early breast cancer detection among immigrant and minority women in multicultural societies. Breast J. 2006;12:S103–10.PubMedCrossRefGoogle Scholar
  43. 43.
    Seow A, Straughan PT, Ng EH, Emmanuel SC, Tan CH, Lee HP. Factors determining acceptability of mammography in an Asian population: a study among women in Singapore. Cancer Causes Control. 1997;8:771–9.PubMedCrossRefGoogle Scholar
  44. 44.
    Canada Health. Quality determinants of organized breast cancer screening programs in Canada. Ottawa: Health Canada; 2003.Google Scholar
  45. 45.
    Saldov M. The ethnic elderly: communication barriers to health care. Canadian Social Work Review. 1991;8:269–77.Google Scholar
  46. 46.
    Weerasinghe S, Mitchell T, Hamilton L, Ragheb M. Equitable access to health care, health promotion, and disease prevention for recent immigrant women living in Nova Scotia, Canada: report on phase 1, fact sheet. Halifax: Maritime Centre of Excellence for Women’s Health; 2000.Google Scholar
  47. 47.
    George U, Ramkissoon S. Race, gender, and class: interlocking oppressions in the lives of South Asian women in Canada. Affilia. 1998;13:102–19.CrossRefGoogle Scholar
  48. 48.
    Meleis AI, Hatter-Pollard M. Arab Middle Eastern American women: Stereotyped, invisible, but powerful. In: Adams DL, editor. Health issues for women of color: a cultural diversity perspective. Thousand-Oaks, CA: Sage Publications; 1995. p. 133–63.Google Scholar
  49. 49.
    Watts T, Merrell J, Murphy F, Williams A. Breast health information needs of women from minority ethnic groups. J Adv Nurs. 2004;47:526–35.PubMedCrossRefGoogle Scholar
  50. 50.
    Ma GX. Between two worlds: the use of traditional and Western health services by Chinese immigrants. J Community Health. 1999;24:421–37.PubMedCrossRefGoogle Scholar
  51. 51.
    Bahl V. Cancer and ethnic minorities–the Department of Health’s perspective. BJC. 1996;74:S2–10.Google Scholar
  52. 52.
    Thomas VN, Saleem T, Abraham R. Barriers to effective uptake of cancer screening among Black and minority ethnic groups. Int J Palliative Nurs. 2005;11(562):564–71.Google Scholar
  53. 53.
    Ahmad F, Stewart DE. Predictors of clinical breast examination among South Asian immigrant women. J Immigr Health. 2004;6:119–26.PubMedCrossRefGoogle Scholar
  54. 54.
    Meadows LM, Thurston WE, Melton C. Immigrant women’s health. Soc Sci Med. 2001;52:1451–8.PubMedCrossRefGoogle Scholar
  55. 55.
    Donnelly TT. The health-care practices of Vietnamese-Canadian women: cultural influences on breast and cervical cancer screening. Canadian J Nurs Res. 2006;38:82–101.Google Scholar
  56. 56.
    Underwood SM, Shaikha L, Bakr D. Veiled yet vulnerable: breast cancer screening and the Muslim way of life. Cancer Pract. 1999;7:285–90.PubMedCrossRefGoogle Scholar
  57. 57.
    Yeo SS, Meiser B, Barlow-Stewart K, Goldstein D, Tucker K, Eisenbruch M. Understanding community beliefs of Chinese-Australians about cancer: initial insights using an ethnographic approach. Psychooncology. 2005;14:174–86.PubMedCrossRefGoogle Scholar
  58. 58.
    Hoare TA. Breast screening and ethnic minorities. BJC. 1996;74:S38–41.Google Scholar
  59. 59.
    Bélanger A, Malenfant EC. Population projections of visible minority groups, Canada, provinces and regions: 2001–2017. Ottawa, ON: Demography Division, Statistics Canada; 2005.Google Scholar
  60. 60.
    Chui T, Tran K, Maheux H. Immigration in Canada: a portrait of the foreign-born population, 2006 Census. Ottawa, ON: Social and Aboriginal Statistics Division, Statistics Canada; 2007.Google Scholar
  61. 61.
    Urban N, Anderson GL, Peacock S. Mammography screening: how important is cost as a barrier to use? Am J Public Health. 1994;84:50–5.PubMedCrossRefGoogle Scholar
  62. 62.
    Miles A, Cockburn J, Smith RA, Wardle J. A perspective from countries using organized screening programs. Cancer. 2004;101:1201–13.PubMedCrossRefGoogle Scholar
  63. 63.
    Rosenstock IM. Historical origins of the health belief model. Health Educ Monogr. 1974;2:328–35.Google Scholar
  64. 64.
    Green LW, Kreuter MW, Deeds SG, Partridge KB. Health education planning: a diagnostic approach. Mountain View, CA: Mayfield; 1980.Google Scholar
  65. 65.
    Sohl SJ, Moyer A. Tailored interventions to promote mammography screening: a meta-analytic review. Prev Med. 2007;45:252–61.PubMedCrossRefGoogle Scholar
  66. 66.
    Black MEA, Frisina A, Hack T, Carpio B. Improving early detection of breast and cervical cancer in Chinese and Vietnamese immigrant women. Oncol Nurs Forum. 2006;33:873–6.PubMedCrossRefGoogle Scholar
  67. 67.
    Kernohan EE. Evaluation of a pilot study for breast and cervical cancer screening with Bradford’s minority ethnic women; a community development approach, 1991–1993. BJC. 1996;74:S42–6.Google Scholar
  68. 68.
    Hoare TA, Thomas C, Biggs A, Booth M, Bradley S, Friedman E. Can the uptake of breast screening by Asian women be increased? A randomized controlled trial of a linkworker intervention. J Public Health Med. 1994;16:179–85.PubMedGoogle Scholar
  69. 69.
    Atri J, Falshaw M, Gregg R, Robson J, Omar RZ, Dixon S. Improving uptake of breast screening in multiethnic populations: a randomised controlled trial using practice reception staff to contact non-attenders. BMJ. 1997;315:1356–9.PubMedCrossRefGoogle Scholar
  70. 70.
    Page A, Morrell S, Tewson R, Taylor R, Brassil A. Mammography screening participation: effects of a media campaign targeting Italian-speaking women. Aust N Z J Public Health. 2005;29:365–71.PubMedCrossRefGoogle Scholar
  71. 71.
    Turnbull D, Irwig L, Adelson P. A randomised trial of invitations to attend for screening mammography. Aust J Public Health. 1991;15:33–6.PubMedCrossRefGoogle Scholar
  72. 72.
    Powe BD, Faulkenberry R, Harmond L. A review of intervention studies that seek to increase colorectal cancer screening among African-Americans. Am J Health Promot. 2010;25:92–9.PubMedCrossRefGoogle Scholar
  73. 73.
    Menon U, Champion V, Monahan PO, Daggy J, Hui S, Skinner CS. Health belief model variables as predictors of progression in stage of mammography adoption. Am J Health Promot. 2007;21:255–61.PubMedCrossRefGoogle Scholar
  74. 74.
    Nilchaikovit T, Hill JM, Holland JC. The effects of culture on illness behavior and medical care: Asian and American differences. Gen Hos Psychiatry. 1993;15:41–50.CrossRefGoogle Scholar
  75. 75.
    Gielen AC, McDonald EM. Using the PRECEDE-PROCEED planning model to apply health behavior theories. In: Glanz K, Rimer BK, editors. Lewis FM: health behavior and health education. 3rd ed. San Francisco: Wiley; 2002. p. 409–36.Google Scholar
  76. 76.
    Campo S, Askelson NM, Routsong T, Graaf LJ, Losch M, Smith H. The green acres effect: the need for a new colorectal cancer screening campaign tailored to rural audiences. Health Educ Behav. 2008;35:749–62.PubMedCrossRefGoogle Scholar
  77. 77.
    Cheesman A. Dealing with ethnic and cultural diversity in breast screening. Retrieved on October 10, 2008 from:
  78. 78.
    Canada Health. Quality determinants of organized breast cancer screening programs in Canada. Ottawa: Health Canada; 2003.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Nour Schoueri-Mychasiw
    • 1
  • Sharon Campbell
    • 2
  • Verna Mai
    • 3
  1. 1.School of Public Health & Health SystemsUniversity of WaterlooWaterlooCanada
  2. 2.Propel Centre for Population Health ImpactUniversity of WaterlooWaterlooCanada
  3. 3.Canadian Partnership Against CancerTorontoCanada

Personalised recommendations