Asian-Americans often forgo mammograms because they don't see breast cancer as a threat.
Back home, that may be true: Rates across Asian countries are extremely low. But according to the National Asian Women's Health Organization, by the time an Asian woman has been in the United States for one decade, her risk of breast cancer has increased by a whopping 80 percent.
Katherine K. Kim, PhD, professor emeritus of nursing science at Grand Valley State University in Allendale, Michigan—who herself recovered from breast cancer decades after emigrating from Korea—has researched other barriers that impede Asian-Americans from getting screened and treated. There's a real fear of social stigma—the worry that should a woman be diagnosed with breast cancer, her husband will leave her or the community will shun her. Kim also found that extreme modesty often plays a large role—many of these women are too embarrassed to undergo an examination.
"The idea of prevention is pretty Western," says Bogomolov. "If you believe your life has been preordained from the moment you were conceived, the disease is either going to occur or it's not. All we can do is show that the interventions being offered are on their life path.
Barbara Bogomolov, who directs refugee health services for Barnes-Jewish Hospital in St. Louis, is strategizing how to reach her observant Muslim patients from countries like Afghanistan and Pakistan who find mammography an affront to their understanding of body modesty. One idea: Train those already permitted into their homes—for example, nuns who teach English—to talk about mammograms and breast health. Another plan is a mammography van completely staffed by female technicians who will stress that mammograms are necessary to keep a woman healthy and pure before Allah.
When Jackie Nolte, who is part Cherokee, was diagnosed with breast cancer three years ago at the age of 54, she found herself angered by the prospect of chemotherapy. "I could not give the white people my hair," she muttered.
At Las Fuentes Health Clinic, Gynecologist John Molina's Native American patients remind him daily that what Western science calls fatalism is, to them, simply acceptance. "Breast cancer doesn't even faze them," he remarks, "because they feel that whatever happens will happen." So screening carries no urgency.
Intense modesty makes it unlikely that these women would ever perform a breast self-exam, says Molina. "They don't even like talking about breasts much less feeling them." He adds that Apache, Hopi, and Navajo women will see healers before medical doctors. "What finally brings them into the clinic is pain. By the time you get pain, it's an advanced cancer."
While the incidence of breast cancer among Native Americans is lower than that of other groups, the mortality rate in some parts of the country is higher, according to available research. Molina suggests that health care providers might do well to learn who the healers and elders are in the community and work through them.
Jeannette Batz Cooperman, PhD, has written for the Utne Reader and Glamour.