Factors associated with routine screening for the early detection of breast cancer in cultural-ethnic and faith-based communities

Objectives: Studies have shown a lower adherence to health behaviors among women in cultural-ethnic minorities and faith-based communities, especially lower screening attendance for the early detection of breast cancer. This study compares factors related to cancer screening adherence in two distinct cultural-ethnic minorities in Israel: Arab women as a cultural-ethnic minority and Jewish ultra-Orthodox women as a cultural-ethnic faith-based minority. Design: During the year 2014, a total of 398 Jewish ultra-Orthodox women and 401 Arab women between the ages of 40–60, were randomly selected using population-based registries. These women answered questionnaires regarding adherence to mammography and clinical breast examination (CBE), health beliefs and cultural barriers. Results: Arab women adhered more than ultra-Orthodox women to mammography (p <.001) and CBE exams (p <.01). Religious beliefs, exposure barriers and perceived risk were higher among the ultra-Orthodox women, while social barriers, accessibility barriers and perceived severity were higher among the Arab women (p <.01). Adjusting for background factors, higher adherence to CBE and mammography were associated with lower levels of religious beliefs (AOR = 0.90, 95% CI = 0.69–1.17 AOR = 0.62, 95% CI = 0.39–0.82, respectively), perceiving a higher risk of cancer (AOR = 1.93, 95% CI = 1.23–3.04 and AOR = 3.22, 95% CI = 1.53–6.61), and having more fears related to cancer-related losses (AOR = 1.51, 95% CI = 1.19–3.00 and AOR = 1.24, 95% CI = 0.63–1.22). In addition, perceiving greater advantages of CBE was associated with higher adherence to CBE (AOR = 1.82, 95% CI = 1.45–2.29), while not receiving a physician’s recommendation was associated with lower adherence to mammography (AOR = 1.82, 95% CI = 1.45–2.29). Conclusion: This study addressed a lacuna in screening behaviors of women from cultural-ethnic and faith-based communities. In order to increase adherence, health care professionals and policymakers should direct their attention to the specific nature of each community.