Breast screening practices among Russian immigrant women in Israel

This article discusses cognitions, attitudes, and practices aimed at secondary prevention of breast cancer in the national sample of 620 women aged over 35 who immigrated to Israel from the former Soviet Union after 1989. The study has shown that universal access to preventive care may not translate into its optimal utilization among the marginalized population groups. Specifically, while being at moderate to high cancer risk, Russian immigrants refrain from screening activities--gynecological check-ups, self- and clinical breast exams and mammography. This is a drastic reversal of the pre-emigration pattern: two-thirds of respondents underwent breast screening in the past and only one-third sustained this practice in Israel. The risk groups for late detection of breast cancer are the women least integrated into the host society: those over age 60, unemployed or having unskilled jobs. Women who had no regular primary care providers showed the lowest cancer awareness and minimal screening activity. Even those who knew key breast cancer facts, considered themselves susceptible, and realized the role of early detection in practice did little to avert the danger. Three explanations of the gap between the cognitions and practice are suggested: (a) immigrants' low health motivation, reflecting their downward social mobility and preoccupation with resettlement problems; (b) low self-efficacy and external locus of control over health typical for ex-Soviet citizens; and (c) communicative and other cultural barriers to health care services.