Advancing Equity in Breast Cancer Screening Among Immigrant East African Women in Seattle, WA: A Focus-Group Study

Black women are diagnosed with breast cancer at later stages and have a higher cancer-related mortality rate than white women. Low mammography completion contributes to racial disparities in breast cancer. Immigrant Black women face additional barriers that compound these inequities; notably, mammography rates are among the lowest for recent immigrants. We sought to describe experiences and preferences related to breast cancer screening among Somali and Ethiopian women, two growing Black immigrant populations in our community, to inform system interventions to increase screening rates within a diverse patient population at a large, urban academic medical center. We conducted semi-structured focus groups with women who were born in Somalia or Ethiopia, had immigrated to the US, and were overdue for breast cancer screening. Each focus group discussed participant views on healthcare, breast cancer screening, and opportunities for outreach. Interviews were conducted in Somali or Amharic with a real-time certified bilingual interpreter and cultural mediator. Verbatim transcripts from audio recordings underwent constant comparison and iterative data reduction analysis by two study authors. Eleven women from Somalia participated in two Somali-speaking focus groups (SSFG) and seven women from Ethiopia participated in two Amharic-speaking focus groups (ASFG). Several themes were shared between groups related to screening barriers (e.g., access, need for interpreters, competing needs and responsibilities, lack of symptoms, silence, fear) and facilitators (e.g., physician recommendation, community information and experiences about screening, stories of people with cancer). Both groups recommended more provider presence in community outreach and recommended oral or visual materials for health communication. Themes more common among SSFG participants included an expectation of pain and consideration of religion in health. ASFG participants described a desire for more separation between religion and healthcare and emphasized the role of the doctor as a trusted source of information. This study identified barriers to screening and opportunities for developing tailored, culturally relevant interventions to improve mammography completion among East African communities in our region. Health systems must consider the unique needs of both populations for interventions to meaningfully impact screening rates and ultimately reduce disparities in breast cancer.