South Asian women are being encouraged to check their breasts and go to screening appointments (mammograms) by a radiographer at Bradford Teaching Hospitals for World Cancer Day.
Julie Hodgins, a health promotion specialist at Pennine Breast Screening Service, has over 40 years worth of experience in radiography, breast Screening and patient care in the UK, Ireland, and Australia.
Mrs Hodgins has worked as a radiographer since 1980 and specialised in breast cancer screening more than 25 years ago. She has also supported new parents with breastfeeding support as a volunteer with National Childbirth Trust (NCTI) since 2000 and Bradford Breastfeeding Buddies, a group on Facebook.
Now, Mrs Hodgins is encouraging South Asian women, particularly women over the age of 65, to check their breasts for signs and symptoms of breast cancer, using the ‘Know your Lemons’ method.
She also urges women to go to their mammogram appointments when they receive their invite through the post.
There are twelve symptoms of breast cancer. These include a hard lump, a thick area, dimple, nipple crust, red or warm breasts, new fluid, skins sores, a bump, a newly inverted or sunken nipple, a growing vein, a new shape, or size, or “orange peel skin”.
Mrs Hodgins is eager to get women talking about their breasts, to increase early detection, and get more women to attend mammograms. She said: “It is really important that we get older women to talk about their health, especially their breasts.
“Older South Asian women may not tell anyone, their family or even the GP, that they don’t feel well or have signs and systems of breast cancer. This may be for several reasons. However, if we get them treated earlier then there is more chance of recovery.
“Early detection means that 94 to 99% of women will recover, but if you wait, this percentage drops to only 65%.”
In the UK, incidence rates of breast cancer are lower in South Asian, Black, Chinese, and mixed groups when compared to white women however women from these backgrounds, experience differences in breast screening attendance, the stage and age of diagnosis, outcomes, and experiences of care and treatment.
In England, every year around 46,000 people are diagnosed with breast cancer, with one in seven women developing breast cancer in their lifetime. Out of these patients, eight of 10 cases of breast cancer are diagnosed in women aged 50 and over with this number expected to skyrocket.
The number of women over the age of 65 being diagnosed with cancer is expected to quadruple over the next 30 years meaning that by 2040, there will be more than one million older women living with cancer.
All women in the UK registered at a GP are invited for a mammogram every three years between the ages of 50 and 71. Lower breast screening uptake among older South Asian women specifically may be due to cultural and language barriers and a lack of tailored intervention.
Late-stage diagnosis is associated with poorer survival outcomes in women from ethnically diverse backgrounds when breast cancer is more difficult to treat.
Mrs Hodgins doesn’t mince her words when it comes to breast cancer. She says: “Talking frankly works the best. If you give women a choice, then they can say no to coming to screenings. They need to have mammograms as age is the biggest risk of cancer.
“Women think family history and genetics are the biggest risks for breast cancer, but it is not. Family history only accounts for a small number of women who get diagnosed.”
There are several reasons for a lower uptake in mammograms from South Asian women, one of these being communication barriers. Women who migrated in the sixties and seventies may not understand English well and have difficulty reading their post, or their children and grandchildren may not speak their language and so there is mixed communication.
Women may also not feel comfortable talking about their breasts, referring to pains in their breast as “chest pains”, which can also increase confusion, says Mrs Hodgins.
Talking about ill-health within families and the wider community can bring about feelings of stigma, embarrassment, or shame (sharam). This means that women “put off” going to their GP or talking about it with family members until it is at a late stage, says Mrs Hodgins.
The pain felt during mammograms vary from person to person. Some women feel mild discomfort due to the pressure, but most women tolerate the x-rays well. Women must be comfortable both physically, mentally, and emotionally during the x-rays. It is advisable to wear a top and bottoms, so you only need to undress the top half of your body, and that they understand only women will administer the screening.
For more information, please visit the Pennine Breast Screening website, here.