Factors contributing to the low participation rate of Turkish women to a breast cancer screening program in Antwerp, Belgium

Objectives: To explore possible factors explaining a low participation rate to breast cancer screening for Turkish women living in Antwerp, Belgium, and to develop ways to increase participation rate. Material and Methods: The authors used focus group discussions with Turkish women to explore their reasons to participate or not to participate in breast cancer screening. Groups consisted of four to six women. Inclusion criteria were: being female, having a Turkish origin, and age between 50 and 69 years. For each focus group, one Turkish women was invited and asked to invite five other women meeting the inclusion criteria. Results: Three focus group discussions with in total 17 women have taken place. Six women had participated to all consecutive invitations for breast cancer screening. One woman had participated once, but not the next time she was invited. Ten women had never participated to screening mammography, although some of them had undergone diagnostic mammography. In all three focus groups, insufficient knowledge of the Dutch language, the unavailability of a professional interpreter, being careless about healthcare, and a negative influence of the husband, were the main reasons not to participate in breast cancer screening. Invitation letters are not read because they are in a language the woman does not understand. Less frequently mentioned obstacles were being on a holiday or being sick on the day of the scheduled mammography, fear of pain, considering an examination useless when not having any symptoms, being anxious for a positive result, and the physical distance to the screening center. Receiving an invitation in Turkish and knowing that a person speaking Turkish will be available at the screening center were proposed as possible measures to improve participation. Conclusion: The single most important reason why Turkish women living in Antwerp, Belgium, do not participate in breast cancer screening was a language problem; other reasons were a lack of knowledge concerning breast cancer screening and not worrying about breast cancer. The language barrier in this population of older women can possible be overcome by Turkish speaking personnel at the screening centers.

Breast cancer screening; Ethnic minorities; Migrants; Prevention; Participation (rate); Belgium; Turkish.

[1] Visser O, van Peppen AM, Ory FG, van Leeuwen F.E.: “Result of breast cancer screening in first generation in Nothwest Netherlands”. Eur. J. Cancer Prev., 2005, 14, 251.

[2] Morgan D.L.: “The Focus Group Guidebook”. Thousand Oaks, Cal-ifornia: Sage Publications, 1998, Kit 1-5.

[3] Dundar P.E., Ozmen D., Ozturt B., Haspolat G., Akyildiz F., Coban S., Cakiroglu G.: “The knowledge and attitudes of breast self-ex-amination and mammography in a group women in a rural area in western Turkey”. BMC Cancer, 2006, 6, 43.

[4] Vahit O.: “Breast Cancer in the world and Turkey”. Meme sagligi dergisi, 2008, 4, 2.

[5] Balikesir D.H. Ketem, Bir Tarama Ornegi: balikesir meme kanseri tarama program, In: Tuncer A.M., Türkiyede kanser kontrolü. Ankara: Saglik bakanligi yayinlari, 2007, 707, 345.

[6] Hartman E., Van den Muijsenbergh M.E., Haneveld R.W.: “Breast cancer screening participation among Turks and Maroccans in the Netherlands: exploring respons for nonattendance”. Eur. J. Cancer Prev., 2009, 18, 349.

[7] Avci I.A, Kurt H.: “Health beliefs and Mammography rates of Turk-ish women living in rural areas”. J. Nurs. Scholarsh., 2008, 40, 170.

[8] Cam O., Gümüs A.B.: “Breast cancer screening behavior in Turkish women: relationships with healt beliefs and self-esteem, body percep-tion and hopelessness”. Asian Pac. J. Cancer Prev., 2009, 10, 49.

[9] Gözüm S., Karayurt O., Kac S., Platin N.: “Effectiveness of peer ed-ucation for breast cancer screening and health beliefs in eastern Turkey”. Cancer Nurs., 2010, 33, 213.

[10] Secginli S., Nahcivan N.O.: “Factors associates with breast cancer screening behaviours in a sample of Turkish women: a questionnaire survey”. Int. J. Nurs. Stud., 2006, 43, 161.

[11] Alimoğlu E., Alimoğlu M.K., Kabaalioğlu A., Ceken K., Apaydin A., Lüleci E.: “Mammography-related pain and anxiety”. Tani girisim Radyol., 2004, 10, 217.

[12] Visser O., Van der Kooy K., Van Peppen A.M., Ory F.G., van Leeuwen F.E.: “Breast cancer risk among Firs-generation migrants in Netherlands”. Br. J. Cancer, 2004, 90, 2135.

[13] Spallek J., Arnold M., Hentschel S, Razum O.: “Cancer incidence rate ratios of Turkish immigrants in Hamburg, Germany: a registry based study”. Cancer Epidemiol., 2009, 33, 413.

[14] McCredie M., Coates M., Grulich A.: “Cancer incidence in migrants to New South Wales (Australia) from the Middle East, 1972-91”. Cancer Causes Control, 1994, 5, 414.

[15] Ziegler R.G., Hoover R.N., Pike M.C., Hildesheim A., Nomura A.M. West J.W., et al.: “Migration patterns and breast cancer risk in Asian-American women”. J. Natl. Cancer Inst., 1993, 85, 1819.

[16] Zeeb H, Razum O, Blettner M., Steigmaier G.: “Transition in cancer patterns among Turks residing Germany”. Eur. J. Cancer, 2002, 38 705.

[17] Raymond L., Fischer B., Fioretta G., Bouchardy G.: “Migration bias in cancer survival rates”. J. Epidemiol. Biostatist., 1999, 1, 167.