Tam Truong Donnelly's mother, who is now 73, felt an odd lump in her left breast about 18 months ago. A mastectomy was performed after a mammogram detected a two-centimetre mass -- something a routine screening would have picked up much sooner when it was far smaller and less worrisome.
But her mother, Tran Thi Ngoc Anh, like so many other Vietnamese women, didn't talk about things like breast cancer. "My mom didn't know anything about mammograms. She didn't have the clinical breast exams either," recalled Dr. Donnelly, who is a professor of nursing at the University of Calgary.
Now, Dr. Donnelly is trying to get a handle on why Vietnamese women -- and by extension, women from other minority groups -- don't take part in basic cancer screening.
"Even though breast cancer and cervical cancer screening services are available, it is not always accessible to these women because they are facing multiple barriers," she said. Dr. Donnelly's research points to embarrassment, traditional beliefs, language issues and cultural insensitivity as key obstacles.
Her findings, which are published in the spring issue of the Canadian Journal of Nursing Research, build on previous studies that have shown lower cancer screening participation rates and higher rates of the disease among some minority groups, compared with the general population.
The Canadian Cancer Society predicts that this year, 22,300 new cases of breast cancer and 1,350 new cases of cervical cancer will be detected; respectively, 19,300 and 390 people will die from these ailments. Screening could cut the number of deaths dramatically.
Women aged 50 to 69 should have a screening mammogram and clinical breast exam every two years, and women who are or have been sexually active should have a Pap test and pelvic exam every one to three years, depending on the guidelines in their province.
Still, the society concludes that participation in screening programs needs to be enhanced, and barriers must be identified in order to develop outreach programs.
Verna Mai, director of screening programs at Cancer Care Ontario, said new immigrants have long been considered a higher-risk population in terms of screening, but studies have identified gaps in the general population.
Doctors should be taught in medical schools that members of some cultures might not feel comfortable discussing screening, Dr. Mai said. As well, organized screening programs should issue reminder notices about check-ups.
"All of us are going to have to make sure we get good information to women," she added.
Dr. Donnelly conducted in-depth interviews with 15 Vietnamese women aged 49 to 78 who had been in Canada for an average of 22.7 years, as well as with six health-care providers. The study sample is small, but in qualitative research terms, it provides valuable clues about how the Canadian health-care system is failing some women.
While most women are uncomfortable with Pap tests and breast exams, the procedures were particularly troubling for Vietnamese women, who generally seek medical advice only when they feel ill.
"Having no symptoms, yet showing the breasts and laying on the table for these kinds of invasive examinations is really difficult for them. It's difficult for them to conceptualize that they may be at risk," Dr. Donnelly said.
Vietnamese women also said they believe in destiny, that some higher power intended they become ill. At the same time, adherence to hierarchy means women wait for a physician to order a test rather than inquire about one.
Many women also believe tests are a waste of time when they are already too busy working at lower-paying jobs and taking care of family, the report found.
"We have to explain it to them, to be more culturally sensitive," Dr. Donnelly said. "Do these tests not only because it benefits you, yourself, but it also benefits the family."
