Fear of Higher Cancer Rates Among Latinas Fuels Scientific Study

A Santa Ana woman told UC Irvine anthropologist Leo Chavez that if she ever developed breast cancer, she would not seek medical care. If she had surgery, she explained, “I would be less of a woman. My husband would leave me.”

Other Orange County Latinas said they would be ashamed to have an examination for cervical cancer. Also, they told Chavez, their husbands would be furious if they underwent an intimate pelvic exam.

Concerned that cervical cancer rates for Orange County Latinas are twice those of Anglo women and that breast cancer in Latinas is diagnosed at a later stage, Chavez and eight UCI and UCLA researchers recently began a three-year study of Latino attitudes toward cancer and cancer screening. The work is being funded by a $1.2-million National Cancer Institute grant.

So far, Chavez has completed the first 35 of 200 lengthy interviews with Latinas about their attitudes. The researchers also plan random surveys of Latino men, women and the physicians who treat them to assess the obstacles that Latinos face in getting health care.

And in an unusual twist for a research project, the grant will help establish a council of doctors and community leaders to promote cancer screening for Latinos.

“Compared to Anglos, Latinos are more fearful about getting cancer. And they have less faith that cancer can be cured once it’s detected,” said Dr. Allan Hubbell, a UCI associate professor of medicine who is principal investigator of the project.

The study will look at barriers in Orange County that make it difficult for Latinas to get Pap smears, mammograms and general medical care. Previous studies by Hubbell have shown that lack of money, no health insurance, no child care and an inability to speak English are all barriers to care.

In addition, some Latinas who develop cancer turn to faith healers, Chavez said. Some return to Mexico for treatment, fearing “cut-happy” American doctors. And some “basically just avoid care.”

“I don’t think it’s hopelessness so much,” Chavez continued. “It seems that a lot of people are just outside the medical system--with no insurance, no money for care. Also, the medical system is somewhat impenetrable; they don’t know where to go, who to talk to, what services are available if you don’t have money.”

The Cancer Surveillance Program of Orange County says cervical cancer in local Latinas occurs at twice the rate as in Anglos--16.7 cases per 100,000 population compared to just 7.7 per 100,000 for Anglos.

Also, though the incidence of breast cancer is significantly less for Orange County Latinas than Anglos--54.1 per 100,000 in Latinas compared to 86.5 per 100,000 in Anglos--Latinas with breast cancer are more likely to be diagnosed in an advanced stage of the disease. The disease has spread in 42% of Anglos diagnosed with breast cancer, but typically it had metastasized in 51% of Latinas with that cancer, Cancer Surveillance data show.

Their research has just begun, but “we’re finding a lot of (Latina) women who do visit doctors have never been told to get a mammogram or a Pap smear,” Chavez said.

“We asked one 60-year-old woman why she’d never had a mammogram and she said no one had told her. Also she said, ‘I don’t have insurance and it would take money.’ ”

In another case, a mammogram detected breast lumps in a woman, but because she lacked a personal physician to send the results to, she never received a diagnosis.

Chavez said he tried to help the woman and ended up as stymied as she was. One hospital required $298 just to schedule an appointment, then $100 for the mammogram, plus $50 to have the scan read--money the woman didn’t have. Chavez said he finally gave her the names of some clinics to call but doesn’t know if she got care. Basically, he said, “I felt frustrated.”