In 1999, breast cancer screening rates among Asian women in Boston reflected significant health inequities, with only 25% reporting having had a mammogram, which was about half the citywide average at the time.
However, recent data from the 2023 Health of Boston report reveals a remarkable change, showing that Asian women now screen for breast cancer at rates equivalent to the overall city average of 77%.
This positive shift is attributed to focused community efforts, according to Magnolia Contreras, vice president of community health at the Dana-Farber Cancer Institute.
In the early 2000s, Dana-Farber collaborated with local health centers, cultural organizations, and faith-based groups to launch the Dana-Farber mobile Mammography Van. This initiative represents Massachusetts’ only traveling breast cancer screening service, designed to reach women where they live and work by providing care in multiple languages.
By bringing screenings to neighborhoods with high Asian and other minority populations, the mobile unit has demonstrated how community-based, culturally responsive healthcare can bridge disparities and enhance access to essential health resources.
Breast cancer stands as the second most prevalent cancer among women in the United States, with one in eight facing a diagnosis in their lifetime. Although mammograms are known to be a noninvasive method that can detect cancer before symptoms arise, many women still remain unscreened.
A 2011 study led by Lisa Gualtieri of the Harvard T.H. Chan School of Public Health and Tufts School of Medicine pinpointed significant barriers faced by Vietnamese, Chinese, and South Asian women in Massachusetts.
These barriers included cultural stigma, lack of understanding regarding insurance coverage, and logistical challenges such as taking time off work or arranging childcare.
Gualtieri noted, “One of the things that we discovered almost accidentally was that screenings were free to anybody with insurance, and people didn’t know that.” This awareness has been crucial, as many barriers involved in accessing services become compounded by the misunderstanding around costs.
Even when financial and logistical obstacles are mitigated, fear around the screening process itself can deter women from seeking mammograms, especially those facing their first encounter with the procedure.
Kate Kuleck, a technician on the mobile unit, shared, “I hear that all the time: ‘My breasts are going to be squashed!’” She reassured patients that modern machines are much advanced compared to those used by previous generations, helping to ease their anxieties through relatable conversations in their native languages.
For some women, the reluctance to seek screenings involves more than just apprehension about the procedure; cultural norms that discourage open dialogue about breast health complicate the process further.
Cynthia Gabriel, a Women’s and Gender Studies lecturer at the University of Michigan, emphasized that many women come from cultural backgrounds where discussions about sex and reproductive health are taboo. This creates a substantial hurdle for women who need to seek medical help.
The mobile Mammography Van, though called a “van,” is more akin to a full-sized RV equipped with advanced imaging technology, a registration area, and private screening rooms.
Since its inception in 2002, Dana-Farber’s Mammography Van has delivered more than 50,000 mammograms and breast health services, running three to four days a week and accommodating 30 to 40 patients daily.
Notably, about 40% of patients report that English is not their preferred language, which illustrates the diverse communities served by the initiative.
In addition to Asian populations, the van has also successfully reached other minority groups, including Black and Latina women. Technologists assist patients throughout the process, while interpreters provide necessary support for registration and medical consultations.
To spread awareness about the van and the significance of routine screenings, promotional materials such as posters, newspaper articles, and digital marketing targets languages notably spoken in the community, including Mandarin, Vietnamese, and Cantonese.
While Contreras acknowledges that the van is a key factor in the rise of screening rates, she also emphasizes that the success cannot be attributed to it alone. Partnerships with community health centers ensure timely follow-up care for women in need.
Reflecting on the data, Contreras remarked, “When we were able to get data and reflect on [the increased rates], I was like, ‘Oh my God. I know the van is a part of that!’ No one can tell me that it’s not.”
Despite these significant advances, Contreras acknowledges that there is still much work to be done. “We can share it, relish in that, and we need to do more,” she states.
image source from：wgbh
