Breaking An Anti-Mammography Culture Barrier

Hiam Hamade travels throughout her community, promoting something that normally gets talked about only in whispers, if at all:

Getting a mammogram.

Hamade is a public-health nurse who literally goes door-to-door among the large Arab-American community in the Detroit area, stressing the importance of breast-cancer screening. It’s a crucial topic. A 2008 Michigan study found that only 42.9% of Arab-American women ages 40 through 49 said they’d had a mammogram within the previous two years, compared with 74% of all Michigan women. A statewide survey of 1,000 Arab-American women by the Michigan Department of Community Health found that 45% had never had a Pap smear and that 31% who were 40 or older had never had a mammogram.

“Cultural inhibitions, combined with language barriers and financial concerns, have been major roadblocks to Arab-American women when it comes to seeking health care that can save lives,” said Adnan Hammad, PhD, senior director of the Community Health & Research Center at the Arab Community Center for Economic and Social Services (ACCESS) in Dearborn, Michigan.

The story of Hamade and her compassionate mission, as detailed in a Detroit Free Press story, shows that it’s not just problems with money, insurance, or easy accessibility that keep women from getting potentially life-saving mammograms. Such difficult-to-address issues as culture and religion pose significant roadblocks as well.

Hamade, who works at ACCESS, is a 55-year-old native of Lebanon who has been a nurse since 1975. She knows very well the barriers of modesty and fear that keep many Arab-American women from cancer screening.

“In our community, it’s something people don’t talk about,” she said. “They keep it a secret. They don’t even like to use the word ‘cancer.’ It’s like this shame; especially men don’t want anyone to know if their wife or daughter has it. And don’t even mention a Pap smear.”

Hamade also knows first-hand about breast cancer. One day in 2004, she got a mammogram simply because a December storm had left the clinic empty. The test revealed cancer. She had surgery during the Christmas break and was back to work by early January.

“She’s a sweet, gentle soul who really believes in what she does,” said Laura Zubeck, a nurse and director of volunteer administration at the Karmanos Cancer Institute in Detroit. “She works tirelessly, going into homes, bringing people into the clinic at ACCESS and to Karmanos. She not only talks to the women, she talks to the men in families to convince them to bring the women or let them come to the clinic. Everybody who knows her loves her.”

In some communities, it may require that kind of energetic outreach before mammography coverage can significantly increase.

Related seminar: Breast Imaging and Digital Mammography