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Breast cancer screening rates for immigrant women in Baltimore are low. These groups are fighting to change that.

Tori Lewitt (left), oncology outreach program manager, and Sandra Villa de León, Baltimore program manager for Nueva Vida, a nonprofit that provides cancer support services to the Latinx community in the Baltimore area, at St. Joseph Hospital Cancer Institute.
Tori Lewitt (left), oncology outreach program manager, and Sandra Villa de León, Baltimore program manager for Nueva Vida, a nonprofit that provides cancer support services to the Latinx community in the Baltimore area, at St. Joseph Hospital Cancer Institute. (Karl Merton Ferron/The Baltimore Sun)

Dr. Hee-Soon Juon was still studying mental health and substance use issues among African Americans at the Johns Hopkins University when a member of her church found a lump in her breast.

Initially, the woman — who, like Juon, had emigrated from South Korea — didn’t think she needed to seek medical attention. But after some nudging from a friend, she eventually got checked out by a doctor, who diagnosed her with late stage breast cancer. She died six months later.

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That was the moment when everything changed, Juon said.

“I was motivated by that. This is really prevalent — many Asian American women have misconceptions about breast cancer,” she said. “I had some kind of thought: ‘I need to increase breast cancer awareness.’ ”

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Along with another researcher at Johns Hopkins, Juon printed brochures in Korean with information on mammography and breast cancer statistics, distributing them in Korean churches and Asian grocery stores. Ultimately, she founded the Asian American Cancer Program at Johns Hopkins, aiming to improve cancer screening rates among Asian Americans and immigrants through community-based intervention efforts.

That was over two decades ago. Now, Juon is a professor at Thomas Jefferson University in Philadelphia and has reoriented her research interests to cover liver cancer among high-risk groups of Asian Americans. But disparities in breast cancer screening rates still abound in the country’s immigrant population — even though medical professionals stress that it is one of the best ways to catch breast cancer early and could ultimately save a woman’s life.

The American Cancer Society recommends that women start receiving annual mammograms at least by the age of 45, if not sooner, and can either continue receiving yearly mammograms or switch to getting one once every other year when they turn 55. But according to last year’s National Health Statistics Report, foreign-born women were more likely than U.S.-born women to never have a mammogram in their lifetime. And studies have continued to show that women who speak no or limited English are less likely to be screened than those who speak it fluently.

Sandra Villa de León is the Baltimore program manager for Nueva Vida, a nonprofit that provides cancer support services to the Latinx community.
Sandra Villa de León is the Baltimore program manager for Nueva Vida, a nonprofit that provides cancer support services to the Latinx community. (Karl Merton Ferron/The Baltimore Sun)

Back before Juon founded the Asian American Cancer Program, she tried to form a focus group of Asian American breast cancer survivors. But it was a struggle to gather a group of women who were willing to talk about their diagnosis, Juon said. When she finally found eight or nine women to participate, Juon said, she was astonished to find that five of them had discovered their cancer without getting a mammogram — instead, they had discovered abnormalities in their breasts while taking showers, or after their spouses had pointed them out.

Juon observed a collection of factors that blocked Asian American women from getting screened for breast cancer: Many didn’t have insurance, didn’t know where to get a mammogram or couldn’t afford to take time off from work. Transportation issues and language barriers also posed a problem for the women, Juon said.

Similar issues stand in the way of Hispanic women receiving regular breast cancer screenings, said Dr. Avonne Connor, an epidemiology professor at the Johns Hopkins Bloomberg School of Public Health. Those who are in the country without documentation may also be dissuaded from seeking health care services, she said, due to fears they may be tracked.

According to a recent report from the American Cancer Society, Hispanic women were less likely to receive regular mammograms than non-Hispanic women, although this gap is decreasing. As a result, Connor says, this population is more likely to be diagnosed at more advanced stages of the disease. According to the same fact sheet, breast cancer is the leading cause of death among Hispanic women in this country — around a third of whom are immigrants, according to the Migration Policy Institute.

But even as the coronavirus pandemic continues to rage across the country, a group of organizations in Baltimore has kept promoting breast cancer awareness in the city’s immigrant community.

Since 1999, Nueva Vida — or, “New Life” — has provided cancer support services to the Latino community in the Washington, D.C., metropolitan area. Sandra Villa de Leon started volunteering with the nonprofit after coming to the Baltimore area from Guatemala in 2004, eventually becoming a part-time worker with the organization and then a full-time worker. Now, she said with a laugh, she works for the nonprofit almost 24/7, answering calls from clients well after business hours.

Though Nueva Vida has switched gears to conducting outreach efforts over the phone and Zoom since the coronavirus pandemic began, Villa de Leon said the nonprofit used to offer up information about breast cancer and mammography at beauty salons, restaurants, churches and Walmarts — pretty much any place where they could find Latinas.

“We approach any Latina we saw in the streets,” said Villa de Leon, a program manager with Nueva Vida. “The people that are cutting the grass — everybody, we have to approach.”

Similarly, Elizabeth Chung, executive director of the Asian American Center of Frederick, said her organization offers information about health services — including breast cancer awareness and prevention — at every possible opportunity. That means representatives not only attend health fairs and career fairs in the community, but also try to promote health literacy during English language classes and citizenship classes offered by the center.

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“Everything we do is giving out information and improving access,” said Chung, who also serves as chairwoman of the Maryland Community Health Resources Commission. “It’s not just: You do health education, and you do outreach. Outreach is really everyday life for us.”

Back at Nueva Vida, the nonprofit’s executive director mentioned that in Hispanic culture, women often take the back seat. “You’re more worried about taking care of your children, your husband and your parents and the rest of the family than you. You don’t take care of yourself,” said Astrid Jimenez.

“The best case that one could make during Breast Cancer Awareness Month is that screening saves lives,” she said. “And a woman’s life is extremely important.”

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