Breast Cancer Awareness Amongst South Asian Women in UK

Breast cancer has been reported to be the most prevalent cancer types in the United Kingdom with the prevalence rate being the highest among South Asian women. Lack of education and awareness about breast cancer has served to be a major obstacle that hinders access to care facilities among the South Asian Women. This report contains five chapters. The first four chapters cover Characteristics of the geographical community, Health improvement issue, Service provision and the role of the nurses. The final and fifth chapter is for summary and conclusion.

Running head: BREAST CANCER AWARENESS AMONGST SOUTH ASIAN WOMAN
BREAST CANCER AWARENESS AMONGST SOUTH ASIAN WOMEN IN UK
Name of the Student
Name of the University
Author’s Note:

1BREAST CANCER AWARENESS AMONGST SOUTH ASIAN WOMAN
Executive summary:
Breast cancer has been reported to be the most prevalent cancer types in the United Kingdom
with the prevalence rate being the highest among South Asian women. Lack of education and
awareness about breast cancer has served to be a major obstacle that hinders access to care
facilities among the South Asian Women. This report contains five chapters. The first four
chapters cover Characteristics of the geographical community, Health improvement issue,
Service provision and the role of the nurses. The final and fifth chapter is for summary and
conclusion. The This report details the strategies undertaken to impart awareness among the
South Asian women in one popular school and community college across six major cities of
UK that include, Manchester, Birmingham, Sheffield, Bristol and Nottingham. The
awareness strategies typically comprise of imparting education about the nature of cancer,
paying attention to the initial signs and symptoms and opting for mandatory screening so as
to ensure initial identification of breast cancer.

2BREAST CANCER AWARENESS AMONGST SOUTH ASIAN WOMAN
Table of Contents
Introduction................................................................................................................................3
Chapter 1 - Characteristics of the geographical community......................................................4
Chapter 2 – Health improvement issue......................................................................................8
Chapter 3: Service Provision....................................................................................................11
Chapter 4: The role of the Nurses............................................................................................14
References................................................................................................................................19
Appendix 1...............................................................................................................................23

3BREAST CANCER AWARENESS AMONGST SOUTH ASIAN WOMAN
Introduction
Globalisation has made many 1st world countries a multi- communal living place and United
Kingdom is no exception to this context. Nine percent of United Kingdom’s total population
is comprises of ethnic minority communities and almost half them minorities communities
are from Indian subcontinent (Wohlandet al. 2010). Community plays a major role in case of
disease awareness and prevention of any particular disease. Communities can be of two types
which are known as interest community and geographic community. In this report, disease
awareness program for a geographic community in the United Kingdom will be discussed.
Geographic community can be defined as a community which is demarcated over a common
geographic space. There might be a common social interaction or tie present amongst the
individual in that said community (Poland and Maré 2005). The geographic community that
will be discussed and analysed in this article is the women living in United Kingdom from
South Asia. Studies have suggested that most common type of cancer in United Kingdom is
breast cancer. The incidence rate of breast cancer is increasing among the South Asian
women. Many of the woman from South Asia is multilingual; however they can only read
their mother tongue(Wohlandet al. 2010). As a direct consequences, breast cancer awareness
and screening amongst them is very low and there is anurgent need for raising awareness
amongst this community. Therefore, in this article, community profile of South Asian
woman, health issues amongst them, service provision, and role of nurses in such case will be
discussed for the disease breast cancer in the following chapter.

4BREAST CANCER AWARENESS AMONGST SOUTH ASIAN WOMAN
Chapter 1 - Characteristics of the geographical community
Community profile: South Asian people are the largest ethnic minority community in
United Kingdom which comprises up to 9 per cent of the total British population. Nearly, half
of the South-Asian population belongs to the Indian sub- continent (Wohlandet al. 2010).
This large per cent is mainly due to the reason of large scale immigration from South Asia
which started in the year of 1950s and hiked in the year of 1960s and 1970s (Farooq and
Coleman 2005). As a direct consequence, few south Asian women over the age of 60 were
born in the United Kingdom (Farooq and Coleman 2005). Unsurprisingly, incidence rate of
breast cancer amongst these woman are almost same as the breast cancer incidence rate
within the Indian sub- continent. However, awareness of breast cancer is very low amongst
the women from south Asian people.
Justification for chosen disease and community: Cancer is one of leading malignant
disease in the United Kingdom. Amongst cancer, breast cancer is the most commonly
occurring disease amongst the British woman in United Kingdom. Breast cancer constitutes
almost 20 per cent of all cancer related deaths among the British woman (dos Santos Silva et
al. 2003). Unfortunately, there is still no cure for the cancer. The only process of treating
cancer is awareness, early detection and prevention. To achieve this goal, awareness is
paramount amongst the individuals within a community. It has been observed that lack of
awareness about breast cancer is very much persistent amongst the South Asian woman.
Hence, raising awareness for breast cancer amongst the South Asian woman has been chosen
as the awareness topic for this article.
Characteristics: Asian or British Asian makes the biggest ethnic community in the United
Kingdom and Wales. According to the 2011 census report, almost 7 to 8 per cent of total
United Kingdom population belongs to the people from South Asian region (Ons.gov.uk

5BREAST CANCER AWARENESS AMONGST SOUTH ASIAN WOMAN
2019). Amongst them, Indian people have the largest share, followed by Pakistanis and
Bangladeshis respectively. Indian population percentage is 2.5 per cent, followed by
Pakistanis with 2 per cent (Ons.gov.uk 2019). Bangladeshis comprises of around 0.75 per
cent of the total South Asian ethnic population (Ons.gov.uk 2019). Asian individuals from
other countries comprises of almost 1.5 per cent of the people (Ons.gov.uk 2019). 1.4 million
people culturally and ethnically belongs from India and international migration report from
2011 census data showed that the individual from south Asian countries which are India,
Pakistan and Bangladesh continuing to be growing higher (Ons.gov.uk 2019). From the 2011
census data, it can be seen that ethnic citizens from India have grown 2.5 per cent from 2 per
cent in the last decade whereas ethnic citizens from Pakistan have grown almost 0.6 per cent
in the last decade (Ons.gov.uk 2019). Table 1 below shows the per cent of Asian ethnic
population present in the various region of the United Kingdom and Wales.
Table 1: Asian ethnic population present in the various region of the United Kingdom
and Wales.
Region Asian/Asian British
England and Wales 7.5
North East 2.9
North West 6.2
Yorkshire and the
Humber
7.3
East Midlands 6.5
West Midlands 10.8
East of England 4.8
London 18.5
South East 5.2
South West 2.0
Wales 2.3
Source: (Ons.gov.uk 2019)
From the above table, it can be seen that the largest population from Asia concentrated in the
London municipal area followed by West Midlands and Yorkshire and the Humber. Almost
18.5 per cent of total population lives in London and amongst them 6.6 per cent are Indian

6BREAST CANCER AWARENESS AMONGST SOUTH ASIAN WOMAN
(Ons.gov.uk 2019). However, in the West Midlands area, highest population is belongs to the
Pakistanis which are 4.1 per cent, followed by Indian which is 3.9 per cent (Ons.gov.uk
2019).
Age structure of the South Asian people is depicted in the following image. Figure 1 shows
the age structure of the people from Indian, Pakistan and Bangladeshi background.
Figure 1: the age structure of the people from Indian, Pakistan and Bangladeshi
background
Source: (Cpa.org.uk, 2019)
From the above figure, it is clear that maximum people who are belongs in this community
are aged below 15 years old followed by the people who are between 50 to 60 years old
(Cpa.org.uk, 2019).

7BREAST CANCER AWARENESS AMONGST SOUTH ASIAN WOMAN
The life expectancy and mortality rate of the people in the south Asian community is in per
with the other community in the United Kingdom. The mortality for the male in this
community is around 75 years whereas mortality for the females in this community is around
80 years old (Cpa.org.uk, 2019). From this data it is evident that females in the south Asian
community have higher life expectancy than males (Cpa.org.uk, 2019).
Studies have shown that people belong in the south Asian community tends to suffer from
obesity related disease more than any other community. Other than genetic factors, lifestyle
choices of the people are also strongly associated with this risk and risk factor for this
smoking, diet, depression and stress (Lucas, Murray and Kinra 2013).

8BREAST CANCER AWARENESS AMONGST SOUTH ASIAN WOMAN
Chapter 2 – Health improvement issue
Health improvement can be defined as a work being done to improve the well being and
health of a particular community through awareness, enabling and encouraging healthy
lifestyle choices by addressing the risk factors such as poverty, unemployment and lack of
educational opportunities. Keeping that in mind, breast cancer awareness program amongst
south Asian women was chosen for this report because it is quite well documented that there
is very poor breast cancer awareness amongst them. There are various reason behind this
health problem. The reasons are:
 Unavailability of language specific information as most them cannot read except their
mother tongue
 Lack of general health literacy
 Unavailability of culturally specific information (Jain et al. 2010).
This health issue amongst the south Asian woman needs to be addressed as they are very
much susceptible and prone to the higher incidence of symptomatic presentation amongst the
younger women in the south Asian community. To tackle this issue, breast screening has to
be performed amongst them, but sadly, the screening rate remains low amongst the women in
this community particularly amongst Bangladeshi and Pakistani women. This can be
attributed to the religion belief of them, social stigma and lack of knowledge amongst them.
The only way to tackle this issue effectively is to raise awareness amongst them and provide
information about the harmfulness and severity of breast cancer. Another issue is that the lack
of translated material. As mentioned above, most of them cannot read except in their mother
tongue even if they are multilingual. Lack of communication and information gap created due
to this particular reason. It has been reported that this screening rate is even lower where this
ethnicity combined with deprivation or poverty. Therefore, it can be stated that poverty or

9BREAST CANCER AWARENESS AMONGST SOUTH ASIAN WOMAN
deprivation plays a significant role in case of the awareness regarding breast cancer. This
scenario is particularly true in case of some small town in northern England and inner city
areas. In a nutshell, NHSBSP or National Health Service Breast Screening program has very
meagre communication with the community of South Asian people. Even the freely provided
translated material regarding breast cancer information was not fully utilised. Although, this
is due to the lack of awareness amongst south Asian people, very little effort has been made
to provide information to the people who came to National Health Service Breast Screening
program.
Women in the south Asian community have familiar Nottingham Prognostic score when
diagnosed cancer at the time of screening. This score is based on historical parameters.
Studies have shown that the Pakistani and Indian women in the United States of America
have more progesterone receptor (PR) and oestrogen receptor (ER) negative tumours in
comparison with their Caucasian counterpart. In comparison with their Caucasian
counterpart, Indian and Pakistani women are much more prone to inflammatory cancer
(Kakarala et al. 2010). Another common histology amongst them is that invasive ductal
carcinoma. Studies have also showed that 17 per cent of patient diagnosed with breast cancer
have been found to have over expression of HER-2neu immune- reactivity rate. In brief,
women with the age of less than thirty five years were presented with larger tumours. These
women are also more likely to be having negative ER and have a chance of higher grade of
cancer (Leong et al. 2010).
Studies have reported that women from Indian sub continent have less incidence rate
compared to women from United Kingdom (Nandakumar et al. 2001). However, south Asian
women living in United Kingdom have significantly higher incidence rate compared to them.
This rate is 64.6 per 100,000 women (Nandakumar et al. 2001). Researchers have suggested
that this difference in incidence rate might be because of change in life style in United

10BREAST CANCER AWARENESS AMONGST SOUTH ASIAN WOMAN
Kingdom with comparison Indian sub continent. These life style changes can be noted as
shorter breast feeding period, fewer number of children, marriage and conceive of first child
in later part life and other environmental risk factors. Table 2 below will depict the diagnosed
breast cancer for Asian and Caucasian in England and the age at diagnosis.
Table 2: Individual diagnosed with breast cancer in Caucasian and Asian ethnicity in
England and the age at the time of diagnosis.
Ethnicity of the
patients
Total Cases
Age at Diagnosis (Median,
Interquartile Range)
Women aged 50-70
Numb
er % No.
Screen-
detected
(%)
Caucasian 26,807 64.6% 62 (52-72) 14,500 56.3%
Asian 611 1.5% 55 (47-65) 359 52.1%
Source: (Ncin.org.uk 2019)
From the above table, it can be seen that the Asian patients have been diagnosed at earlier age
than their Caucasian counterparts and the percentage of screen detection is almost equal for
both the group. So, form this table, it can be said that Asian individual are susceptible to
breast cancer at earlier age.
From the above data, it can be deduced that south Asian women have lower prognostic
outcome, however limited treatment options have been availed by them due lack of
awareness or diagnosed at later stage of cancer. Therefore, even though south Asian women
have lower incidence rate of breast cancer, the mortality rate higher compared to other

11BREAST CANCER AWARENESS AMONGST SOUTH ASIAN WOMAN
community. This can be prevented by better awareness and hence, there is a paramount need
breast cancer awareness amongst the women in South Asian community.

12BREAST CANCER AWARENESS AMONGST SOUTH ASIAN WOMAN
Chapter 3: Service Provision
Identification of health improvement issue:
On the basis of the findings accumulated from the research studies, it can be stated that the
South Asian Community is at a high of developing breast cancer (Crawford et al. 2016;
Shirley et al. 2014). Therefore the awareness program should critically focus upon creating
awareness about breast cancer among the South Asian women. It should further be noted that
the population statistics reveal that 4.3% of the total population of UK is composed of people
belonging to the South Asian origin (Shirley et al. 2014). Further as stated by Ginsburg et al.
(2014), the incidence of breast cancer has increased significantly up to 8% in comparison to
the women population of British origin. Research studies have attributed lack of education
and awareness to be the primary cause for the alarming prevalence of breast cancer among
the identified community (Hasnain et al. 2014). Therefore, the service provision program
would principally focus on imparting education and awareness related to breast cancer among
the community of south Asian women.
Description of service provision programs:
The service program would aim at delivering services in order to fulfil the following three
objectives:
Objective 1: Imparting Education about Breast cancer and its increased prevalence among the
identified community members
Objective 2: Delivering knowledge in relation to paying attention to the important symptoms
of Breast Cancer
Objective 3: Promoting awareness about the services available for screening of breast cancer
and the treatment option available to foster effective treatment in case of positive screening

13BREAST CANCER AWARENESS AMONGST SOUTH ASIAN WOMAN
It is critical to note that on strategically planning an awareness strategy that covers the three
designed objectives, it would be easier to improve access to care opportunities for the South
Asian community people. Further, it should also be specified in this regard that the service
provision programs would intend to acquire two devised goals that include the short-term
goal and the long-term goal. The accomplishment status of the goals would be monitored on
the basis of evaluation that would be different for both the goals. While the effectiveness of
accomplishing the short-term goal would be determined on the basis of the strength of the
community members opting for a mandatory breast cancer screening, the effectiveness of
accomplishing the long-term goal would be dependent upon the comparison of the prevalence
data in the forthcoming 5 years.
Nature of service provision programs:
According to Hasnain et al. (2014), it has been found that women of South Asian Community
origin are exposed more to a conservative society design which does not permit the
discussion about the diseases of primary and secondary reproductive organs freely. This
accounts for the main reason which directly contributes to the lack of knowledge and
information about the nature of breast cancer and its symptoms. It is also important to note
here that a significant proportion of the South Asian women population are immigrants who
have moved to diverse regions of UK to pursue higher education or jobs. Thus, the primary
agenda of the service programs should be to impart education and awareness about breast
cancer. In order to ensure the same, reputed schools and colleges of UK would be shortlisted
spanning across five major cities that include Manchester, Birmingham, Sheffield, Bristol and
Nottingham. At the initial stage, one school and one community college would be shortlisted
on the basis of the population concentration of the above mentioned community and different
teams of awareness professionals would be appointed who would head to the shortlisted
schools and community colleges. The appointed professionals would mainly be the

14BREAST CANCER AWARENESS AMONGST SOUTH ASIAN WOMAN
community nurses who would conduct awareness seminars in order to educate the target
audience about Breast cancer and its implication on health. Further, relevant medical
information about the identification of related signs and symptoms of the disease would be
illustrated by the community nurses in the organized health camps where the nurses would
demonstrate the identification technique using in- hand simulation and also highlight the risk
factors. The community care professionals would further discuss the importance of diagnostic
screening in order to detect breast cancer and also talk about the treatment options available
for recovery.
 Primary service provision: Imparting education and awareness about breast cancer
 Secondary service provision: Imparting education about the techniques to identify
signs and symptoms of breast cancer
 Tertiary service provision: Organize complimentary screening service for the
detection of breast cancer and offer counselling about the treatment options available
Consideration of accessibility of services:
According to Poonawalla et al. (2014) the social and cultural background of a community
largely determines the readiness to access a specific healthcare service. In relation to South
Asian Community it should be mentioned that the dominant religions perceive the open
discussion of genitals and mammary gland as a taboo (Crawford et al. 2016). This largely
serves a hindrance that limits the accessibility to care facilities (Gathani et al. 2014). Further,
on account of the lack of awareness about the nature of the health issue, the target population
is not aware about the diagnostic screening procedure and this leads to the increased
prevalence of breast cancer among the identified community members (Slotter et al. 2014;
DeSantis et al. 2015).

15BREAST CANCER AWARENESS AMONGST SOUTH ASIAN WOMAN
Chapter 4: The role of the Nurses
As has already been discussed the previous chapter, the strategic awareness health campaigns
would be majorly conducted by the community nurses who would educate the target audience
about Breast Cancer and its implication on the physical health of the people. However, it
should be mentioned here that the role of the care professionals spans across several domains
to ensure improvement in the accessibility of the health services. The structure and planning
of the health promotion and awareness campaign is broadly based upon the health belief
model. According Green and Murphy (2014), the health belief model can be defined as a
psychological model that aims at deriving an explanation to predict health related behaviour.
The rationale for the choice of this model over other models includes the available evidence
base of successful awareness health promotion campaigns against Tuberculosis and HIV
(Green and Murphy 2014). The specific criteria that would be covered under the model
would comprise the following steps:
 Creating an awareness among the target population that Breast Cancer could be
avoided
 Motivate the target audience through knowledge to bring out a positive expectation
that on complying with the recommended strategies, the negative impact of the
disease can be avoided
 Elicit a positive response of the targeted audience towards the recommendation
strategies such as opting for mandatory screening and paying attention towards the
signs and symptoms of Breast Cancer
Therefore, the health promotion campaign would largely span across the four constructs of
the Health Belief Model that would include perceived threat and cumulative benefits,
perceived susceptibility, perceived barriers and perceived benefits. These constructs would

16BREAST CANCER AWARENESS AMONGST SOUTH ASIAN WOMAN
help promote awareness and at the same time stimulate the reaction of the target audience for
immediate acceptance of the awareness strategies. Further it is critical to note that the
campaigns would not solely be managed by the community nurses but would also include
allied professionals such as physicians, pathologists, interpreters, marketing and promotion
team and sponsors. The team of professionals would be responsible for managing different
functions. It should be mentioned here that the success of the campaign would largely be
based upon the communication skills of the care professionals to convey the correct message
to the people. This could only be reinforced through proper staff training that would
eventually make every contact count (MECC) (Lucas et al. 2013). Therefore the success rate
of a health promotion program would largely be dependent upon the quality of the training
and developing competence within the staff professionals to ensure that the key objectives of
the program are delivered with confidence. Hence, effective training ensures staff readiness,
systematic leadership and spontaneity in implementing appropriate guidelines to guarantee
the effectiveness of the awareness programs. However, it should be emphasised that the role
of the community nurses would be integral in imparting education and providing counselling
to the targeted audience. Apart from imparting education through informative presentations,
the nurses would also offer support and discuss referrals that could be availed if patients
suffer from cancer. Also, the nurses would critically discuss the implication of cancer on the
quality of life and clarify concerns or misconceptions related to the nature of the disease. The
Nurses would also discuss the treatment options such as chemotherapy and cite practical
examples with the help of case-studies to educate the community members aged 50 and
above about care interventions as the risk advances with advancing age. Further, the Nurses
would also discuss about the estimated medical expenditure and offer financial advises so
that the community members obtain information about the medical expenditure involved in
the treatment of the disease. Thus, it can be said that the nurses would work together with the

17BREAST CANCER AWARENESS AMONGST SOUTH ASIAN WOMAN
cancer patients and their family members and prioritize the needs of the patient. Further
nurses show sympathy to the suffering patients and treat them with dignity and respect.
Cancer patients invariably suffer from anxiety apprehending about the negative outcome of
the disease (Hasnain 2014). Nurses must treat the patients compassionately and exhibit a
culturally safe care delivery. While caring for patients belonging to a different religion,
nurses must ensure that the spiritual needs of the patients are addressed. This could be done
by arranging time and space for prayer. Further, acquiring assistance from an interpreter
while dealing with a linguistically diverse patient can help in acquiring positive outcome
(Stotter et al. 2014). Further, nurses should respect patient autonomy and dispense
information about end of life care and other cancer care opportunities that are available,
which includes cancer care home, day centres and support groups (Ginsberg et al. 2017).
Nurses also inform patients and their families about housing benefit and unemployment
support schemes provided by the government for wellness (Crawford et al. 2016). Therefore,
it can be expected that with the help of the devised strategies of the service campaign, it
would be easier to positively influence the target audience about breast cancer and its related
impact on the physical and mental wellness of the patients. In addition to this, the program
would also expose the targeted community to a wide range of options in terms of referrals,
financial assistance and treatment options which could be availed in order to prevent the
progression of Breast cancer (Crawford et al. 2016).

18BREAST CANCER AWARENESS AMONGST SOUTH ASIAN WOMAN
Chapter 5: summary and conclusion
Summary:
Therefore, to conclude it can be said that Breast Cancer happens to be the most common type
of cancer in UK in comparison to all other types of cancer. Research studies have indicated
that one in every eight women and one in every 870 men can develop breast cancer (Breast
Cancer Care 2019; Cancer research UK 2019). However, on account of the rarity of the
condition in men, the awareness campaign has broadly been based upon the prevalence of the
condition in women. It should be critically stated here that the percentage of women affected
with breast cancer in UK is significantly higher in South Asian women (Evans et al. 2018).
On evaluating the reasons for the above stated phenomenon it was found that lack of
education and awareness related to breast cancer pertaining to the conservative cultural and
religious background of the women belonging from South Asia was responsible for the
increased prevalence ratio of breast cancer (Assets.publishing.service.gov.uk 2019).
Therefore an awareness campaign had been designed to be conducted at six major cities of
UK which included Manchester, Birmingham, Sheffield, Bristol and Nottingham. The
awareness program was organized with one popular school and community college within the
mentioned locations. The health promotion campaign was largely based upon the components
of the health belief model so as to impart quality strategically impart awareness among the
targeted audience.
Conclusion:
Therefore, to conclude it can be said that the primary, secondary and the tertiary objectives of
the awareness campaign largely focused on imparting education and awareness about breast
cancer and mandatory screening of the cancer among the community members. Typically, the

19BREAST CANCER AWARENESS AMONGST SOUTH ASIAN WOMAN
target audience comprised of South Asian women aged 18 years and above and included
participants who were students, mentors or staff members working in the educational
institution. The health promotion team comprised of team of care professionals, interpreter,
pathologists, community nurses, marketing and promotion executives and sponsors. The team
had been equipped with substantial training so as to make every contact count and
substantiate mass awareness about breast cancer. In this regard, it should be mentioned that
the community nurses apart from imparting education about breast cancer, also provided
information about the related medical expenditure and offered financial advice that could
help in availing treatment facilities. Further, the implication of breast cancer on the physical
and mental health of the patients was also discussed by the care professionals so as to
improve access to care options.

20BREAST CANCER AWARENESS AMONGST SOUTH ASIAN WOMAN
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24BREAST CANCER AWARENESS AMONGST SOUTH ASIAN WOMAN
Appendix 1

25BREAST CANCER AWARENESS AMONGST SOUTH ASIAN WOMAN
Appendix 2

26BREAST CANCER AWARENESS AMONGST SOUTH ASIAN WOMAN
Fig: Screenshots from CINAHL database