Sweden’s record on breast cancer is one of the best in Europe – just not for women like me | Fatuma Mohamed

1 month ago 3

Four years ago I met a woman in the street. I was doing research on why so many immigrant women in Sweden don’t have mammograms. Had she received an invitation for an appointment? ”Yes, but I’ve never gone to hospital to have a mammogram,” the 53-year-old replied. When I asked why, she said why would she go to a hospital to see a doctor when she was healthy and didn’t have any symptoms?

A few months ago I bumped into her again, this time at a bus stop near Karolinska hospital in Stockholm. I didn’t recognise her at first when she approached me. She said she had just been for breast cancer treatment. Recalling our first meeting, she said she now understood why she should have gone for a mammogram, but it was too late. The doctors had done everything they could, but the cancer had already spread.

That night, all I could think about was what had happened to her and how so many immigrant women I come across in my job as a health communicator forgo free breast cancer screenings because they don’t understand their purpose.

The chance of surviving breast cancer is almost doubled among women who go to mammogram appointments because an early cancer notice can make the difference between staying alive and dying.

Sweden has one of the best cancer survival rates in Europe, especially for breast cancer. Each year about 8,000 women are diagnosed with breast cancer in Sweden and eight out of 10 survive. One reason is early detection through a national mammogram programme offered free every two years to all women aged 40 to 74. Sweden screened 95% of women in 2019 and 2020 – the highest percentage in the OECD.

Despite this success, the Swedish healthcare service is utterly failing one group of women. Survival rates for women from an immigrant community, like myself, are much lower than the average.

A 2012 longitudinal study of about 5 million women from 1961 to 2007 found that immigrant women and women with a low level of education actually had a lower risk of developing breast cancer than those who were highly educated and born in Sweden. And yet, from 2000 onwards, the mortality rate was significantly higher among the first group. One reason is likely to be because only 60% of women born outside Sweden go for their mammogram appointments compared to 80% of those born in the country, according to research by Sweden’s breast cancer association.

One explanation for the disparity is language. Government data from 2018/19 states that nearly one in five women in Rinkeby, a diverse district of Stockholm, weren’t educated to the equivalent of Swedish high-school level, making it hard for them to learn the Swedish language. Yet little health information is provided in languages the community speaks (particularly Somali, Arabic, Urdu, Persian, Amharic and Tigrinya). Information about breast-screening appointments, for example, is only produced in Swedish.

Immigrant women say they are also reluctant to attend a mammogram because of fear of not knowing if the examination will be carried out by a man or a woman (they would only feel comfortable with a woman), and whether it will hurt.

In addition, many – especially among those from the Middle East and Africa – cannot comprehend, like the woman I met in the street, why they should attend a doctor’s appointment if they’re not sick. In many countries where these women come from mammography screening does not exist. If it does, it’s prohibitively expensive so most women couldn’t go regularly.

In the Stockholm region, where mammogram attendance is the lowest in Sweden – 71% of those invited in the capital attend compared with 81% for the whole country – screening fees were abolished in 2012 (in 2016 the whole of the country followed suit) to encourage attendance of more lower-educated women. But it led to just a 3% increase on the previous year, so clearly more needs to be done.

It’s vital that Swedish authorities provide health information in languages immigrant women can understand and address their concerns in a culturally sensitive manner. This is particularly important for older immigrants who are less likely to speak Swedish and are often socially isolated and excluded from mainstream society. Research confirms that language is the key to being able to integrate into society at all levels.

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The health system in Sweden works wonderfully well for those who understand it, but for those who don’t, such as the women from Africa and Asia that I come across in my job, it can be extremely difficult to navigate.

I wish that the whole of society – Swedish language schools, job centres, employers – would all play their part in providing information about mammograms in different languages to foreign-born women. It’s not just the responsibility of healthcare centres or religious institutions, this is a problem for the whole of society to tackle together. And mammograms don’t just save lives, they also save taxpayers’ money on treatment for breast cancer.

Designing screening programmes with women from immigrant communities in mind would also help us to feel more included in Swedish society.

If Swedish health authorities truly want to increase mammogram attendance and breast cancer survival rates within immigrant communities, surely communicating in a language these women can understand isn’t too much to ask.