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

Fyears ago I met a woman on the street. I was busy research about why so many immigrant women in Sweden don’t get mammograms. Had she received an invitation for an appointment? “Yes, but I’ve never been to the hospital to get a mammogram,” the 53-year-old replied. When I asked why, she said why would she go to a hospital to see a doctor if she was healthy and had no symptoms?

A few months ago I bumped into her again, this time at a bus stop outside the Karolinska Hospital in Stockholm. I didn’t recognize her at first when she came up to me. She said she had just been for breast cancer treatment. She remembered our first meeting and said she now understood why she had had to have 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 encounter in my work as a health educator turn down free breast cancer screenings because they don’t understand their purpose.

The chance of surviving breast cancer is almost doubled among women who go for mammograms, because early diagnosis of cancer can make the difference between living and dying.

Sweden has one of the best cancer survival rates in Europespecially for breast cancer. Every year, approximately 8,000 women diagnosed with breast cancer in Sweden and eight out of ten survive. One reason is early detection through a national mammogram program that is offered free of charge 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 health care system is completely failing one group of women. The survival chances of women from an immigrant community, like myself, are much lower than average.

a Longitudinal study 2012 of about 5 million women from 1961 to 2007 found that immigrant women and women with low educational attainment actually had a lower risk of developing breast cancer than highly educated women born in Sweden. And yet, death rates were significantly higher among the former group from 2000 onwards. One reason for this is likely that only 60% of women born outside Sweden attend their mammogram appointments, compared with 80% of those born in the country, according to research by the Swedish Breast Cancer Association.

One explanation for the difference is language. facts from 2018/19 states that almost one in five women in Rinkeby, a diverse district of Stockholm, is not educated to Swedish high school level, making it difficult for them to learn Swedish. Yet little health information is provided in the languages ​​spoken by the community (particularly Somali, Arabic, Urdu, Persian, Amharic and Tigrinya). For example, information about breast screening appointments is only produced in Swedish.

Immigrant women also say they are reluctant to have mammograms because they worry about not knowing whether the exam will be performed by a man or a woman (they would only feel comfortable with a woman) and whether it will be painful.

Furthermore, many – especially those from the Middle East and Africa – cannot understand, like the woman I met on the street, why they should go to a doctor’s appointment if they are not sick. In many of the countries where these women come from, mammography screening does not exist. If it does exist, it is prohibitively expensive, so most women cannot go regularly.

In the Stockholm region, where mammogram attendance is highest, lowest in Sweden – 71% of invitees in the capital show up, compared to 81% nationwide. In 2012, screening fees were abolished (the entire country followed in 2016) to encourages the presence of more low-educated women. But it led to only a 3% increase compared to the previous year, so clearly more needs to be done.

It is vital that Swedish authorities provide health information in languages ​​that immigrant women can understand and address their concerns in a culturally sensitive way. 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 integration into society at all levels.

The Swedish health care system works wonderfully for those who understand it, but for those who don’t, like the women from Africa and Asia I meet in my work, it can be incredibly difficult to navigate.

I wish that society as a whole – Swedish language schools, job centres, employers – would all do their bit to provide information about mammograms in different languages ​​to foreign-born women. It is not just the responsibility of health centres or religious institutions, this is a problem that society as a whole must tackle together. And mammograms not only save lives, they also save taxpayers money on breast cancer treatments.

If we designed screening programs with women from immigrant communities in mind, we would also feel more involved in Swedish society.

If Swedish health authorities really want to increase mammography attendance and breast cancer survival in immigrant communities, then surely it’s not too much to ask that they communicate in a language these women can understand?