Breast Cancer Awareness, Screening Attitudes, and Biochemical Profile in a Sample of Houston-Based Afghan Refugee Women

Background: Breast cancer is the second-leading cause of cancer death in US women, and Afghan women exhibit low screening rates. Our study evaluates breast cancer awareness and risk among Afghan refugee women in Houston through demographic survey data and biochemical measurement of inflammatory markers associated with chronic stress and breast cancer risk, C-reactive protein (CRP), cortisol, and interleukin-6. Methods: Houston-based 501(C)(3) non-profit organizations assisted with recruitment of Afghan refugee women (n=67), who answered these psychometrically valid online surveys with language and culturally tailored versions: Self-Report Questionnaire (SRQ), Afghan Symptom Checklist (ASC), Perceived Stress Scale (PSS), Refugee Post-Migration Stress Scale (RPMSS), and Breast Cancer Screening Beliefs Questionnaire (BCSBQ) assessing general well-being, mental health, stress levels, and breast cancer awareness via REDCap ($25 Target gift card compensation). Descriptive statistics and correlation analysis between Demographics, ASC, RPMS, and BCSBQ responses were evaluated. Saliva samples were deidentified before inflammatory marker examination using commercially available kits (Salimetrics, USA). Results: ASC scores correlated with many factors including time spent in the US, perceived discrimination, and economic strain (p<0.05). Women exhibited low attitude toward general health checkups, limited breast cancer knowledge, and high barriers toward mammogram screening (BCSBQ). Approximately half and 71.4% reported not knowing about clinical-breast examinations and mammograms, respectively. Conclusions: High stress levels, determined through ASC and RPMS, in susceptible Afghan women correlated with elevated CRP and IL-6 levels. Targeted interventions into stress reduction and breast cancer awareness for Afghan refugee women are warranted.