FA few years ago I met a woman on the street. I was researching why so many immigrant women in Sweden do not have mammograms. Had she received an invitation to an appointment? “Yes, but I have never been to the hospital to have a mammogram,” the 53-year-old replied. When I asked why, she said why should she go to the hospital to see a doctor if she is healthy and has no symptoms?

A few months ago I met her again, this time at a bus stop near Karolinska Hospital in Stockholm. When she approached me, I didn’t recognize her at first. She said she had just been treated for breast cancer. When she recalled 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 many immigrant women I meet in my work as a health communicator forgo free breast cancer screenings because they don’t understand the purpose of them.

Women who get mammograms almost double their chances of surviving breast cancer because early cancer detection can mean the difference between life and death.

Sweden has one of the best cancer survival rates in Europe, especially for breast cancer. Each year, about 8,000 women in Sweden are diagnosed with breast cancer and eight out of ten survive. One reason for this is early detection through a national mammography program, 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 these successes, the Swedish health care system is completely failing one group of women. Survival rates for women from immigrant communities like me are well below average.

A 2012 longitudinal study of around 5 million women between 1961 and 2007 found that immigrants and women with low levels of education actually had a lower risk of developing breast cancer than well-educated women born in Sweden. And yet the death rate was significantly higher in the former group from 2000 onwards. One reason for this may be that, according to a study by the Swedish Breast Cancer Society, only 60% of women born outside Sweden go for mammography, compared to 80% of women born in the country.

One explanation for this inequality is language. Government data from 2018/19 say that almost one in five women in Rinkeby, a diverse district of Stockholm, does not have a school leaving certificate equivalent to the Swedish Abitur, making it difficult for them to learn the Swedish language. Yet little health information is provided in the languages ​​spoken by the community (particularly Somali, Arabic, Urdu, Persian, Amharic and Tigrinya). Information about breast cancer screening appointments, for example, is only provided in Swedish.

Migrant women say that they are also afraid to go for a mammogram because they are afraid of not knowing whether the examination will be performed by a man or a woman (they would only feel comfortable with a woman) and whether the examination will be painful.

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

In the Stockholm region, where mammography incidence is lowest in Sweden – 71% of those invited in the capital participate, compared to 81% nationwide – screening fees were abolished in 2012 (followed by the whole country in 2016) to Promoting the participation of women with lower levels of education. But it only led to an increase of 3% compared to the previous year, so there is clearly still a need for action.

It is crucial that Swedish authorities provide health information in languages ​​that immigrant women understand and address their concerns in a culturally sensitive way. This is especially important for older immigrant women who speak less Swedish and are often socially isolated and excluded from mainstream society. Research confirms that language is key to integration into society at all levels.

For those who understand it, the Swedish healthcare system works wonderfully. But for those who don’t understand it – like the African and Asian women I meet in my job – it can be extremely difficult to navigate.

I wish the whole of society – Swedish schools, employment offices, employers – would do their part to inform foreign-born women about mammograms in different languages. This is not just the responsibility of health centers or religious institutions, but a problem that the whole of society must tackle together. And mammograms not only save lives, they also save taxpayers’ money on breast cancer treatment.

Developing screening programmes targeting women from immigrant communities would also help us feel more integrated into Swedish society.

If Swedish health authorities really want to increase mammography uptake and breast cancer survival rates in immigrant communities, communicating in a language these women understand is surely not too much of a challenge.

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