Cancer Control Efforts for Asian Americans Focus on West Coast

By Bill Stephens

LOS ANGELES—Efforts to boost cancer screening and education among Asian Americans and Pacific Islanders are growing. Much of the activity is on the West Coast, the heart of Asian-American life in the United States and the main entry point for new immigrants from Asia and the Pacific Islands.

Many feel these efforts are overdue. "Little funding has been put into Asian-American cancer prevention" said Roshan Bastani, PhD, professor of public health, associate director of the Division of Cancer Prevention and Control Research, UCLA Jonsson Comprehensive Cancer Center. "But now there is recognition that Asian-American communities are special populations with many cancer-related health problems."

The urgent need for increased cancer screening and education for Asian Americans has been somewhat hidden in the past by the "model minority" myth. In fact, many Asian Americans on the West Coast—especially more recent immigrants—are at higher risk for cancer because they are poor, have low education levels, don’t have insurance, don’t speak English, and don’t get screened for cancer, Dr. Bastani said.

The longer Asian Americans live in the United States, the higher their risk of developing cancer. One reason is a more sedentary lifestyle. Also, "by migrating to the US, they’ve abandoned a healthy diet of fruit and vegetables for fast food," Dr. Bastani said.

Many Asian-American groups have low cancer screening rates, little knowledge of resources, and vulnerability to various cancers. "Vietnamese-American women are five times more likely to get cervical cancer than white women," said Marjorie Kagawa-Singer, PhD, RN, MSN, associate professor, UCLA School of Public Health. "Japanese-American women have higher breast cancer rates than women living in Japan. Because many Asian Americans carry hepatitis B, liver cancer is more common among this group. Colorectal cancer rates are high for Asians living in America. Because Asian-American men often smoke, they have high lung cancer rates."

Barriers to Cancer Screening

While there is a strong need for more cancer screening and education among Asian Americans, there are many barriers. Low income is a major barrier. Many recent Asian-American immigrants have no insurance or transportation and little education. Some are unfamiliar with the US health care system and fear deportation if they use it. "Many recently immigrated Asian Americans are very concerned about just making a living, so they are not thinking about cancer prevention," Dr. Bastani said.

There are also cultural issues, Dr. Kagawa-Singer said. Asian and Pacific Islander concepts of health are based on beliefs of balance and harmony with nature. Lifeways are designed to prevent illness. Western biomedical ideas and technology regarding early detection are newer and less familiar. "These are ideas that many of the less-educated immigrants from rural areas may not utilize because they are unaware of their benefit or how one accesses them," she said.

Many Asian Americans may see a doctor only when they feel sick. They may be fatalistic about cancer because they come from countries that do not stress preventive medicine, or they may not have insurance and can’t afford to pay out-of-pocket for screening. "Many come from countries that have socialized medicine and are unaware of our payment system," Dr. Kagawa-Singer said.

Moreover, because many Asian-American doctors in the United States were educated in Asia, they too may not be aware of the advances in technology here and may not have the latest information about cancer screening and treatment. Therefore, they may not stress prevention and screening with their less-educated, low-income populations.

Cultural taboos also may present problems. Some Asian-American women fear visiting male doctors for Pap smears and mammograms. They may associate these examinations with loss of fertility and virginity, and with pain. Furthermore, there are few doctors, especially female doctors, representing some Asian-American nationalities.

But now efforts are growing to boost cancer awareness among Asian Americans living on the West Coast—especially poorer Asian Americans.

On the front lines are Asian-American community-based organizations. Some of these groups focus on cancer awareness and outreach. Others are clinics that also do screening. These community groups reach out to inform their communities about screening, diet, and exercise through the ethnic media and at other forums like health fairs, churches, and festivals. They also help navigate Asian Americans through the American health care system.

In the last few years, a number of nationally funded programs have been launched that support these community organizations. They typically supply cancer information and technical support, research community needs, and train Asian-American health care providers.

REACH 2010-PATH for Women

Funded by the Centers for Disease Control and Prevention Foundation through the generosity of The California Endowment, the Promoting Access to Health for Pacific Islander and Southeast Asian Women (PATH for Women) project supports seven Pacific Islander and Southeast Asian organizations representing the Laotian, Tongan, Cam-bodian, Chamorro, Thai, Samoan, and Vietnamese communities in Southern California.

PATH for Women is a component of REACH 2010 (Racial and Ethnic Approaches to Community Health). PATH for Women promotes breast and cervical cancer screening. It assesses community needs, designs programs, and provides technical help. Special Services for Groups is an organization that is helping to implement the project at the local level.

"We’re making progress getting women to seek breast cancer screening, but the challenge is to get them to also seek cervical cancer screening," said PATH for Women co-principal investigator Mary Anne Foo, MPH. These seven ethnic groups generally have low screening rates and a high incidence of breast and cervical cancer, she said. Many of their self-sacrificing women say they are too busy to be screened, and are uncomfortable seeing a male doctor for screening.

Said UCLA’s Dr. Kagawa-Singer, co-principal investigator for PATH for Women: "A majority of these people are first-generation immigrants. Cancer incidence isn’t as high in their countries. But as they age and spend more time here, they become vulnerable. The goal is getting to them before these cancers develop."

The seven PATH for Women community partners use resourceful methods to reach their communities with cancer awareness and screening messages.

For instance, the Samoan Nurses Association does workshops with local ministers to enlist their support in encouraging Samoan women to seek cancer screening examinations.

Families in Good Health sets up a table in a local minimarket to reach Laotian women. The group also educates Laotian husbands, convincing them to let their wives go for screening.

Said Lola Sablan-Santos, of the Guam Communications Network: "Our Cha-morro people are very social, so we reach them at weddings and other social gatherings." Outreach workers often go table-to-table at weddings, she said.

AANCART Program

While AANCART (Asian American Network for Cancer Awareness, Research, and Training) is a national program funded by the National Cancer Institute, much of its activity is on the West Coast.

UCLA-based AANCART-Los Angeles (LA) helps 17 Asian community groups with cancer awareness, research, and training. Dr. Bastani is principal investigator and Dr. Kagawa-Singer is co-principal investigator.

AANCART-LA updates these groups on cutting edge cancer prevention information, researches community cancer control needs, and trains community organization staffs about cancer care and awareness promotion. It also provides technical help and funding, and encourages Asian Americans to participate in research.

One community organization that AANCART-LA helps, the Korean Health Education, Information, and Referral (KHEIR) Center, has an outreach team that visits local Korean churches. The KHEIR center also offers low-cost mammograms and Pap smears and has a stop smoking program for Korean Americans.

KHEIR’s Angela Jo, MD, who is also affiliated with UCLA’s Jonsson Comprehensive Cancer Center, is currently involved in the planning phase of a project to educate and encourage physicians who serve indigent minority patients to increase cancer screening among these populations.

Through a UCLA-KHEIR collaboration, Dr. Jo is also conducting a pilot research project to increase colorectal cancer screening among Korean immigrants. The purpose of this project, she said, is to develop culturally appropriate intervention strategies targeting the Korean immigrants that will be tested in a larger randomized, controlled trial.

The South Asian Network (SAN) translates cancer awareness material into four South Asian languages (Hindi, Punjabi, Bangla, and Gujarati); makes presentations at temples and mosques; and makes referrals to low- or no-cost screening programs.

"There is a lack of awareness of cancer and related services," said SAN’s Pra-deepta Upadhyay. "We stress the importance of yearly screenings and we follow up to remind people."

Los Angeles’ Filipino American Service Group, Inc. (FASGI) has persuaded 1,700 Filipino-American women to get Pap smear tests over the last 2 years by doing outreach in three languages at Filipino restaurants, markets, and churches, and by retaining a "Pap mobile" that brings Pap smear testing to the community.

The Chinatown Service Center in Los Angeles has video material in Cantonese and Mandarin on how to do a breast self-examination, and provides free breast examinations.

AANCART-San Francisco operates out of the University of California, San Francisco (UCSF), and concentrates on the local Vietnamese community. Principal investigator is Steve McPhee, MD, professor of medicine, UCSF.

Its cervical cancer project in Santa Clara County includes a Pap smear media campaign, educational updates for Vietnamese doctors, a "Pap" clinic run by Vietnamese doctors, and a database system. The organization also has completed a hepatitis B immunization and screening program.

AANCART-Seattle helps the local Cambodian and Southeast Asian communities with cancer awareness.

PICCN Program

In Irvine, California, another program funded by the NCI, called Pacific Islander Cancer Control Network (PICCN), promotes cancer research and awareness for the Tongan, American Samoan, and Chamorro communities on the West Coast.

"We collaborate with six community organizations," said F. Allan Hubbell, MD, MSPH, professor of medicine, University of California, Irvine. "We identify and address the cancer control needs of these communities."

Dr. Hubbell said that when it comes to cancer awareness, these are neglected communities, with little awareness of cancer prevention methods. He notes that, until recently, there was not even a Samoan word for "cancer."

"PICCN is increasing cancer awareness," he said. "People are getting screened and trying healthy lifestyles. The challenge is to develop good, culturally sensitive programs that promote cancer screenings and follow-up."

In general, efforts to raise cancer awareness among West Coast Asian-American and Pacific Islander groups are having an impact, and cancer screening rates are up. But experts say information on these groups remains sketchy and that much more screening and education needs to be done.

Still, Dr. Bastani is encouraged. "The awareness is out there. A problem is being addressed," she said.