API Women at Risk
API Health organization works to lower population’s high rates of cancer
By Janet Dang

Early detection and better treatments, are offering women new hope in overcoming breast cancer. However, while this news should be reassuring for all, some API women still haven’t gotten the message. In fact, health providers are struggling to reach out to this population, which, they say, not only demonstrates a higher rate of breast and cervical cancer than the national average, but also shows a lower rate of screening for early prevention.

In an effort to tackle the alarming health patterns among various API communities, one health advocacy agency is gearing up to launch breast and cervical cancer programs tailored to meet the needs of API women.

The Association of Asian Pacific Community Health Organization (AAPCHO), based in Oakland, Calif., helped launch the programs with grants funded in part by the Center for Disease Control. The organization met with five other health clinics across the country to streamline protocols used to aid API women in their health needs—from outreach strategies and funding to delivering culturally competent care.

Jeffrey Caballero, executive director of AAPCHO, said he hopes the training will lead to the development of more programs tailored to meet the unique needs of API women.

“Despite the startling statistics on cancer and Asian American Pacific Islanders, there is still a shortage of culturally and linguistically appropriate breast and cervical cancer programs targeting API women,” he said. The meeting, added, “will strengthen the community health centers’ ability to address this shortage.”

During the period of 1991 to 1992, API women had the lowest rates of Pap test scrmening, mammography and clinical breast examination compared to any other racial or ethnic population, one study found. A 1994 report by the Massachusetts Department of Health indicated that close to 40 percent of API women age 18 and over had never had a Pap test, in contrast to 5.3 percent for white women and 7 percent for black women. (Data for Latino Americans was unavailable.) Furthermore, a California study found that 34 percent of Vietnamese and 75 percent of Chinese women over the age of 40 had never had a mammogram.

Although breast cancer rates under the all-encompassing API group are lower than the rates for all other ethnic groups, these numbers mask disparities found among the different subgroups. For example, Vietnamese American women have the highest rate of cervical cancer of any ethnic group in the country. Breast cancer is the leading cause of death for Filipino American women, while Native Hawaiian women have the second highest breast cancer mortality rates in the country.

At the Kalihi-Palama Health Center, an APPCHO-affiliated clinic in Honolulu, over 80 percent of the patient population is API. Health educator Andrea Macabeo, who works closely with Filipino and Pacific Islander women, said the breast cancer mortality rates for Filipino and Native Hawaiian women continue to be higher than the rates for white women largely because the disease is diagnosed in later stages. In other words, the API women aren’t screened for early detection. One of the clinic’s challenges is to get more women into the clinic for free screenings.

To that end, health workers make cold calls to uninsured Tagalog-speaking women, who Macabeo said, continue to be in the dark about their cancer risks. “What we’ve been finding is that they don’t know about breast cancer or they know and they don’t know the seriousness of it,” she said.

One of the biggest concerns the center has is transportation. Hosting parties and offering breast examination workshops in various community centers are just some of the methods undertaken by the clinic to get women into the labs. However, oftentimes women will miss follow-up appointments, or forgo the exams altogether because they have no means to get to the clinic.

Yunkyung Kim, an associate manager at the Asian Pacific Health Care Venture in Los Angeles, said its AAPCHO-CDC program will develop an organizational capacity to care for patients by building partnerships with other community organizations. For example, her clinic, which serves a large population of Thai women, collaborates with a Thai community center, which provides a van to pick up women from their homes and deliver them directly to the clinic for breast and cervical cancer screenings and follow-up appointments.

Though health advocates say Los Angeles has the largest Thai community in the United States, there are no local statistics available on cancer rates. However, health workers do know that cervical cancer is the leading cause of death for women in Thailand. Considering most Thai Americans are recent immigrants, arriving in the United States only within the last two decades, some health workers believe Thai American women are at a higher risk for cervical cancer compared to other API women, similar to women of Vietnamese descent.

“We do think Thai women are at higher risk for cervical cancer [than API and the general population.] There tends to be an earlier age of sexual activities, which is one of the risk factors for cervical cancer. Also, screening is just not perceived as important,” Kim said. She also added that the Thai population is a relatively young one compared to the overall API and general populations, further increasing their risk for the disease.

The most difficult challenge in offering care for API women usually arises after the screening process. Once a patient has been diagnosed with cancer, Kim said, she usually is left to grapple with the disease on her own—there just isn’t any culturally and linguistically sensitive support. “Employment support, social services, home care, transportation, psycho-social support—it’s just not there,” Kim explained.

Oftentimes, the women, most of whom are uninsured, get put into the county health care system where they are likely to get lost in the bureaucracy. Kim said that the clinic would continue to work with other providers in establishing the necessary protocols for API women once they are diagnosed.

“We need to build the capacity to do case management for breast and cervical cancer, do follow-up care, from screening and if necessary, to the end life stage.”