English Proficiency Impacts Cancer Screening for APAs
December 5, 2003
Despite the fact that cancer is the second leading cause of death in California and the United States, second only to heart disease, Asian Pacific Americans consistently trail other racial and ethnic groups in cancer screening, especially for cervical and breast cancer, according to a new study by the UCLA Center for Health Policy Research.What was most important from this study, researchers say, was that racial and ethnic disparities exist in cancer screening rates and within the APA population, ethnic subgroups differ substantially in their rate of cancer screenings at recommended intervals, with APAs, who have limited English proficiency, having the lowest cancer screening rates among APAs statewide.
Ninez Ponce, one of the authors of the study and an assistant professor at the UCLA School of Public Health said an earlier study that suggested APAs had one of the lowest cancer screening rates prompted the center to release this new fact sheet.
“We suggested that education of individuals and their doctors is key and this should be tailored by that individual’s language and culture,” Ponce said. “But, because Asians consist of many different groups such as Filipinos, Koreans and Cambodians, we thought that aggregated statistics were not enough.”
Ponce added that it was pertinent to present cancer screening rates for each group to the APA community and health care providers.
Researchers gathered information from the California Health Interview Survey, a telephone survey of over 55,000 households in California conducted in 2001. More than 6,000 APAs were interviewed in Mandarin, Cantonese, Vietnamese, Korean, Khmer, Spanish and English.
To my knowledge, the largest sample on Asians ever done in the United States,” Ponce said.The study shows considerable variations within the various APA ethnic groups on the frequency of cancer screening tests. All APA ethnic subgroups, except Filipino women, fall significantly below the overall cervical cancer screening rate for California (86.2 percent), while Chinese, Japanese, Vietnamese, Korean, South Asian and Cambodian women have lower rates of Pap smears, a test for cervical cancers, in the past three years than California’s average. Researchers say this is a disturbing statistic since a National Institutes of Health report showed Vietnamese American women are five times more likely than white women to have cervical cancer.
Language ability seemed to play a part in those who received routine Pap tests. Among Chinese American women, the proportion reporting a Pap test is lower for limited English-proficient women (56.7 percent) than that for English-proficient women (75.5 percent).
æWe thought that rates for Asians may be lower because many may have difficulty navigating a health care system or communicating with their doctors because of language barriers,” Ponce said. ¢We found that language barriers are associated with lower rates of receipt of a mammogram and Pap tests for most groups, but not for colorectal cancer screening. &Mac253;urprisingly, Vietnamese American women who reported that they speak English poorly or not at all had higher rates of Pap tests than Vietnamese American women who speak English well or very well. This may indicate that some culturally tailored strategies to expand cervical screening among Vietnamese Americans — a group that has one of the nation’s highest rates of cervical cancer — has worked well in California.”
With routine mammograms, Cambodian American and Korean American women have had rates far below the state average continuously for the past two years compared to all women over the age of 40 in California. But the study also cited that language acted as a barrier to preventive care services. While 63.8 percent of English-proficient Korean American women received mammograms within the past two years, only 45.4 percent with limited English proficiency reported having a mammogram.
Among the Japanese Americans and South Asian Americans, screening rates for colorectal cancer are comparable to the overall rate for the state, but less than 40 percent of Cambodian American and Korean American adults over the age of 50 reported having be screened for colorectal cancer.
“Tests for colorectal cancer screening are very low overall for California (53.2 percent), but even lower for Chinese, Filipino, Vietnamese, Korean and Cambodian men and women,” Ponce said.
Ponce said the disparities in screening rates stress the need for public policy and culturally sensitive outreach to help high-risk population groups receive preventive care and education.
“The report is for community advocates, health providers, legislators, program planners and funders to direct their attention on the low rates of cancer screening among specific Asian groups,” Ponce said. “These three tests — Pap tests, mammograms and colorectal cancer tests — should be done routinely even if one does not have any symptoms or even if their doctor does not recommend it. These tests could save lives.”
She added that doctors who see APA patients need to be educated and be culturally sensitive, and patients need to learn to be more proactive with their doctors.
A common reason among APAs who haven’t received a recent test is that the doctor never informed them about the routine exams.
“We tried to get at the cultural question by examining cancer screening rates by how well the person speaks English,” Ponce said. “The language effect was less for mammograms, and not significant for colorectal test rates. It certainly is an access issue for colorectal tests since getting a sigmoidoscopy/colonoscopy (a colorectal test) usually requires insurance. In California, there are programs that provide free Pap tests and mammograms, so financial access to these tests is not such an issue as it is for colorectal tests. This is surely a big reason why the rates for breast and cervical cancer tests are higher than the rates for colorectal tests.”
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