BETHESDA, Maryland–Cancer deaths have declined in general, but not among Asian Americans. In fact, Asians are the only group where cancer is the leading cause of death in the nation, compared with heart disease in all other ethnic groups.

            This was one of the issues highlighted at the Cancer Health Disparities Summit 2007 held on July 16-18th here. Organized by the National Institutes of Health’s National Cancer Institute (NCI), the event drew over 700 people across the nation.

In collaboration with the National Center on Minority and Health Disparities (NCMHD) and the National Center on Research Resources (NCRR), the conference focused on the theme “Catalyzing Trans-disciplinary Regional Partnerships to Eliminate Cancer Health Disparities”.

Health agencies note that what’s challenging is the diversity of the Asian American population. Asians come from nearly 50 countries and ethnic groups and with over 100 languages and dialects–and two quarters of them are recent immigrants while others American-born. But they are usually lumped together into a single category:  Asian American/Pacific Islander (API). 

Groups that have been in this country for a while, have increased risk of developing cancers common in this country like breast, colorectal cancer and lung cancer. This is largely due to Asian Americans increasingly adopting American lifestyles of obesity, inactivity, high alcohol intake and diets high in fat and low in fruits and vegetables.

Recent immigrants on the other hand, tend to suffer from types of cancers that are predominant in their native countries like stomach and liver cancer.

Working with other minorities, such as the Hispanics, means dealing in only one language. But dealing with Asian Americans means addressing the differences in language, culture, beliefs and misconceptions. These factors contribute to their low cancer screening rate.

To complicate matters, Asian Americans are also the least likely of all racial/ethnic groups to have seen a physician in a 12-month period.  Not all cancers are the same, but all, regardless of ethnicity, can benefit from early detection.

In addressing Asian American health disparities, several barriers were cited: financial, physical, barriers related to information or education, and barriers related to cultural differences and biases on cancer care.

But what’s the biggest challenge facing these health experts? Dr. Moon Chen, Jr., principal investigator of Asian American Network for Cancer Awareness, Research, and Training (AANCART), said, “It is not the norm for Asians to pro-actively seek care.” People seek care only when symptoms appear and they are already very ill.

The American Cancer Society (ACS) and the AANCART have developed a Web tool to enable cancer education materials in Asian and Pacific Islander languages to be electronically retrievable from participating organizations.

Cancer information materials are available in the following API languages:  Chamorro, Chinese, Chuukese, Hmong, Khmer, Korean, Kosraean, Marshallese, Somoan, Thai, Tongan, Vietnamese, and Tapese.  Go to http://cancer.org/apicem or http://aancart.org/apicem

Forge partnerships

In her welcome remarks, NCMHD Deputy Director Joyce Hunter challenged conference attendees, “Draw from Summit ‘07 new ways to forge partnerships and explore new avenues to advance the campaign to eliminate cancer health disparities.”

            NCI funding has made it possible for committed Asian Americans of NCI-funded projects like the Asian American Network for Cancer Awareness, Research, and Training (AANCART) and Asian Community Cancer Network (ATECAR) to seek ways and implement best practices to improve the quality of life of Asian Americans.

            Its acronym name sums up its mission of cancer awareness, research, and training.  Its network of nine consortiums aims to: Sustain a robust infrastructure to support community-based participatory education, research, and training to reduce cancer health disparities (Phase I); Foster community-based participatory research and training programs to reduce cancer health disparities (Phase II), and Establish AANCART as a credible and sustainable CNP to reduce cancer health disparities (Phase III).

Specific solutions

Though they serve all Asian Americans, their goal is to provide ethnically specific solutions by focusing on these populations in their locale and for the cancer type unique to them.  The five populations of emphasis are Hawaii (Filipinos), Los Angeles (Koreans), Sacramento (Hmong), San Francisco (Chinese and Vietnamese), and Seattle (Cambodians). 

AANCART found that in California, Asians are the least likely to get Pap testing.  But what they found is that the Hmongs are just the opposite.  The Hmong, the least English literate the more likely get Pap tested.  One of the reasons, Dr. Chen thinks is that Hmong having a higher birthrate.  As part of the pre-natal care in the U.S., they get Pap tested.

ATECAR, which has been instrumental in empowering communities of Pennsylvania, New York, New Jersey, Delaware, and DC areas to work towards cancer control in Asian communities, also saw variations among different Asian groups in the Northeast regions of U.S.  Dr. Grace Ma, principal investigator of ATECAR and director of Center for Asian Health Temple University, surmised that out of the national uninsured rate of 15 per cent, “Koreans have a very low rate of health insurance.” 52 per cent of them are uninsured.  She said, “a lot of them are working long hours in mom/pop shops, in the laundry.” 

Dr. Ma also noted, “Vietnamese also have less insurance, but Vietnamese are less culturally reluctant to getting regular, preventive services.” She added that they are more receptive to female physicians, and reluctant to work with male physicians. 

Current baselines of screenings for several cancers have also been established.  Dr. Chen added, “We found that (CME) Continuous Medical Education Credits is one way to persuade pro-active practice of medicine…Asian trained physicians are less likely to practice preventive care, and CME has increased their practice of preventive care.”