BETHESDA, MD – The dirty little secret about cancer is that it kills Asian Pacific Americans too.

As a matter of fact, it is the leading cause of death among them.

                 What’s distressing about this secret – if can be called that – is that APAs are the least likely of all racial/ethnic groups to show up for a doctor’s visit, hence are the ones who would least be helped by early detection.

                There are also assumptions – call them misconceptions -- in the medical field at-large that may need correcting.  For instance, it is assumed Asian women do not have the same risk in having breast cancer as women in other racial groups do.  Hence, a young Asian Pacific American woman may be lulled into thinking that she need not bother to learn how to check herself or to go to a physician for a breast examination.

                And yet, who among APAs can say that they do not know or have heard of anyone among them who have developed cancer, and unfortunately, have succumbed to the disease. 

Fact is:  there are more Asian women than meet the eye or reach the ear who develop and die of breast or cervix cancer; and same goes for Asian men: their mortality rate in lung cancer outranks other diseases that afflict them.

                These issues of concern – as they should be – took central stage at a three-day summit held by National Cancer Institute (NCI) July 17-19, 2006 at the Bethesda North Marriott Hotel & Conference Center.

                With the overall theme “Strengthening Our Culture of Collaborators for Reducing Cancer Health Disparities,” the summit aimed to get professionals in the health care system to be more aware of the needs of the underserved in the nation’s multicultural landscape.

The summit also could have the effect of increasing awareness and understanding of the disease at the community level of the underserved in the Asian Pacific American community. 

                This was a first event of its kind funded by NCI for cancer researchers and the National Center on Minority Health and Health Disparities (NCMHD), as well as health professionals and community health advocates, convened for the purpose of sharing accomplishments, challenges, and best practices.

                The program objectives included:  examining issues of common need; sharing strategies, models, and tools for providing solutions within respective programs and communities; empowering partnerships to access the resources needed to sustain programs that benefit the community; and facilitating discussion on unique issues that influence programmatic progress.

                This may sound daunting to the lay reader’s patience, but the messages and insights squeezed out of the presentations and discussions were apparently more interesting than they sound.

                Why?  Because the facts and figures cited beamed a glaring spotlight on the dirty little secret about cancer and Asian Pacific Americans.  They flushed the secret out.

                Here is how Dr. Moon S. Chen, Jr., of the Asian American Network for Cancer Awareness, Research and Training (AANCART), helped flush the secret out.

                Cancer among Asian Pacific Americans, he said, could be described in three ways: “unique, unusual and unnecessary.”

                “Unique,” he said, “because Asian Pacific Americans are the only racial ethnic population that experience cancer as the leading cause of death in both age categories of 25-44 years and 45-64 years.”

                Imagine your active, ambitious and aspiring twentysomething son or daughter, or your best friend enjoying a full career or preparing for early retirement as a not-unseemly candidate for the cancer mortality rates?

                “Unusual,” he went on, “because compared to other racial/ethnic groups, Asian-Americans experience proportionally more cancers of infectious origin.”

                H-m-m-m, wonder why, a reader might ask. Asians have no problem adapting, but do they have to out-adapt everybody?

                 “Unnecessary,” Dr. Chen cites lastly, “because earlier detection and behavioral changes can at least in part reduce the risk of dying from cancer or acquiring cancer.”

                Now, that can be said of everybody else, Asians and non-Asians alike.

                But apparently, research in the past 12 months shows that Asian-Americans are the least likely of all racial/ethnic groups to have seen a physician in that period. 

“Hence, the avoidance of visits to doctors’ offices may contribute to the unnecessary cancer burden,” Dr. Chen surmised.       

These revelations therefore point to the grave need for cancer prevention and control among Asian Pacific Americans. 

In order to address APA cancer health disparities, the several barriers faced by them need to be targeted to ensure appropriate cancer care and information:

1.       Systems & Financial barriers:

Financial sources of disparities include individuals who have

no insurance or who are underinsured.  Those who lack financial resources to cover treatment delay seeking medical care.  The costs of cancer care can be devastating, leading to bankruptcy and a loss of dignity.  Some patients, even those with insurance, find that uncovered financial costs for items such as transportation, childcare, and medical supplies can rapidly drain family resources.

2.       Physical barriers:

Many individuals lack physical access to cancer treatment

because they are often too ill from the disease or the treatment to make the long trips to care providers, or because they live in rural areas with poor access to transportation. 

3.       Barriers related to information or education:

Quality care comes from a doctor that knows the patient and his

or her history, because these personal doctors can provide crucial information.  Lack of information or education (including the failure to comprehend English), an inability to find or access information, inadequate actions/response to the available information, and lack of knowledge on how to get needed care within the health system can all constitute enormous barriers to cancer care. 

According to the Commonwealth 2001 Health Quality Survey, a quarter of all APAs report they have difficulty communicating with their doctors.  Sometimes the information is not readily available and usable by patients because of their isolation from resources, poor literacy, and language barriers that prevent understanding.

4.        Barriers related to cultural differences and biases on cancer

care:

Many fail to receive cancer information or care for reasons that stem

from cultural or racial differences, and from biases from those differences.  The bias can originate from both patients and health care providers.  Disparities exist for cultures where discomfort and pain are tolerated; where the problems of having or treating a disease would be such a problem for the family that a potential disease will be ignored as long as possible; where treatment is different from available medical treatment; and where cancer is still regarded fatalistically. 

In some Asian cultures, there is a strong fear of being shunned by both family and community, thus creating a “silence” that prohibits discussion of cancer.  This kind of fear results in delayed/lack of care, needless suffering, personal isolation, and perhaps preventable death. 

The avoidance of visits to doctors’ offices may also contribute to the

unnecessary cancer burden.  As mentioned above, APAs are the least likely of all racial/ethnic groups to have seen a physician in the past 12 months.  If the barrier to seeking medical care is not overcome, then APAs are the most likely to disagree with their physicians’ advice and to cite cultural or religious beliefs as their reasons for the use of alternative care.

                [Haven’t you seen signs advertising alternative folk medicine and cures, such as one sweeping the façade of a two-storey building on Old Columbia Pike Road off Little River Turnpike in Alexandria?]

                How can a culture-disparity conscious cancer-prevention program challenge these findings?

Dr. Chen said, “Reducing cancer deaths among Asian-Americans would require customized, ethnically specific, and linguistically appropriate interventions focused on amenable cancer risk factors for distinct Asian-American groups.”

For instance, because lung cancer is responsible for more cancer deaths than any other cancer among APAs, there is need to focus on reducing cigarette smoking, which is the major risk factor for lung cancer for all groups of people. 

Compared to non-Hispanic whites, APAs also have a greater number of deaths from liver cancer, a cancer attributable to infectious origins.  Thus, reducing liver cancer health disparities will require treatment, vaccination, or screening to detect those who are antigen-positive.

NCI-funded projects like Asian-American Network for Cancer Awareness, Research, and Training (AANCART) are engaged in cooperative agreements with the NCI to convene individuals and resources that contribute to reducing the Asian American burden for cancer.  AANCART is the largest network focused on APAs’ cancer health disparities.

AANCART investigators have been on the forefront of determining intervention needs and applying them. 

Drawing from the existing studies, as Dr. Chen pointed out, there are measures that can be brought to bear:  smoking avoidance, increasing hepatitis B vaccination rates, and overcoming barriers to age-appropriate and gender-appropriate cancer screening. 

Programs such as linguistically appropriate and culturally competent cancer control preventions can also be developed.  Use of the media, increasing the numbers of lay health workers, expanding medical education, and increasing APA representation in clinical trials are among the salient ones to pursue.

Dr. Chen stressed that measures would “require orchestrated efforts and partnerships among governmental entities, such as the National Cancer Institute (NCI) and Centers for Disease Control and Prevention (CDC); voluntary health agencies, such as the American Cancer Society; academic institutions, such as universities and their associated cancer centers; community-based organizations, and committed individuals.”

Nevertheless, more research is needed to reduce disparities in the healthcare delivery system for APA cancer patients.  Outcome of the research on cancer control interventions and issues of access can be applied to agenda involving collective efforts of the institutions already involved, as well as APA community-based networks and sensitized individuals who impact their communities.

(With assistance from Rita M. Gerona-Adkins)