Image by Grace Hsu
Advances in medical sciences and biomedical technologies have improved the prognosis of some cancers from being untreatable to potentially curable diseases. Despite the current progress in cancer treatment though, cancer remains the second leading cause of death in the United States, with nearly one-half of all men and one-third of all women in the US developing cancer during their lifetime1. In many ways, the cancer burden is unequally distributed in various populations within the US. While Asian Americans have the lowest cancer incidence when compared to other ethnic groups in the US, cancer is still the leading cause of death among Asian Americans, with heart disease first among all other American racial and ethnic groups2. Much of the Asian American cancer burden is unnecessary and caused by several avoidable factors including lack of cancer education, barriers to both healthcare and cancer screening, and ultimately a culturally ineffective effort to solve the issue.
Effective preventative measures must first consider factors that lead to the earliest step of cancer development such as genetic predisposition and environmental factors that lead to increased susceptibility. Only once these determinants have been successfully traced, can an effective and community-focused plan of action be developed.
The immense diversity amongst Asian Americans and their cultural environments necessitates a more community-focused effort with cancer education, prevention and treatment, while addressing the particular risk factors for each subgroup. Specific cancers affect particular Asian subgroups, so cancer prevention polices should be directed towards the needs of each community.
Liver Cancer and Chinese Americans
Asian Americans, particularly Chinese Americans, suffer from a proportionately large burden of cancers of infectious origin. Liver cancer caused by hepatitis B is the leading cause of cancer mortality in Asian Americans3. The Chicago Department of Public Health, in conjunction with The University of Chicago Comprehensive Cancer Center, conducted extensive research over the past decade on the cancer risks imposed by the hepatitis B virus (HBV). These studies found that Chicago is one of the hubs of hepatitis B derived liver cancer in the US, and the highest rates of incidence are found in Asian American neighborhoods. The heightened incidence is due in large part to low HBV vaccination rates in the Asian American community.
The hepatitis B vaccine has been strictly incorporated into the childhood vaccination regimen in the US, but since over 75% of Asian Americans in Chicago are foreign born and the regulation of the HBV vaccine amongst immigrants has been far less stringent, this particular city mandated vaccination hardly benefits foreign migrants4. Thus the Chicago Department of Public Health should make HBV vaccination a priority, especially in migrant Chinese communities such as the Chinatown neighborhood of Armor Square. Chinatown is home to a significant proportion of the Chinese immigrant population in Chicago. A targeted HBV vaccination campaign to expand awareness about hepatitis B and provide free hepatitis B screenings and vaccines would greatly lower the liver cancer burden for Chinese Americans in Chicago. The campaign could consist of community health fairs as well as raise awareness through (Chinese language/Mandarin) radio and print media around the community. Moreover, the high degree of community engagement within Chinatown, and collaboration between Chinatown residents and community health organizations would allow smooth implementation of the initiative.
Colorectal Cancer and Korean Americans
National statistics show that Korean Americans have the highest annual incidence and mortality rate for stomach and colorectal cancer among all Asian subgroups, more than five times the rate of stomach cancer in White American men2. While some of the disease burden can be attributed to genetic susceptibility, a disproportionate amount of the burden is actually due to a lack of adequate preventive and diagnostic measures. Regular colorectal cancer screening is one of the most effective tools for preventing colorectal cancer, and men above the age of 50 are recommended to start annual screenings. The mortality rate from colorectal cancer has declined drastically over the past 20 years due to advances in the screening technique5. This progress, however, has not yet reached the Asian American population in many large cities in the US including Chicago, and Korean Americans continue to have the lowest rates of colorectal cancer screenings in the US5. Cancer education and screening recommendations could be the most powerful weapon for Korean Americans against colorectal cancer and could be also delivered through community based initiatives and health fairs in neighborhoods with high Korean American densities.
Lung Cancer and Southeast Asian Americans
Lung cancer is the number one killer for Asian American men and yet studies have shown that tobacco and cigarette billboards are significantly larger in size and more densely predominant in Asian American neighborhoods throughout the US2. Particularly among Southeast Asian Americans, such as Indian Americans, lung cancer rates are 18% higher than among White Americans2. Southeast Asian Americans have the highest rates of smoking among all Asian Americans and have significantly higher rates than other American minorities2.
Since the risk for lung cancer does not stem from the lack of screenings but rather, behavioral risk factors such as smoking, cancer risk awareness should be brought to the frontlines of health advocacy for these communities. The education campaign for lung cancer within these communities must be delivered in a more sensitive, personal manner. Doctors, community health workers, and locally trusted leaders would be a more effective vehicle to deliver the smoking cessation messages to this patient population rather than media. Just as the disease follows a two-step development process, cancer prevention work in this community must also come in two waves. The first step is ensuring that the physicians and community leaders recognize cancer as a preventable illness and raise cancer prevention awareness. The antedated biomedical view of cancer must be replaced by a more comprehensive understanding of the disease, its social determinants and the environmental factors that lead to a predominance of the disease in certain populations. The second step will then follow naturally from the first as physicians and community leaders spread key information to the patient population and promote behavioral change in effective, culturally competent patient interactions to transform the smoking habits within these communities.
Although devising a unique campaign for each community is a more resource-intensive method, a targeted approach is necessary to deliver the most pertinent cancer education to each Asian subgroup and close the gap in cancer disparities between ethnic communities. Biomedical cancer therapies have progressed from broad, system-based cancer treatments to more advanced, targeted therapies over the past two decades, and cancer prevention should follow suit. The Chicago Department of Public Health has already taken some steps towards promoting cancer education, but a more culturally targeted approach is required. Drastically reducing cancer health disparities within the Asian American population in Chicago will require a deeper insight into the Asian American subgroups, the specific risks related to each, and their unique, unusual, and unnecessary burdens of cancer. Cancer education and preventive measures could truly be the key to turn the course of this disease from death sentence to cure in the Asian American population.
1 “Cancer Facts & Figures 2014.” American Cancer Society, 22 December 2014. Web. <http://www.cancer.org/acs/groups/content/@research/documents/webcontent/acspc-042151.pdf>
2 “Asian American Cancer Health Disparities.” Cancer Education. AANCART- The National
Center for Reducing Asian American Cancer Health Disparities, Web. <http://www.aancart.org/cancer-research/publications/asian-american-cancer-health-disparities>.
3 “Asian Americans and Hepatitis B.” Centers for Disease Control and Prevention, 13 May 2013. Web. <http://www.cdc.gov/Features/aapihepatitisb/index.html>.
4 “Pathways to Discovery: Winter 2011.” UC Comprehensive Cancer Center. The University of Chicago Medicine. Web. 21 Oct 2013. <http://cancer.uchicago.edu/about/news/pathways2011winter-HPV.shtml>.
5 “Importance of colorectal cancer screening.” Colon/Rectal Cancer Early Detection. The American Cancer Society , 8 May 2013. Web. 21 Oct 2013. <http://www.cancer.org/cancer/colonandrectumcancer/moreinformation/colonandrectumcancerearlydetection/colorectal-cancer-early-detection-importance-of-crc-screening>.
Shruti Zaveri is a second year MD/MPH student at Feinberg School of Medicine. She studied Economics and Global Health through her undergraduate career at Northwestern University. She is active in the Chicago Medical Society and is interested in medical policy surrounding access to care issues.