MISSING IN ACTION : Ethnic Groups in Cancer Screening Annette E. Maxwell, Dr.P.H. Division of Cancer Prevention and Control Research Jonsson Comprehensive Cancer Center University of California, Los Angeles April 20, 2005
Cancer Screening Tests done on normal people to find hidden disease People with symptoms need diagnostic tests Cancer screening is for your body like an oil change is for your car
Why Is Screening Important? Find cancer early before it starts to spread Improve survival
Colorectal Cancer 5-Year Relative Survival Probabilities, 1995-2000 Survival Probability (%) 90 80 70 60 50 40 30 20 10 0 90 67 63 ALL RACES ALL STAGES LOCALIZED REGIONAL DISTANT 10 SOURCE: Surveillance, Epidemiology and End Results Data, 1995-2000.
Five Year Survival among Filipino Americans with Cancer CERVIX BREAST COLON/RECTUM (female) COLON/RECTUM (male) PROSTATE Number of Filipino Americans who survive 5 years or longer for every 10 Filipino Americans who get the above cancers
What screening tests are recommended?
Breast Cancer Screening Mammography Screening Yearly, starting at age 40
Cervical Cancer Screening Pap test once a year
Colorectal Cancer Screening Stool Blood Test: Once a year beginning at age 50
Colorectal Cancer Screening Flexible Sigmoidoscopy: : once every 5 years beginning at age 50
Colorectal Cancer Screening Colonoscopy: once every 10 years beginning at age 50
Prostate Cancer Screening Men over 50 yrs should discuss the following tests with their doctor: Digital Rectal Examination Prostate-Specific Antigen Test
Which Groups are Missing in Action?
Colorectal Cancer Screening by Californians Age 50 and Over by Race/Ethnicity, CHIS 2001 100 Recent CRC Screening 90 PERCENT SCREENED (%) 80 70 60 50 40 30 20 63 61 42 48 10 0 WHITE AFRICAN-AMERICAN LATINO ASIAN stool blood test in the past year; sigmoidoscopy or colonoscopy in the past 5 years. SOURCE: Ponce N, Babey S, Etzioni D, et al. (December 2003). Cancer Screening in California. California Health Interview Survey. UCLA Center for Health Policy Research.
Colorectal Cancer Screening by Californians Age 50 and Over by Asian Ethnic Subgroup, CHIS 2001 100 RECENT CRC SCREENING PERCENT SCREENED (%) 90 80 70 60 50 40 30 20 63 55 46 45 38 10 0 WHITES JAPANESE CHINESE FILIPINO KOREAN stool blood test in the past year; sigmoidoscopy or colonoscopy in the past 5 years. SOURCE: Ponce N, Gatchell M, Brown ER. (November 2003). Cancer Screening Rates Among Asian Ethnic Groups. Health Policy Fact Sheet. UCLA Center for Health Policy Research.
Colorectal Cancer Screening among Low-Income Filipino Age 50 and Over 100 RECENT CRC SCREENING 90 PERCENT SCREENED (%) 80 70 60 50 40 30 20 63 45 25 10 0 WHITES FILIPINO MEN & WOMEN (CHIS 2001) FILIPINO WOMEN (LA STUDY) stool blood test in the past year; sigmoidoscopy or colonoscopy in the past 5 years. SOURCE: Maxwell AE, Bastani R, Warde U. Am J Prev Med 2000; 18: 62-68.
Mammography Utilization by Asymptomatic Women Age 40 and Over in California by Race/Ethnicity, CHIS 2001 PERCENT UTILIZATION (%) 100 90 80 70 60 50 40 30 20 10 0 78 MAMMOGRAM IN PAST TWO YEARS 78 WHITE BLACK HISPANIC ASIAN/OTHER 70 67 SOURCE: Ponce N, Babey S, Etzioni D, et al. (December 2003). Cancer Screening in California. California Health Interview Survey. UCLA Center for Health Policy Research.
Mammography Utilization by Asian Ethnic Subgroups Age 40 and Over in California by Race/Ethnicity, CHIS 2001 PERCENT UTILIZATION (%) 100 90 80 70 60 50 40 30 20 10 0 78 76 MAMMOGRAM IN PAST TWO YEARS 72 WHITES JAPANESE FILIPINO CHINESE KOREAN 65 53 SOURCE: Ponce N, Gatchell M, Brown ER. (November 2003). Cancer Screening Rates Among Asian Ethnic Groups. Health Policy Fact Sheet. UCLA Center for Health Policy Research.
Mammography Utilization among Korean Americans with Limited English Proficiency Age 40 and Over in California by Race/Ethnicity, CHIS 2001 PERCENT UTILIZATION (%) 100 90 80 70 60 50 40 30 20 10 78 MAMMOGRAM IN PAST TWO YEARS 64 45 40 0 WHITES KOREAN (English Proficient) KOREAN (Limited English Proficient) LOW-INCOME KOREAN WOMEN IN LA (Maxwell et al., 2000) SOURCE: Ponce N, Gatchell M, Brown ER. (November 2003). Cancer Screening Rates Among Asian Ethnic Groups. Health Policy Fact Sheet. UCLA Center for Health Policy Research.
Lowest Screening Rates Among Uninsured Low income Non-English speaking Recent immigrants No usual source of care
Ways to Increase Cancer Screening Increase cancer awareness Change social norms Make free or low-cost screening tests available Work with communities to design screening programs that work! Conduct research studies to demonstrate what programs are effective.