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Determinants of cancer screening in Asian-Americans

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Abstract

Purpose

Recent data suggest that Asian-Americans (AsAs) are more likely to present with advanced disease when diagnosed with cancer. We sought to determine whether AsAs are under-utilizing recommended cancer screening.

Methods

Cross-sectional analysis of the 2012 Behavioral Risk Factor Surveillance System comprising of AsAs and non-Hispanic White (NHW) community-dwelling individuals (English and Spanish speaking) eligible for colorectal, breast, cervical, or prostate cancer screening according to the United States Preventive Services Task Force recommendations. Age, education and income level, residence location, marital status, health insurance, regular access to healthcare provider, and screening were extracted. Complex samples logistic regression models quantified the effect of race on odds of undergoing appropriate screening. Data were analyzed in 2015.

Results

Weighted samples of 63.3, 33.3, 47.9, and 30.3 million individuals eligible for colorectal, breast, cervical, and prostate cancer screening identified, respectively. In general, AsAs were more educated, more often married, had higher levels of income, and lived in urban/suburban residencies as compared to NHWs (all p < 0.05). In multivariable analyses, AsAs had lower odds of undergoing colorectal (odds ratio [OR] 0.78, 95 % confidence interval [CI] 0.63–0.96), cervical (OR 0.45, 95 % CI 0.36–0.55), and prostate cancer (OR 0.55, 95 % CI 0.39–0.78) screening and similar odds of undergoing breast cancer (OR 1.29, 95 % CI 0.92–1.82) screening as compared to NHWs.

Conclusions

AsAs are less likely to undergo appropriate screening for colorectal, cervical, and prostate cancer. Contributing reasons include limitations in healthcare access, differing cultural beliefs on cancer screening and treatment, and potential physician biases. Interventions such as increasing healthcare access and literacy may improve screening rates.

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Acknowledgments

Quoc-Dien Trinh is supported by an unrestricted educational grant from the Vattikuti Urology Institute, a Young Investigator Award from the Prostate Cancer Foundation and a Career Development Award from the Conquer Cancer Foundation of the American Society of Clinical Oncology.

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Author notes

    Authors and Affiliations

    1. Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, 45 Francis Street, Boston, MA, 02115, USA

      Quoc-Dien Trinh, Christian P. Meyer, Julian Hanske, Gally Reznor, Stuart R. Lipsitz, Adam S. Kibel & Jesse D. Sammon

    2. Vattikuti Urology Institute Center for Outcomes Research, Henry Ford Health System, Detroit, MI, USA

      Hanhan Li, Mani Menon & Jesse D. Sammon

    3. Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA

      Toni K. Choueiri

    4. Center for Outcomes Research and Evaluation, Maine Medical Center, Scarborough, ME, USA

      Paul K. Han

    5. Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA

      Paul L. Nguyen

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    1. Quoc-Dien Trinh
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    Correspondence to Quoc-Dien Trinh.

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    Conflict of interest

    Firas Abdollah is a consultant for GenomeDx biosciences. Paul Nguyen is a consultant for Ferring and Medivation. Adam Kibel is a consultant for Sanofi Aventis, Profound, and Dendreon. All other authors declare no conflict of interest.

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    All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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    This article does not contain any studies with human participants performed by any of the authors.

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    Quoc-Dien Trinh and Hanhan Li have equal contribution to this work.

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    Trinh, QD., Li, H., Meyer, C.P. et al. Determinants of cancer screening in Asian-Americans. Cancer Causes Control 27, 989–998 (2016). https://doi.org/10.1007/s10552-016-0776-8

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