| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | COVER ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
||||||||
|
||||||||||
Ms. McCracken is Epidemiologist, Department of Epidemiology and Surveillance Research, American Cancer Society, Atlanta, GA.
Ms. Olsen is Epidemiologist, Rollins School of Public Health, Emory University; and Department of Epidemiology and Surveillance Research, American Cancer Society, Atlanta, GA.
Dr. Chen is Professor and Principal Investigator, Asian American Network for Cancer Awareness Research and Training; and Associate Director, Population Research and Cancer Disparities, University of California-Davis, Cancer Center, Sacramento, CA.
Dr. Jemal is Strategic Director, Cancer Occurrence, Department of Epidemiology and Surveillance Research, American Cancer Society, Atlanta, GA.
Dr. Thun is Vice President, Department of Epidemiology and Surveillance Research, American Cancer Society, Atlanta, GA.
Dr. Cokkinides is Strategic Director, Risk Factor Surveillance, Department of Epidemiology and Surveillance Research, American Cancer Society, Atlanta, GA.
Dr. Deapen is Professor, Keck School of Medicine, University of Southern California, Los Angeles, CA.
Dr. Ward is Managing Director, Surveillance Research, Department of Epidemiology and Surveillance Research, American Cancer Society, Atlanta, GA.
This article is available online at http://CAonline.AmCancerSoc.org
Disclosures: The collection of cancer incidence data used in this study was supported by the California Department of Health Services as part of the statewide cancer-reporting program mandated by California Health and Safety Code Section 103885; the National Cancer Institute's Surveillance, Epidemiology, and End Results Program (SEER Program) under contract N01-PC-35136 awarded to the Northern California Cancer Center, contract N01-PC-35139 awarded to the University of Southern California, and contract N02-PC-15105 awarded to the Public Health Institute; and the Centers for Disease Control and Prevention's National Program of Cancer Registries under agreement #U55/CCR921930–02 awarded to the Public Health Institute.
Funding for M.S.C.'s role is attributable to Grant Number U01 CA114640 from the National Cancer Institute and P01 CA109091–01A, funded both by the National Cancer Institute and the National Center on Minority Health and Health Disparities.
The ideas and opinions expressed herein are those of the authors, and endorsement by the State of California, Department of Health Services, the National Cancer Institute, and the Centers for Disease Control and Prevention or their contractors and subcontractors is not intended, nor should it be inferred.
 |
ABSTRACT |
|---|
 TOP ABSTRACT INTRODUCTIONDATA SOURCES FOR CANCER...BACKGROUND: IMMIGRATION HISTORYSOCIODEMOGRAPHICSCANCER INCIDENCE AND MORTALITY...CHALLENGES IN MONITORING CANCER...RESOURCES FOR CLINICIANSSUMMARYREFERENCES |
|---|
|
INTRODUCTION |
|---|
|
TOPABSTRACTINTRODUCTIONDATA SOURCES FOR CANCER...BACKGROUND: IMMIGRATION HISTORYSOCIODEMOGRAPHICSCANCER INCIDENCE AND MORTALITY...CHALLENGES IN MONITORING CANCER...RESOURCES FOR CLINICIANSSUMMARYREFERENCES |
|---|
Asian Americans are defined by the US Census Bureau as individuals with origins in "any of the original people of the Far East, Southeast Asia, or the Indian subcontinent. Asian groups are not limited to nationalities but include ethnic terms as well, such as the Hmong."5 The Census has analyzed data for 11 Asian groups with the residual category being "Other Asian."5 These populations are extraordinarily diverse with respect to country of origin, time since immigration, socioeconomic status, languages and dialects spoken, religion, and many other characteristics that affect health. It is, therefore, not surprising that the various Asian American ethnic groups differ with respect to cancer and other chronic diseases.2,6 This article summarizes available information on cancer incidence, mortality, risk factors, and screening among Asian Americans, with special focus on 5 of the largest populations: Chinese, Filipino, Vietnamese, Koreans, and Japanese for which data are available. Throughout this paper, we will refer to these populations as Asian American ethnic groups. Ethnic-specific data are available from California, which is home to approximately 3.7 million Asian Americans, 12% of the total population.5 Ethnic groups are presented in order of population size from largest to smallest.
|
DATA SOURCES FOR CANCER INCIDENCE, MORTALITY, AND RISK FACTORS |
|---|
|
TOPABSTRACTINTRODUCTIONDATA SOURCES FOR CANCER...BACKGROUND: IMMIGRATION HISTORYSOCIODEMOGRAPHICSCANCER INCIDENCE AND MORTALITY...CHALLENGES IN MONITORING CANCER...RESOURCES FOR CLINICIANSSUMMARYREFERENCES |
|---|
Nationwide socioeconomic and demographic characteristics of the Asian Americans by ethnic groups were derived from Census reports.8 Information on cancer incidence and mortality rates for ethnic groups of Asian Americans and non-Hispanic Whites in California for the years 2000 to 2002 were provided by the Los Angeles Cancer Surveillance Program9 and the California Cancer Registry (CCR). The CCR uses 9 categories for race/ethnicity: White, Black, Latino, Chinese, Filipino, Korean, Japanese, South Asian, and Vietnamese. The CCR also develops its own population estimates for denominators to calculate rates for ethnic populations.10 Information on risk factors and screening behaviors was obtained from the California Health Interview Survey (CHIS), a telephone survey of self-reported health-risk behavior information that oversamples minority populations in the state. The CHIS is conducted in 5 different languages (English, Spanish, Chinese, Korean, and Vietnamese) and includes detailed ethnicity questions.11
Our analysis considered all cancers combined, the 4 most common cancers (lung, colorectal, breast, and prostate), and 3 other cancer sites (stomach, liver, and cervix) for which risk is known to be high in Asian Americans. Information on the prevalence of selected behavioral risk factors for cancer (smoking, overweight, physical inactivity, and alcohol intake) and use of cancer screening tests (colonoscopy, fecal occult blood test [FOBT], prostate-specific antigen [PSA] tests, Pap tests, and mammograms) were derived from the 2003 CHIS data using Survey Data Analysis Software (Version 9.1; SAS Institute, Cary, NC). All incidence and mortality estimates are age-adjusted to the standard US year 2000 population. Weights were applied to the CHIS data that adjusted for age, sex, race, and ethnicity to produce estimates that were consistent with the 2003 California Department of Finance Population Projections.12
|
BACKGROUND: IMMIGRATION HISTORY |
|---|
|
TOPABSTRACTINTRODUCTIONDATA SOURCES FOR CANCER...BACKGROUND: IMMIGRATION HISTORYSOCIODEMOGRAPHICSCANCER INCIDENCE AND MORTALITY...CHALLENGES IN MONITORING CANCER...RESOURCES FOR CLINICIANSSUMMARYREFERENCES |
|---|
Chinese Americans are the largest Asian ethnic group in the United States and have one of the oldest immigration histories. Many Chinese laborers came to the United States beginning in the 1850s, initially attracted by the California gold rush and, later, by employment in the agricultural and railroad industries. The Chinese population in 2000 numbered over 2.4 million, concentrated in California (40.3%), New York (17.5%), and Texas (4.4%) (Table 1). Immigrants from the Philippines reportedly first arrived sometime between the middle of the 1700s and the 1830s.13 Filipinos are now the second largest Asian group in the United States, with a population of almost 1.9 million concentrated in California (49.6%) and Hawaii (9.2%) (Table 1). Vietnamese immigrated more recently, primarily after the end of the Vietnam War in 1975.13 Over 1.1 million Vietnamese reside in the United States, 40% in California and 12% in Texas (Table 1). The first Korean immigration period began in the early 1900s, when Koreans were employed as plantation workers in Hawaii. In the 1950s, the Korean War led to immigration of Korean-born wives and the orphaned children of US soldiers; immigration from Korea increased again following the 1965 Immigration Act.13 The number of Korean Americans exceeded 1 million in the 2000 US Census, with concentrations in California (32.1%) and New York (11.1%) (Table 1). Japanese Americans first immigrated to the United States around 1885 and were the largest Asian subgroup in 1900. However, the rate of continuing immigration for Japanese has been slower than that of other Asian groups, even after the 1965 Immigration Act,13 partly because of the strong economy and high standard of living in Japan. Consequently, the number of Japanese immigrants has remained small (800,000 in 2000). Two thirds of Japanese Americans are US-born13 (Table 2).
|
|
|
SOCIODEMOGRAPHICS |
|---|
|
TOPABSTRACTINTRODUCTIONDATA SOURCES FOR CANCER...BACKGROUND: IMMIGRATION HISTORYSOCIODEMOGRAPHICSCANCER INCIDENCE AND MORTALITY...CHALLENGES IN MONITORING CANCER...RESOURCES FOR CLINICIANSSUMMARYREFERENCES |
|---|
Time since immigration is directly related to language spoken at home and English-language fluency. Ethnic groups that have lived longer in the United States, such as Japanese and Filipinos, are more likely to speak English "very well" or speak only English at home. In contrast, among more recent immigrant groups, such as Vietnamese, Cambodian, and Hmong, less than half of the populations speak English "very well." A singular exception to this are Asian Indians, many of whom entered the United States as highly educated professionals having high levels of English proficiency, which is prevalent in India (Table 2).
Variations in income are also observed among the Asian American ethnic groups. The median family income for all Asians in 2000 was $59,324. Across ethnic groups, it ranged from $32,284 for Hmong to $70,849 for Japanese. Vietnamese, Koreans, Cambodians, Hmong, and Laotians have median family incomes more than $10,000 below the median value for Asians combined (Table 2).
Education levels are much higher for persons of Indian, Chinese, Filipino, and Japanese descent than among Cambodians, Hmong, and Laotians. Whereas 44.1% of the overall Asian population achieved a bachelor's degree, less than 10% of Cambodians, Hmong, and Laotians graduated from college, and only half were high school graduates (Table 2).
|
CANCER INCIDENCE AND MORTALITY AND RISK BEHAVIORS |
|---|
|
TOPABSTRACTINTRODUCTIONDATA SOURCES FOR CANCER...BACKGROUND: IMMIGRATION HISTORYSOCIODEMOGRAPHICSCANCER INCIDENCE AND MORTALITY...CHALLENGES IN MONITORING CANCER...RESOURCES FOR CLINICIANSSUMMARYREFERENCES |
|---|
|
|
|
|
Filipino
Filipino men had the highest incidence and mortality rates for prostate cancer among all Asian ethnic groups (Figures 1 and 2). Although prostate cancer incidence rates are much lower among Asian Americans compared with non-Hispanic Whites, it is still the most commonly diagnosed cancer among Asian American men.27 Risk factors for prostate cancer are not well understood. International studies suggest that a diet high in saturated fat may be a risk factor and that the risk of dying of prostate cancer may be associated with obesity.19,27 Higher prevalence of PSA testing is associated with higher incidence rates. The prevalence of PSA testing within the past year among Filipino men (46.1%) was intermediate among the Asian ethnic groups and lower than non-Hispanic Whites (57.7%). Filipino men have the second highest incidence (71.9/100,000) and the highest mortality (49.8/100,000) rate from lung cancer among the Asian ethnic groups, although the prevalence of current smoking is higher in Korean and Vietnamese men (Tables 3 and 4). These differences may reflect differences in age at initiation of smoking, as well as intensity and duration of smoking in the populations.
|
|
Cervical cancer is the second most common malignancy after breast cancer for women worldwide19 and is more common in Asian American women than in non-Hispanic White women in the United States. The incidence of cervical cancer among Filipino women (8.5/100,000) is higher than that in Whites, although not as high as among Korean and Vietnamese women (Table 3). The prevalence of Pap screening within the last 3 years (Table 5) among Filipino women in California was 86.3%—higher than the prevalence for any other Asian ethnic group and for non-Hispanic Whites. Longer US residency has been associated with higher frequency of Pap tests in some studies.28
The majority of Filipino men and women speak English fluently and are either native-born or naturalized citizens. Filipino Americans have among the highest levels of income, education, health insurance, and usual source of health care of all Asian ethnic groups (Tables 2 and 4). Filipinos have among the lowest screening rates for colorectal cancer (Table 5), but also among the lowest incidence and death rates from this cancer. Further research is needed to understand whether perceptions about risk, awareness of the importance of screening, and/or unique cultural factors are affecting colorectal cancer screening behaviors in this population.
Vietnamese
Vietnamese men in California have by far the highest incidence and death rates (54.3 and 35.5 per 100,000, respectively) from liver cancer of all the Asian ethnic groups. Their incidence rate is over 7 times higher than the incidence rate among non-Hispanic White men. Among Vietnamese women, the incidence and death rates from liver cancer are lower than in men (15.8 and 10.4 per 100,000, respectively), but still second only to Korean women (Table 3). Chronic infection with HBV causes most cases of hepatocellular carcinoma, the primary type of liver cancer, and is common in regions where liver cancer is endemic.17 As a result of their recent immigration history, Vietnamese may retain an increased prevalence of risk factors, such as HBV infection, which are more prevalent in Vietnam.
Vietnamese women in California had the highest incidence and mortality from cervical cancer compared with other Asian ethnic groups. The incidence rate for cervical cancer among Vietnamese women (14.0/100,000) was nearly twice as high as that for non-Hispanic White women (7.3/100,000) (Table 3). Human papillomavirus (HPV) infection has been identified as a universal risk factor for cervical cancer,29 although variations in HPV infection rates and types do not appear to explain the large international variation in cervical cancer risk. High cervical cancer incidence and mortality in developing countries is likely related to lack of access to Pap testing, which prevents cervical cancer through identification of precancerous lesions, which leads to earlier treatment and detection of cancers at an early stage. Despite their high risk of cervical cancer, Vietnamese women in California have low prevalence of Pap testing within the past 3 years (69.8%) (Table 5).
Stomach and lung cancer are also common among the Vietnamese in California. Vietnamese males had the second highest incidence and the third highest death rate from stomach cancer compared with other Asian ethnic groups (Figures 1 and 2). Vietnamese females have lower rates than men, but still have high risk of developing and dying from stomach cancer (Figures 3 and 4). It is not clear why Vietnamese men and women have the highest lung cancer incidence rates, given that the prevalence of current smoking in Vietnamese women is the lowest of all Asian ethnic groups. Further studies that examine the influence of environmental tobacco exposure in lung cancer etiology are needed to assess its effect as a risk factor in this population.
|
|
Korean
Koreans in California have a singularly high incidence of stomach cancer. The incidence rate (per 100,000) for Korean men (54.6) is nearly twice that of Vietnamese men (28.1) and over 5 times higher than that of non-Hispanic White men (9.5) (Table 3). Similarly, stomach cancer incidence rates for Korean females (27.5) are nearly twice as high as Vietnamese females (14.5) and over 7 times higher than non-Hispanic White females (3.8) (Table 3). Mortality due to stomach cancer was also the highest among Korean males and females in California (35.2/100,000 and 13.9/100,000, respectively) (Table 3). In general, the highest stomach cancer rates worldwide are found in Asia and parts of South America. Infection with Helicobacter pylori is thought to be an important risk factor for stomach cancer. Declines in stomach cancer in most industrialized counties during the latter part of the 20th century are likely due to improved hygiene; use of refrigeration rather than smoking, salting, or pickling to preserve foods; and antibiotic use.19 Worldwide, Korea has the highest incidence of stomach cancer for males and ranks third in the incidence of stomach cancer among females (Table 6). The unusually high rate of stomach cancer in Korea may be related to traditional dietary patterns in Korea, which include consumption of foods that are highly salted and rich in nitrites/nitrates.
Liver cancer incidence and mortality rates among Koreans residing in California are the highest of all of the Asian ethnic groups in females and the second highest in males. In Korea, the incidence of liver cancer ranks third worldwide for men and 15th for women (Table 6). This is likely related primarily to high prevalence of HBV infection in the Korean population. Koreans in California also have the highest proportion who report alcohol consumption in men (71.1%) and women (43.4%) among all Asian ethnic groups (Table 4).
Korean women have the second highest incidence and death rate from cervical cancer (Table 3); only two thirds of Korean women report receiving a Pap test in the last 3 years. Overall, Koreans have the lowest prevalence of nearly every type of screening examined: endoscopy, FOBT, Pap smears, and mammograms (Table 5). A high proportion of Korean immigrants are foreign-born, and half the population has limited facility with English (Table 2). Koreans also have the lowest proportion of individuals covered by health insurance and the highest proportion with no usual source of health care (Table 5).
Korean men have the second highest incidence and death rates from colorectal cancer, comparable with those of non-Hispanic White males (Figures 1 and 2). Low screening rates may contribute to these higher rates, since colorectal cancer screening may reduce the incidence of colorectal cancer by removal of precancerous polyps. Korean men have the highest lung cancer death rates among the Asian ethnic groups, although the incidence rate is the third largest. About 36% of Korean men are current smokers, the highest smoking prevalence among all Asian American ethnic groups examined (Table 4).
Japanese
High incidence rates for colorectal, stomach, prostate, and breast cancer were observed for Japanese Americans relative to other Asian American ethnic groups. Colorectal cancer incidence and mortality rates for Japanese males were higher than those of every other Asian ethnic group and even surpassed the rates for non-Hispanic Whites (Figures 1 and 2). Japanese females also had higher incidence of colorectal cancer than all other groups, including non-Hispanic Whites; however, their colorectal cancer mortality rate (15.1/100,000) was slightly lower than that of non-Hispanic White females (15.7/100,000) (Table 3). Diets high in processed and/or red meat and lacking sufficient intake of fruits and vegetables have been associated with an increased risk of colorectal cancer. Heavy alcohol consumption, physical inactivity, and overweight are also risk factors.19,30–33
CHIS data indicate that Japanese Americans exhibit a number of behavioral risk factors that could place them at risk for colorectal and other cancers. Most notable is the prevalence of overweight, which is defined as having a body mass index (BMI) greater than or equal to 25. The prevalence of overweight for Japanese males (52.5%) and females (28.3%) in California was greater than that of any other Asian ethnic group with the exception of Filipino females, although still lower than the prevalence for non-Hispanic Whites. A higher percentage of Japanese males (82.8%) reported that they did not meet physical activity guidelines compared with all other Asian subgroups and non-Hispanic Whites (78.3%) (Table 4). In addition, Japanese females reported a prevalence of current smoking of 15.6%, which was higher than all other Asian ethnic groups and similar to the prevalence among non-Hispanic Whites (15.9%) (Table 4). It is interesting to note that despite an historically low incidence of colorectal cancer in Japan, by 2002, Japan ranked fifth worldwide in colorectal cancer incidence for men and 21st for females (Table 6). The colorectal cancer rates in Japan are far higher than in any other Asian country, presumably reflecting changes in the Japanese dietary and behavior patterns as a result of "Westernization" in that country.
With respect to colorectal cancer screening behaviors, the prevalence of use among the Japanese was similar to that of non-Hispanic Whites, with the exception of FOBT screening within the past year, which was lower among Japanese males (10.4%) compared with non-Hispanic White males (20.4%). Rates of endoscopic colorectal cancer screening were more similar (48.1% for Japanese and 51.3% for non-Hispanic White males) (Table 5).
Dietary and behavioral factors associated with "Westernization" may also play a role in the high incidence of breast cancer observed for Japanese American females. Although the breast cancer incidence rate for Japanese females (102.8/100,000) is lower than that for non-Hispanic White females (152.9/100,000), it is the highest of all Asian American ethnic groups and twice as high as that for Korean (50.7/100,000) and Vietnamese (55.5/100,000) females (Table 3). Decreased age at menarche, late childbearing, fewer pregnancies, and increased use of postmenopausal hormone therapies are all factors that are prevalent in Western countries and associated with increased risk of breast cancer. It has also been suggested that the intake of soy and green tea, which are part of the Asian diet, may have protective effects against breast cancer.34 The prevalence of mammography within the past year was higher for Japanese Americans than for non-Hispanic Whites or any other Asian ethnic group; higher rates of mammography may also be associated with higher incidence rates.
The incidence and mortality rates for stomach cancer were also high among Japanese Americans. Japanese males and females in California had the third highest incidence rates (27.0/100,000 and 14.0/100,000, respectively) and second highest mortality rates (18.1/100,000 and 11.6/100,000, respectively) of stomach cancer compared with all other Asian ethnic groups (Table 3). As mentioned earlier, factors more common in developing countries, such as Helicobacter pylori infection, poor sanitation, and lack of refrigeration, increase the risk of stomach cancer. Despite industrialization, Japan ranked third and fifth for the incidence of stomach cancer among men and women, respectively, in 2002 (Table 6). Consumption of diets high in intake of salty and nitrite/nitrate rich food as part of the traditional Japanese diet may play a role.19,35–37
The similarity in screening behaviors between Japanese and non-Hispanic Whites may be the result of the long residency, high socioeconomic status, high prevalence of health insurance, and having a usual source of medical care in this population (Table 5).
|
CHALLENGES IN MONITORING CANCER OCCURRENCE, RISK FACTORS, AND SCREENING AMONG ASIAN SUBGROUPS |
|---|
|
TOPABSTRACTINTRODUCTIONDATA SOURCES FOR CANCER...BACKGROUND: IMMIGRATION HISTORYSOCIODEMOGRAPHICSCANCER INCIDENCE AND MORTALITY...CHALLENGES IN MONITORING CANCER...RESOURCES FOR CLINICIANSSUMMARYREFERENCES |
|---|
An example of possible misclassification was noted in the analysis of lung cancer incidence and mortality rates: while Korean men have the third highest incidence rates, they have the highest lung cancer death rate among the Asian ethnic groups. Factors that could have contributed to this discrepancy could include differences in survival rates or subtypes of lung cancer or differential misclassification of ethnicity in registry compared with death certificate data. Monitoring cancer occurrence among ethnic groups requires systematic recording of race/ethnicity, place of birth, and native language in health system records, as well as accurate intercensual population counts.
|
RESOURCES FOR CLINICIANS |
|---|
|
TOPABSTRACTINTRODUCTIONDATA SOURCES FOR CANCER...BACKGROUND: IMMIGRATION HISTORYSOCIODEMOGRAPHICSCANCER INCIDENCE AND MORTALITY...CHALLENGES IN MONITORING CANCER...RESOURCES FOR CLINICIANSSUMMARYREFERENCES |
|---|
In response to the need for linguistically appropriate cancer materials for lay audiences, the Asian American Network for Cancer Awareness, Research and Training (AANCART), a National Cancer Institute-funded Network, and the American Cancer Society have collaborated to produce a searchable Web portal for Asian language cancer materials for lay audiences (www.cancer.org/apicem or www.aancart.org/apicem). This Web portal serves as a single point of access for cancer education materials that have been translated into more than 12 Asian and Pacific Islander languages. Physicians and other health care providers are encouraged to use this Web-based tool to find medically sound, linguistically appropriate, and culturally competent materials for lay adults in selected Asian and Pacific Islander languages.
Clinicians should be aware of cancers that are more common in persons of Asian ethnicity than in other population groups. For example, the excess in liver cancer mortality among Asians overall, and particularly among Vietnamese and Korean men and women, is likely associated with a higher prevalence of chronic hepatitis B infection.46 Hepatitis B vaccination and hepatitis B-immune globulin administration are recommended to reduce the transmission of hepatitis B to neonates of mothers who are hepatitis B carriers, and the likelihood of cirrhosis and hepatocellular cancer among hepatitis B carriers can be reduced by antiviral treatment.47 Although no routine screening for stomach cancer is recommended in the United States, screening programs have been effective in reducing stomach cancer mortality in Japan, and a high index of suspicion, including diagnostic evaluation of symptomatic patients in high-risk subgroups, may be warranted.46 The prevalence of cervical cancer screening, which plays a critical role in both prevention and early detection of cervical cancer, is low for Chinese, Vietnamese, and Korean women; clinicians should encourage their female patients to have regular screening and HPV vaccination when appropriate.48 In addition, research should be done to better understand cultural barriers with respect to cancer.
|
SUMMARY |
|---|
|
TOPABSTRACTINTRODUCTIONDATA SOURCES FOR CANCER...BACKGROUND: IMMIGRATION HISTORYSOCIODEMOGRAPHICSCANCER INCIDENCE AND MORTALITY...CHALLENGES IN MONITORING CANCER...RESOURCES FOR CLINICIANSSUMMARYREFERENCES |
|---|
Thus, providers have the obligation to assist in overcoming linguistic and cultural barriers by using tools such as the American Cancer Society/AANCART's Asian and Pacific Islander Cancer Education Web portal as they strive to communicate cancer prevention and early detection messages to their Asian language-speaking patients. When examining patients of Asian ancestry for cancer, the scope of attention should extend beyond the typical chronic cancers and their risk factors to those cancers of infectious origins, as well. Tobacco use is a common risk factor for most populations, including non-Hispanic Whites and Asian American ethnic groups; therefore, focusing on smoking cessation and reducing secondhand tobacco smoke exposure is always warranted.
As one of the fastest growing racial/ethnic components of the US population, the Asian American population has a cancer burden that deserves special attention. Asian Americans are heterogeneous with cultures, languages, malignancies, and risk factors specific to each of the populations aggregated within this group. Efforts to improve the quality of nationwide cancer incidence, mortality, and behavioral risk factor data for each of the Asian American ethnic populations should be made to better address the cancer burden among Asian Americans and help prevent its future occurrence.
|
Acknowledgments |
|---|
|
REFERENCES |
|---|
|
TOPABSTRACTINTRODUCTIONDATA SOURCES FOR CANCER...BACKGROUND: IMMIGRATION HISTORYSOCIODEMOGRAPHICSCANCER INCIDENCE AND MORTALITY...CHALLENGES IN MONITORING CANCER...RESOURCES FOR CLINICIANSSUMMARYREFERENCES |
|---|
This article has been cited by other articles:
|
|
 |
|
  M. Kagawa-Singer, A. Valdez Dadia, M. C. Yu, and A. Surbone Cancer, Culture, and Health Disparities: Time to Chart a New Course? CA Cancer J Clin, January 1, 2010; 60(1): 12 - 39. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. X. Truong, V. T. C. Mai, H. Tanaka, L. T. Ly, T. M. Thong, H. H. Hai, D. Van Long, K. Furumatsu, M. Yoshida, H. Kutsumi, et al. Diverse Characteristics of the cagA Gene of Helicobacter pylori Strains Collected from Patients from Southern Vietnam with Gastric Cancer and Peptic Ulcer J. Clin. Microbiol., December 1, 2009; 47(12): 4021 - 4028. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Tomida, T. Takeuchi, Y. Shimada, C. Arima, K. Matsuo, T. Mitsudomi, Y. Yatabe, and T. Takahashi Relapse-Related Molecular Signature in Lung Adenocarcinomas Identifies Patients With Dismal Prognosis J. Clin. Oncol., June 10, 2009; 27(17): 2793 - 2799. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Teas, T. G. Hurley, J. R. Hebert, A. A. Franke, D. W. Sepkovic, and M. S. Kurzer Dietary Seaweed Modifies Estrogen and Phytoestrogen Metabolism in Healthy Postmenopausal Women J. Nutr., May 1, 2009; 139(5): 939 - 944. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H.-R. Han, H. Lee, M. T. Kim, and K. B. Kim Tailored lay health worker intervention improves breast cancer screening outcomes in non-adherent Korean-American women Health Educ. Res., April 1, 2009; 24(2): 318 - 329. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. M. Taylor, T. T. Nguyen, J. C. Jackson, and S. J. McPhee Cervical Cancer Control Research in Vietnamese American Communities Cancer Epidemiol. Biomarkers Prev., November 1, 2008; 17(11): 2924 - 2930. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Hou, D. Wang, R. Zhang, and H. Wang Experimental Therapy of Hepatoma with Artemisinin and Its Derivatives: In vitro and In vivo Activity, Chemosensitization, and Mechanisms of Action Clin. Cancer Res., September 1, 2008; 14(17): 5519 - 5530. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. W. Ward Time for Renewed Commitment to Viral Hepatitis Prevention Am J Public Health, May 1, 2008; 98(5): 779 - 781. [Full Text] [PDF]
|
|
|
|
|
|
R. A. Smith, V. Cokkinides, and O. W. Brawley Cancer Screening in the United States, 2008: A Review of Current American Cancer Society Guidelines and Cancer Screening Issues CA Cancer J Clin, May 1, 2008; 58(3): 161 - 179. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Sankaranarayanan Commentary: Cancer incidence among Asian Indians in India and abroad Int. J. Epidemiol., February 1, 2008; 37(1): 160 - 161. [Full Text] [PDF]
|
|
Read all eLetters
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | COVER ARCHIVE | SEARCH | TABLE OF CONTENTS |
