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| OHSU Researcher Frances Lee-Lin |
Frances Lee-Lin, a researcher and assistant professor at Oregon Health & Science University, recently completed a study that focused on cancer screening rates among Chinese-American immigrant women in Portland. Her goal? To better understand knowledge and beliefs about mammograms and Pap smears in an effort to lay the groundwork for more effective ways to communicate the importance of regular cancer screenings.
Early detection of breast and cervical cancers through regular mammography and Pap smears makes it possible for health care providers to diagnose cancer before they start to cause symptoms. According to the American Cancer Society, finding cancers as early as possible improves the likelihood that treatment will be successful.
“Asian-American women have low screening rates and are often diagnosed at later stages of the disease. They also are generally afraid to talk about cancer,” said Lee-Lin, an assistant professor at the OHSU School of Nursing. She recently earned a Ph.D. degree in nursing at the University of Utah, focusing on oncology.
Her study – funded by a two-year grant from the American Cancer Society – builds on her previous research that focused on the informational needs of recently diagnosed Chinese-American cancer patients.
In recent years, Americans have become more knowledgeable about and open about discussing breast and cervical cancers, thanks to a growing awareness about the diseases. The increasing number of cancer survivors who are willing to talk about cancer has helped increase knowledge about the importance of screening, prevention and modes of treatment.
“Among Asian-Americans— especially older people or those who have it – people don’t want to talk about cancer. Cancer means death, so people don’t talk about it and many may not know that there are survivors within our community,” she says.
Lee-Lin’s study included 100 Chinese-American immigrant women in the Portland area – ranging in age from 40 to 91 – who completed a written survey. Respondents have immigrated to the U.S. as early as age 9 and as late as age 70, with the mean age at 38.8.
Recent immigrants, as well as women who have spent most of their adult life in the U.S., completed the survey. Some survey participants have lived in the U.S. for as little as one month and for as long as 43 years, with the average length of U.S. residence at 17. 5 years.
Respondents were given the choice to complete the survey in English and Mandarin, available in simplified and traditional Chinese. Only 7 percent of respondents chose to fill out the survey in English. About 48 percent of those who completed the survey said they have either a college or graduate degree, while 18 percent had elementary level or no formal education.
Some 47 percent reported earning less than $30,000, while 26 percent earned more than $100,000. Twenty-three percent did not report their income. “Those who did not report their income were also less likely to have had a recent mammography. This could be related to a health insurance issue,” she says.
Thirteen percent of respondents reported that they have no health insurance, while 77 percent have a regular health care provider. Of these respondents, about 57 percent reported having a female health care provider, while 76 percent said that their provider is non-Asian. “Health insurance is very important, because that means that you have a regular health care provider and having him/her tell you that you need to do regular screening,” Lee-Lin says.
Previous studies have shown that women with immediate family members who have had breast cancer tend to have higher mammography screening rates. Some 72% of respondents indicated that they have close relatives with breast cancer.
However, only 36 percent responded that they knew someone with cervical cancer. This finding is interesting, considering the incidence and death rates of cervical cancer is higher among Asian women than whites. “Cervical cancer is not a disease that people don’t feel comfortable talking about,” she says.
About 26% knew that being overweight increased their risk for breast cancer, and only 36% knew that breast cancer risk increases with age.
While 86 percent of survey respondents indicated that they have had a mammogram, only 48.5 percent had the screening done within the last year. It is recommended that women age 40 and above have annual mammograms, Lee-Lin says.
Some 84 percent reported they’ve had a Pap smear, but only 68 percent had the screening completed within the past year. “Having a mammography or Pap smear done once is not going to save your life. The concept that needs to be communicated to the Asian community is that you need regular adherence to the screening guidelines for breast and cervical cancers,” she says.
Respondents who have a high barrier score also were less likely to have regular mammograms and Pap smears. Among the six “barriers” that prevented women from having regular screenings include: trouble remembering when to get mammography; believe or experience mammography is painful; afraid of being exposed to x-rays; didn’t think that a mammography is important; did not have time; and language barrier.
Lee-Lin’s study sheds light on important health education issues and approaches that would be most effective for increasing screening rates among Chinese-American immigrant women. She is now working on modifying her study to focus on Japanese- American and Vietnamese-American women. Based on those findings, she hopes to come up with ways that cancer screening rates can be improved among these groups as well.
“We have so many subgroups of Asians – we are different, but in many ways, we share similarities. In terms of cancer screening, how different are we? We need to find it out, so we can target more effective intervention studies for our subgroups,” says Lee-Lin.
Lee-Lin says she’s interested in working with Japanese-American and Vietnamese-American community groups to identify potential respondents for the next phase of her study. For more information, e-mail leelinf@ohsu.edu.