Colorectal Cancer Screening among Chinese, Cambodian, and Vietnamese Immigrants in Chicago

Barriers to Colorectal Cancer Screening in US Immigrants: A Scoping Review

INTRODUCTION

Timely colorectal cancer (CRC) screening has been shown to improve CRC-related morbidity and mortality rates. However, even with this preventative care tool, CRC screening rates remain below 70% among eligible United States (US) adults, with even lower rates among US immigrants. The aim of this scoping review is to describe the barriers to CRC screening faced by this unique and growing immigrant population and discuss possible interventions to improve screening.

METHODS

Four electronic databases were systematically searched for all original research articles related to CRC screening in US immigrants published after 2010. Following a full-text review of articles for inclusion in the final analysis, data extraction was conducted while coding descriptive themes. Thematic analysis led to the organization of this data into five themes.

RESULTS

Of the 4637 articles initially identified, 55 met inclusion criteria. Thematic analysis of the barriers to CRC screening identified five unique themes: access, knowledge, culture, trust, health perception, and beliefs. The most cited barriers were in access (financial burden and limited primary care access) and knowledge (CRC/screening knowledge).

CONCLUSIONS

US immigrants face several barriers to the receipt of CRC screening. When designing interventions to increase screening uptake among immigrants, gaps in physician and screening education, access to care, and trust need to be addressed through culturally sensitive supports. These interventions should be tailored to the specific immigrant group, since a one-size-fits approach fails to consider the heterogeneity within this population.

Cancer Screening Literacy among Vietnamese Population: Does Annual Checkup Improve Cancer Screening Literacy?

BACKGROUND

Colorectal, breast, and cervical cancers disproportionately impact the Vietnamese population. However, research on cancer prevention among this population was very limited. The purpose of this study is to examine the cancer screening literacy levels for these three types of cancers among rural Vietnamese and investigate correlates of cancer screening literacy.

METHODS

A sample of 226 Vietnamese men and women aged 25-70 years old was recruited from rural Vietnam and finished a self-administered questionnaire. Andersen's Behavioral Model was used to guide this cross-sectional study to identify modifiable variables. Bivariate analysis was used to explore the relationship between demographic factors and cancer screening literacy levels. Multiple linear regressions were also used to identify significant factors for cancer literacy levels.

RESULTS

Cancer screening literacy levels of Vietnamese men and women were low regarding all three types of cancers, especially HPV symptom questions. Only about 24% of women answered correctly on "most people with genital HPV have no visible signs/symptoms" and less than 18% answered correctly on "I can transmit HPV to my partner(s) even if I have no HPV symptoms." Findings suggested that having an annual checkup was associated with higher colorectal (β=.15, p <.05), breast (β=.25, p <.001), and cervical (β=.18, p <.01) cancer screening literacy.

CONCLUSIONS

Public health efforts should focus on encouraging annual checkups in the Vietnamese population. During the annual checkup, health care professionals should educate patients about importance of cancer screening and provide recommendations for regular cancer screenings to reduce cancer health disparities.

A national study of gender and racial differences in colorectal cancer screening among foreign-born older adults living in the US

This study examined within group heterogeneity in colorectal cancer screening (CRCS) among foreign-born individuals. Data were from the 2010, 2013 and 2015 National Health Interview Survey data on older adults (N = 5529). In 2018, multivariable logistic regression analysis was conducted to determine whether gender and race/ethnicity were associated with CRCS after controlling for sociodemographic, health access, and acculturation related factors. Overall, Asians were significantly less likely to report CRCS compared with Whites (aOR 0.63, CI 0.52-0.76). Hispanic race/ethnicity was negatively associated with CRCS among men (aOR 0.68, CI 0.50-0.91), but not women compared to white men/women, respectively. Additionally, factors associated with CRCS include having fair/poor health, usual source of care, insurance, ≥ 10 years of US residency and citizenship. Screening disparities experienced by these immigrants may be addressed by improving healthcare access, especially for noncitizens and those with limited healthcare access.

Colorectal cancer screening prevalence and predictors among Asian American subgroups using Medical Expenditure Panel Survey National Data

BACKGROUND

Asian American (AA) ethnic subgroups are diverse in socio-economic status, years in the United States, English proficiency, and cultures with different health seeking behaviors and health care access. Fifty-two percent of AAs age ≥50 years had colorectal cancer screening (CRCS) in 2013, compared with 61% of non-Hispanic whites. We hypothesized that CRCS prevalence among AA ethnicities is heterogeneous and that the reasons related to CRCS among AA subgroups are associated with demographic characteristics, acculturation, health care access, and health attitudes.

METHODS

Medical Expenditure Panel Survey data for 2009-2014 compared CRCS status among whites (n = 28,834), Asian Indians (n = 466), Chinese (n = 652), and Filipinos (n = 788). Multivariate logistic regression examined ethnic differences and correlates of CRCS accounting for complex sampling design.

RESULTS

Whites had the highest prevalence of screening (62.3%), followed by Filipinos (55.0%), Chinese (50.9%), and Asian Indians (48.6%). Older age, having health insurance, and having a usual care provider predicted CRCS across all ethnicities. Different demographic, health care access, and health attitude predictors within each ethnic group were related to CRCS.

CONCLUSION

This study contributes to the literature on influences of differential CRCS prevalence among AA subgroups. CRCS promotion should be tailored according to attitudes and structural barriers affecting screening behavior of specific ethnic subgroups to truly serve the health needs of the diverse AA population. Cancer 2018;124:1543-51. © 2018 American Cancer Society.

Wnt/catenin β1/microRNA 183 predicts recurrence and prognosis of patients with colorectal cancer

The present study assessed the association between the Wnt/catenin β1 (CTNNB1)/microRNA (miR)183 signaling pathway and the recurrence and prognosis of colorectal cancer. The expression of Wnt, CTNNB1 and miR183 in primary colorectal cancer tissue was increased compared with that in the paracarcinoma tissue. Disease-free survival and overall survival were decreased in patients with colorectal cancer and increased miR183 expression compared with those in patients with colorectal cancer and decreased miR183 expression. The human colorectal cancer cell line HCT-116 was treated with 5 µM inhibitor of Wnt response (IWR-2) for 24 h to inhibit Wnt protein expression. Downregulating Wnt and CTNNB1 expression inhibited the viability of, and induced cell death and caspase 3 protein expression in, HCT-116 cells. The expression of BCL2 associated X protein and miR183 was increased, and cyclin D1 protein expression was suppressed, by the downregulation of Wnt and CTNNB1 expression in HCT-116 cells. Collectively, the results of the present study suggested that the Wnt/CTNNB1/miR183 signaling pathway may represent a promising biomarker for the recurrence and prognosis of colorectal cancer.

Risk of colorectal cancer among immigrants to Ontario, Canada

Background

The risk of colorectal cancer (CRC) varies around the world and between females and males. We aimed to compare the risk of CRC among immigrants to Ontario, Canada, to its general population.

Methods

We used an exposure-control matched design. We identified persons in the Immigration, Refugees and Citizenship Canada Permanent Resident Database with first eligibility for the Ontario Health Insurance Plan between July 1, 1991 and June 30, 2008 at age 40 years or older, and matched five controls by year of birth and sex on the immigrant’s first eligibility date. We identified CRC from the Ontario Cancer Registry between the index date and December 31, 2014. All analyses were stratified by sex. We calculated crude and relative rates of CRC. We estimated risk of CRC over time by the Kaplan-Meier method and compared immigrants to controls in age and sex stratified strata using log-rank tests. We modeled the hazard of CRC using Cox proportional hazards regression, accounting for within-cluster correlation by a robust sandwich variance estimation approach, and assessed an interaction with time since eligibility.

Results

Among females, 1877 cases of CRC were observed among 209,843 immigrants, and 16,517 cases among 1,049,215 controls; the crude relative rate among female immigrants was 0.623. Among males, 1956 cases of CRC were observed among 191,792 immigrants and 18,329 cases among 958,960 controls; the crude relative rate among male immigrants was 0.582.. Comparing immigrants to controls in all age and sex stratified strata, the log rank test p < 0.0001 except for females aged > = 75 years at index, where p = 0.01. The age-adjusted hazard ratio (HR) for CRC among female immigrants was 0.63 (95% CI 0.59, 0.67) during the first 10 years, and 0.66 (95% CI 0.59, 0.74) thereafter. Among male immigrants the age-adjusted HR = 0.55 (95% CI 0.52, 0.59) during the first 10 years and increased to 0.63 (95% CI 0.57, 0.71) thereafter. The adjusted HR > = 1 only among immigrants born in Europe and Central Asia.

Conclusions

The risk of CRC among immigrants to Ontario relative to controls varies by origin and over time since immigration.

Predictors of Colorectal Cancer Knowledge and Screening Among Asian Americans Aged 50-75 years old

Colorectal cancer, the second leading cause of mortality in the USA, can be prevented with colorectal cancer screening. However, many people who should receive the screening do not get screened. To learn more, this study estimated the prevalence of up-to-date colorectal cancer (CRC) screening and examined the relationship between CRC knowledge and screening compliance among Asian Americans living in the Baltimore-Washington Metropolitan area. The study included a cross-sectional sample of 274 Chinese, Korean, and Vietnamese Americans aged 50-75 years old. Participants completed a questionnaire regarding CRC knowledge in either their preferred native language or in English, and data were collected in person. The percentage of total participants with up-to-date overall CRC screening was 52.9%. Up-to-date fecal occult blood test (FOBT) screening was 15.0% and colonoscopy was 50.7%. The average CRC knowledge score was 6.10 out of 9 (SD = 2.91). Those with high education, high English proficiency, married, health insurance, and good physical health ratings had higher CRC knowledge. In multivariate analysis, CRC knowledge was significantly correlated with increasing up-to-date colonoscopy (aOR = 2.74, 1.13-6.64). Having health insurance (aOR = 4.40, 2.33-8.32) was another predictor of up-to-date colonoscopy. These findings suggest that CRC knowledge is a strong predictor of CRC screening behavior in Asian American populations. Lack of CRC screening knowledge still remains an important barrier to screening, and increased public awareness is necessary to achieve greater screening compliance.