Hidden breast cancer disparities in Asian women: disaggregating incidence rates by ethnicity and migrant status.

OBJECTIVES: We estimated trends in breast cancer incidence rates for specific Asian populations in California to determine if disparities exist by immigrant status and age. METHODS: To calculate rates by ethnicity and immigrant status, we obtained data for 1998 through 2004 cancer diagnoses from the California Cancer Registry and imputed immigrant status from Social Security Numbers for the 26% of cases with missing birthplace information. Population estimates were obtained from the 1990 and 2000 US Censuses. RESULTS: Breast cancer rates were higher among US- than among foreign-born Chinese (incidence rate ratio [IRR] = 1.84; 95% confidence interval [CI] = 1.72, 1.96) and Filipina women (IRR = 1.32; 95% CI = 1.20, 1.44), but similar between US- and foreign-born Japanese women. US-born Chinese and Filipina women who were younger than 55 years had higher rates than did White women of the same age. Rates increased over time in most groups, as high as 4% per year among foreign-born Korean and US-born Filipina women. From 2000-2004, the rate among US-born Filipina women exceeded that of White women. CONCLUSIONS: These findings challenge the notion that breast cancer rates are uniformly low across Asians and therefore suggest a need for increased awareness, targeted cancer control, and research to better understand underlying factors.

Why do Asian-American women have lower rates of breast conserving surgery: results of a survey regarding physician perceptions.

BACKGROUND: US Asian women with early-stage breast cancer are more likely to receive a modified radical mastectomy (MRM) than White women, contrary to clinical recommendations regarding breast conserving treatment (BCT). METHODS: We surveyed physicians regarding treatment decision-making for early-stage breast cancer, particularly as it applies to Asian patients. Physicians were identified through the population-based Greater Bay Area Cancer Registry. Eighty (of 147) physicians completed a questionnaire on sociodemographics, professional training, clinical practices, and perspectives on the treatment decision-making processes. RESULTS: The most important factors identified by physicians in the BCT/MRM decision were clinical in nature, including presence of multifocal disease (86% identified this as being an important factor for selecting MRM), tumor size (71% for MRM, 78% for BCT), cosmetic result (74% for BCT), and breast size (50% for MRM, 55% for BCT). The most important reasons cited for the Asian treatment patterns were patient attitudes toward not needing to preserve the breast (53%), smaller breast sizes (25%), and fear and cultural beliefs (12%). CONCLUSION: These survey results suggest that physicians perceive major roles of both clinical and cultural factors in the BCT/MRM decision, but cultural factors may be more relevant in explaining surgical treatment patterns among Asians.

Effectiveness of continuing medical education in increasing colorectal cancer screening knowledge among Vietnamese American physicians.

Colorectal cancer (CRC) screening rates are lower in Vietnamese Americans than in non-Hispanic Whites. Most Vietnamese Americans have ethnically concordant physicians and are willing to have CRC screening if their physicians recommend it. We conducted two continuing medical education (CME) seminars with participants recruited from the Vietnamese Physician Association of Northern California to increase their CRC screening knowledge. We used pre- and post-CME surveys to evaluate the CMEs and per-item McNemar's tests to assess changes in knowledge. Correct responses increased significantly from pre- to post-CME for all five items on CRC burden and four of 11 items on screening guidelines and practices at the first CME and for five of seven items on screening guidelines and practices at the second CME. Continuing medical education seminars were effective in increasing CRC screening knowledge among Vietnamese American physicians. This increase may lead to physicians' recommending and their patients' completing CRC screening tests.