By Holly Tenaglia, DNP, APRN, AGCNS-BC, OCN®
The leading cause of death for most of the U.S. population is heart disease, but since 2000, the Asian American, Native Hawaiian, and Pacific Islander (AANHPI) community has been the only racial and ethnic group whose leading cause of death is cancer. One of the fastest-growing minorities in the United States—currently comprising about 6% of the population—the AANHPI community traces its roots to more than 20 countries across Asia and the Pacific Islands. It is a vastly heterogenous group consisting of people with various languages and cultural backgrounds.
Cancer Disparities
Although they are less likely to be diagnosed with prostate and breast cancer, AANHPI patients have a higher likelihood of having stomach or liver cancer compared to the non-Hispanic White population. Community-related risk factors that may contribute include:
- Exposure to cultural-specific carcinogens, such as high pickled vegetable consumption (Koreans have the highest rate of stomach cancer.)
- Higher incidence of infectious diseases such as hepatitis B virus (liver cancer) and Helicobacter pylori (stomach cancer) in their countries of origin
The AANHPI community also has cancer disparities within itself. For example, when broken into subgroups, data demonstrated that although breast cancer was the most common cause of new cancer diagnoses in 18 subgroups, lung cancer was the most common for Chamoru, Micronesian, and Vietnamese patients whereas colorectal cancer was most common among Cambodian, Hmong, Laotian, and Papua New Guinean patients. Additionally, the Republic of the Marshall Islands experiences the highest incidence of cervical cancer in the world.
Consulting disaggregated data may reveal more barriers and disparities in the AANHPI community. Because of the community’s heterogeneity, use of aggregated data often masks disparities in genetic and cultural risk factors among AANHPI subgroups, such as the increased rate of epidermal growth factor receptor–related lung cancer in Chinese women despite having lower rates of smoking history. Disaggregated data demonstrates the wide disparities in social determinants of health related to household income, education, immigration status, and health insurance status among various AANHPI subgroups.
Screening Barriers
Cervical, breast, and colorectal cancer screening rates are very low in the AANHPI community when compared to the overall American population, even when accounting for socioeconomic factors such as income, education, and healthcare access. Although the community’s health-seeking behaviors and beliefs vary widely, many AANHPI subgroups hold a stigma about cancer that may contribute to screening avoidance.
Additionally, many cancer screening procedures challenge cultural-specific beliefs about preservation of modesty. In a phenomenologic study of Chinese women’s experiences with cervical cancer screening, a majority of study participants reported experiencing cultural perceptions of shame with discussing sexual organs, even with a healthcare provider.
What Nurses Can Do
Because of the group’s vastly diverse languages and cultural backgrounds, culturally tailored and community-based interventions are the most effective strategy to reduce barriers and resulting disparities. For example:
- The Hawaii Comprehensive Cancer Coalition engaged in a culturally and linguistically tailored media campaign to increase hepatitis B vaccination throughout the state to address the high rate of liver cancer in the AANHPI community.
- Similarly, researchers partnered with Korean church-based organizations in the Philadelphia–New Jersey region to successfully increase colorectal screening through the use of culturally and linguistically tailored education, health system navigation, and fecal immunochemical tests.
- In a meta-analysis of strategies to increase mammography screening among Asian patients, the most successful approaches focused on access-enhancing interventions and culturally appropriate information to target individuals’ beliefs, not just linguistically adapted educational support.
Strategies to eliminate cancer disparities and the effects of social determinants of health must be multifaceted and culturally appropriate. Oncology nurses have a responsibility to educate themselves, patients, and other providers about cancer disparities in the AANHPI community and lead and participate in programs that improve healthcare access. By demonstrating a commitment to health equity for all patients, oncology nurses can help improve the lives of their patients, families, and communities.