Asian American and Pacific Islander breast and cervical carcinoma screening rates and healthy people 2000 objectives.
BACKGROUND
Breast carcinoma is the number one cause of cancer-related mortality among Asian American and Pacific Islander (AAPI) women, and for certain subgroups cervical carcinoma is among the top three causes. Yet AAPI women have the lowest cancer screening and early detection rates of all ethnic groups. The practice of merging AAPI data hides significant variation among AAPI groups, and the groups at highest risk for late presentation of disease become invisible. To the authors' knowledge, this study is the first report of disaggregated national data for breast and cervical carcinoma screening in AAPI subpopulations. The authors used data from the National Health Interview Survey (NHIS 1993 and 1994) and evaluated major socioeconomic and access variables associated with screening practices.


METHODS
Healthy People 2000 (HP2000) criteria were used to evaluate the most recent NHIS screening rates for AAPIs as one group and for six distinct subgroups compared with HP2000 criteria. The sample included 2756 non-Hispanic AAPI and 64,196 non-Hispanic white women age 18 years or older in the 1993 and 1994 NHIS. The effects of socioeconomic and access-to-care indicators on screening were explored.


RESULTS
Breast and cervical carcinoma screening rates for AAPIs were below those for white women and well below national goals and guidelines. Lack of insurance, low income, and lack of a usual source of care had a significantly greater negative impact on AAPIs than on white women, indicating that AAPIs may be more vulnerable to structural barriers to cancer control efforts.


CONCLUSIONS
AAPI women have very low rates of breast and cervical screening, which increases their chances of later stage disease presentation. To reach the Healthy People 2000 objectives, targeted efforts are needed to increase cancer screening among AAPI women overall and specific subgroups in particular.
Department of Community Health Sciences and Asian American Studies, UCLA School of Public Health, Los Angeles, California 90095-1772, USA.
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Kagawa-Singer
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Pourat
D000328:Adult; D001213:Asian / Q000706:statistics & numerical data*; D001943:Breast Neoplasms / Q000453:epidemiology / Q000208:ethnology* / Q000517:prevention & control*; D005260:Female; D006297:Health Services Accessibility; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D008327:Mammography / Q000706:statistics & numerical data; D008403:Mass Screening / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000208:ethnology* / Q000517:prevention & control*; D014626:Vaginal Smears / Q000706:statistics & numerical data