title: Low rates of colorectal, cervical, and breast cancer screening in Asian Americans compared with non-Hispanic whites: Cultural influences or access to care?
abstract: BACKGROUND
  Asian Americans have lower cancer screening rates compared with non-Hispanic whites (NHWs). Little is known about mechanisms that underlie disparities in cancer screening. The objectives of the current study were 1) to determine the relation between nativity, years in the United States, language, and cancer screening in NHWs and Asian Americans, independent of access to care and 2) to determine whether Asians reported different reasons than NHWs for not obtaining cancer screening.
  
  
  METHODS
  This population-based study included 36,660 NHWs, 1298 Chinese, 944 Filipinos, 803 Koreans, 857 Vietnamese, and 1036 Other Asians from the 2001 California Health Interview Survey. The main study outcomes were 1) self-reported colorectal, cervical, and breast cancer screening and 2) reasons for not obtaining cancer screening.
  
  
  RESULTS
  After adjusting for access to care, several Asian subgroups still had significantly lower rates of all types of cancer screening compared with NHWs. Adjusting for nativity, years in the United States, and English language attenuated the relation between Asian ethnicity and lower rates of colorectal and breast cancer screening. When they were asked what the most important reason was for not having each screening test, foreign-born Asians were significantly more likely than United States-born NHWs to report that they "didn't have problems/symptoms" (P < .01).
  
  
  CONCLUSIONS
  Nativity, years in the United States, and English language may be markers of cultural differences that are mediating cancer screening disparities. Foreign-born Asians may believe that cancer screening is in response to symptoms rather than tests that are used prior to the development of symptoms. Health education messages must consider how to communicate effectively that "cancer screening is valuable, because it finds cancer before it is advanced enough to cause symptoms."
authors.affiliation: Division of General Internal Medicine, Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois 60611, USA. n-kandula@northwestern.edu
authors.forename: Namratha R
authors.initials: NR
authors.lastname: Kandula
authors.forename: Ming
authors.initials: M
authors.lastname: Wen
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Jacobs
authors.forename: Diane S
authors.initials: DS
authors.lastname: Lauderdale
mesh_terms: D000328:Adult; D001213:Asian; D001943:Breast Neoplasms / Q000175:diagnosis / Q000208:ethnology; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000208:ethnology; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000208:ethnology*; D014481:United States / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000208:ethnology; D044465:White People