摘要：Objectives. We examined patterns of cervical and breast cancer screening among Asian American women in California and assessed their screening trends over time. Methods. We pooled weighted data from 5 cycles of the California Health Interview Survey (2001, 2003, 2005, 2007, 2009) to examine breast and cervical cancer screening trends and predictors among 6 Asian nationalities. We calculated descriptive statistics, bivariate associations, multivariate logistic regressions, predictive margins, and 95% confidence intervals. Results. Multivariate analyses indicated that Papanicolaou test rates did not significantly change over time (77.9% in 2001 vs 81.2% in 2007), but mammography receipt increased among Asian American women overall (75.6% in 2001 vs 81.8% in 2009). Length of time in the United States was associated with increased breast and cervical cancer screening among all nationalities. Sociodemographic and health care access factors had varied effects, with education and insurance coverage significantly predicting screening for certain groups. Overall, we observed striking variation by nationality. Conclusions. Our results underscore the need for intervention and policy efforts that are targeted to specific Asian nationalities, recent immigrants, and individuals without health care access to increase screening rates among Asian women in California. Cancer is the leading cause of death among Asian American women, with breast cancer and cervical cancer being 2 of the most commonly diagnosed types of cancer among this population. 1–6 Although Asian American women have lower mortality rates for breast cancer compared with women from other racial/ethnic groups, existing research suggests that they have later cancer stage at diagnosis, 3 younger age at diagnosis, 7 and poorer survival among certain subgroups. 8,9 Notably, studies have highlighted significant variation in cancer risk factors and differential cancer burden among Asian nationalities. 4–6 Therefore, researchers have increasingly made efforts to disaggregate data on Asian Americans for analyses to identify subgroup differences. In one study conducted in California, McCracken et al. 10 found that Vietnamese women had the highest mortality rates for cervical cancer, whereas Filipino women had the highest mortality rates for breast cancer. Another study conducted by Bates et al. 11 found that Vietnamese and Korean women had the highest rates of cervical cancer mortality compared with other Asian women and White women. Despite a clear need for cancer screening among all Asian American women, their screening rates for breast and cervical cancers remain well below national objectives promoted by Healthy People 2020 . 12,13 Miller et al. 2 found that 73.7% of all Asian women reported a mammogram in the past 2 years—nearly 10% lower than the Healthy People 2020 objectives of 81.1%, and lower than all other racial/ethnic groups except for American Indians or Alaska natives. 12 In addition, Asian American women consistently have the lowest rates of cervical cancer screening, with 65.6% reporting a Papanicolaou (Pap) test in 2008. 2 This rate was almost 10% lower than screening rates for White women and nearly 30% lower than the national recommendation of 93.0%. 12 Additional research has noted that these disparities in breast and cervical cancer screening among Asian women have persisted over time for many groups. 14–19 Asian American women experience significant challenges and barriers to cancer screening, with notable differences by Asian nationality. Some factors associated with this heterogeneity include disparate levels of access to care, 20–27 socioeconomic status, 26–28 English proficiency, 29,30 immigration status and length of US residency, 23–25,27,31–33 screening-related knowledge, 24,34,35 and health beliefs among Asian women. 22,26,35,36 Studies have also documented that several Asian communities tend to use health care services for treatment rather than for prevention. 37–39 Available research suggests that Asian American orientation toward preventive behaviors includes using complementary and alternative medicine rather than health care services for prevention of disease and may be influenced by low knowledge levels about the technology of Pap tests and mammograms. 40–42 Additionally, studies have found that some Asian American communities associate cancer with “a death sentence” and describe fatalism as a barrier to cancer screening. 43–45 Until release of the California Health Interview Survey (CHIS), population-based data on Asian Americans were limited by small sample sizes that prevented the ability to disaggregate data on Asian American subgroups. One study that used CHIS data found a wide range of screening rates among Asian American women, with certain groups facing greater disadvantage, such as Vietnamese and Southeast Asian women. 46 However, this study did not examine changes in cancer screening trends over time. In our study, we pooled data from the 2001 to 2009 CHIS to assess breast and cervical cancer screening rates for 6 different Asian American subgroups and examined the following research questions: What are the patterns of breast and cervical cancer screening among Asian American women in California, and how have they changed over time? Which subgroups of Asian American women have lower screening rates? What differences and similarities exist in factors associated with screening use among Asian Americans? Findings from this research may provide helpful insights for interventions targeting Asian American women and for future research in this diverse population.
