Trinh Quoc-Dien, Li Hanhan, Meyer Christian P, Hanske Julian, Choueiri Toni K, Reznor Gally, Lipsitz Stuart R, Kibel Adam S, Han Paul K, Nguyen Paul L, Menon Mani, Sammon Jesse D
Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 45 Francis Street, Boston, MA, 02115, USA.
Vattikuti Urology Institute Center for Outcomes Research, Henry Ford Health System, Detroit, MI, USA.
Cancer Causes Control. 2016 Aug;27(8):989-98. doi: 10.1007/s10552-016-0776-8. Epub 2016 Jul 2.
Recent data suggest that Asian-Americans (AsAs) are more likely to present with advanced disease when diagnosed with cancer. We sought to determine whether AsAs are under-utilizing recommended cancer screening.
Cross-sectional analysis of the 2012 Behavioral Risk Factor Surveillance System comprising of AsAs and non-Hispanic White (NHW) community-dwelling individuals (English and Spanish speaking) eligible for colorectal, breast, cervical, or prostate cancer screening according to the United States Preventive Services Task Force recommendations. Age, education and income level, residence location, marital status, health insurance, regular access to healthcare provider, and screening were extracted. Complex samples logistic regression models quantified the effect of race on odds of undergoing appropriate screening. Data were analyzed in 2015.
Weighted samples of 63.3, 33.3, 47.9, and 30.3 million individuals eligible for colorectal, breast, cervical, and prostate cancer screening identified, respectively. In general, AsAs were more educated, more often married, had higher levels of income, and lived in urban/suburban residencies as compared to NHWs (all p < 0.05). In multivariable analyses, AsAs had lower odds of undergoing colorectal (odds ratio [OR] 0.78, 95 % confidence interval [CI] 0.63-0.96), cervical (OR 0.45, 95 % CI 0.36-0.55), and prostate cancer (OR 0.55, 95 % CI 0.39-0.78) screening and similar odds of undergoing breast cancer (OR 1.29, 95 % CI 0.92-1.82) screening as compared to NHWs.
AsAs are less likely to undergo appropriate screening for colorectal, cervical, and prostate cancer. Contributing reasons include limitations in healthcare access, differing cultural beliefs on cancer screening and treatment, and potential physician biases. Interventions such as increasing healthcare access and literacy may improve screening rates.
近期数据表明，亚裔美国人（AsAs）被诊断出患有癌症时，更有可能呈现出病情已发展至晚期的情况。我们试图确定亚裔美国人是否未充分利用推荐的癌症筛查。
对2012年行为危险因素监测系统进行横断面分析，该系统涵盖符合美国预防服务工作组建议、有资格进行结直肠癌、乳腺癌、宫颈癌或前列腺癌筛查的亚裔美国人和非西班牙裔白人（NHW）社区居住个体（说英语和西班牙语）。提取年龄、教育程度和收入水平、居住地点、婚姻状况、医疗保险、是否能定期看医疗服务提供者以及筛查情况。复杂样本逻辑回归模型量化了种族对接受适当筛查几率的影响。数据于2015年进行分析。
分别确定了加权样本中6330万、3330万、4790万和3030万符合结直肠癌、乳腺癌、宫颈癌和前列腺癌筛查条件的个体。总体而言，与非西班牙裔白人相比，亚裔美国人受教育程度更高、结婚率更高、收入水平更高，且居住在城市/郊区（所有p<0.05）。在多变量分析中，与非西班牙裔白人相比，亚裔美国人接受结直肠癌筛查（比值比[OR]0.78，95%置信区间[CI]0.63 - 0.96）、宫颈癌筛查（OR 0.45，95% CI 0.36 - 0.55）和前列腺癌筛查（OR 0.55，95% CI 0.39 - 0.78）的几率较低，而接受乳腺癌筛查（OR 1.29，95% CI 0.92 - 1.82）的几率与非西班牙裔白人相似。
亚裔美国人接受结直肠癌、宫颈癌和前列腺癌适当筛查的可能性较小。促成因素包括医疗服务可及性受限、对癌症筛查和治疗的文化观念不同以及潜在的医生偏见。增加医疗服务可及性和健康素养等干预措施可能会提高筛查率。
