By Kai Curry
NORTHWEST ASIAN WEEKLY
Dr. Margaret Chin
Death from cancer is disproportionately high among Asian American and Pacific Islanders (AAPI) in the U.S. compared to other races and ethnicities. With October marking Breast Cancer Awareness Month, the Northwest Asian Weekly talked to Dr. Margaret Chin, director of Cancer Screening at Kaiser Permanente Washington, about the urgent need for regular cancer screenings.
The rate of deaths from cancer continues to be concerning among the AAPI population in the U.S. This is compounded by the low rate of cancer screenings within the same population. Screening for cancer is important because it allows your physician to catch cancer early. Chin pointed out that once someone is already showing symptoms, treating the cancer becomes more difficult, as it has likely already taken hold in their body.
The three primary types of cancer for which screenings are recommended as part of your healthcare routine are colorectal, cervical, and breast. Each has specific guidelines for when and how often to begin screening. For colorectal cancer, starting from age 45, an at-home test is recommended every year, and a colonoscopy every 10 years. For cervical cancer, starting from age 21, a PAP smear is recommended every three years and/or an Human Papillomavirus, or HPV, screening every five years for men and women. Starting from age 40, a breast cancer screening is recommended every one to two years. While some of these cancers are more commonly associated with women, men can also be affected. Screening frequency may vary based on your personal and family medical history.
Cancer is the second leading cause of death in the U.S., and mortality rates are especially high among Native Hawaiians and Pacific Islanders (NHPI). This disparity became more visible only in recent years, after NHPI cancer data began to be reported separately from Asian American data. In 2020, according to the Journal of the National Cancer Institute, there were approximately 601,000 deaths from cancer in the U.S for people aged 20 and above. For NHPI males, the number was 205,600; for Asian males, 147,900; for NHPI females, the number was 192,100; for Asian females, 111,400. The highest death rate by age group was among NHPI individuals from 20 to 49 years old.
“There are notable racial and ethnic disparities in cancer death rates, driven by differences in cancer incidence and survival, barriers to accessing health care, and other structural factors,” notes the article in the Journal of the National Cancer Institute. Economic and language barriers within the AANHPI community can make accessing cancer screenings more difficult—particularly for those without health insurance. Chin told the Asian Weekly, “We can only speculate as to why these rates occur and why people in these populations don’t get screened as often as others. Could there be a misperception about what a screening means?” It doesn’t mean you’re not healthy, Chin said. In fact, it means you’re healthy and your doctor wants you to stay that way! There can be, also, a “self-perception” that one is healthy, Chin said.
“You can be healthy and screening is still really important.” She recommends screenings as part of your yearly routine by scheduling them around your birthday as a helpful reminder.
Breast cancer survivor and Korean American, Shari Leid, sought treatment here in Seattle, and seems to confirm many of Chin’s suggestions in a personal essay titled, “Breaking the Silence: One Survivor’s Journey to Transform AANHPI Conversations on Cancer. As Leid describes, “Cancer is a word that whispers through our communities, loaded with fear, stigma, and a quiet hope that if we don’t talk about it, it won’t touch our families. But as a Korean American woman, I learned that silence can be just as dangerous as the disease itself.”
Leid is now a mindset coach and speaker who shares her story with the world.
For the fear that surrounds cancer screening for some, such as worrying that seeking answers could lead to a diagnosis, and concerns about how to manage or afford potential treatment, there is some relief in knowing that first, early detection significantly increases the chances of successful treatment. Second, most health insurance plans cover routine cancer screenings.
If a person is feeling modest or shy, there are screenings that can be done at home, such as the colorectal cancer screening. These are topics that people don’t want to talk about, so making sure that doctors use culturally sensitive language is also important, Chin said. For instance, a doctor might suggest, “Okay, so you don’t care about getting a screening for yourself. How about getting one for the peace of mind of your loved ones?” “We want you to live a really long, healthy life. and the way you do that is by screening and catching things earlier,” said Chin.
Another factor in reduced doctor visits or reduced screenings might be the challenge of finding a relatable doctor. Chin noticed that, even when she tells Asian patients she doesn’t speak Chinese, they still want to come to her because she looks familiar. “I want you. I want to see you,” patients tell her. They simply feel more comfortable with another Asian face. Language access is also important, which is why Kaiser Permanente has been translating its health materials in up to 12 different languages. This effort goes beyond literal translation, as some words don’t have direct equivalents in other languages. It’s crucial to address these nuances to ensure the translations are culturally relevant and meaningful. As Chin said, even a perfectly translated pamphlet can fall short if it doesn’t also resonate culturally.
“There are subtle ways that we can encourage people to screen by really focusing on what’s important to them, and that can vary by groups and cultures, and so we at Kaiser are just trying to be thoughtful about our messaging.”
In addition to the three primary cancers mentioned earlier, Chin also suggests that Asians in the U.S. speak to their doctors about screening for liver and stomach cancer. While these cancers are less common among the white population in the U.S., they are more prevalent in parts of Asia. For individuals who have emigrated from Asia, it’s important to share this background with healthcare providers, as doctors may not be aware of your immigrant status or associated risks. This includes getting screened and vaccinated for Hepatitis B because Hepatitis B is a risk factor for liver cancer.
“Growing up in South Seattle, health was something we kept behind closed doors. Illness wasn’t discussed at the dinner table. We didn’t ask many questions of our doctors. And vulnerability? That was something we rarely admitted to anyone, even our immediate family members,” said Leid in her essay. “My story isn’t only about surviving cancer. It’s about choosing to flip the script on silence so that others feel safe to speak, to listen, and to act.”
The more comfortable we can become around the topic of cancer, the better, both Chin and Leid suggest. Normalize talking to your family about their medical history, said Chin, including any history in the family of cancer. Cancer is more treatable when it’s caught earlier, and there can be better outcomes to that treatment, Chin insisted. “If we’re not screening, then we’re getting and treating later stage cancers, and there is going to be much higher mortality in those groups.”
Kai can be reached at newstips@nwasianweekly.com.