Culture Puts Vietnamese Women at Increased Cancer Risk

By CATHY PASCUAL

Oct. 12, 2000 12 AM PT

TIMES STAFF WRITER

Lack of knowledge about the Pap smear and cultural myths about cancer are costing Vietnamese American women their lives, experts say.

Vietnamese Americans have the highest cervical cancer rate (43 cases per 100,000) of all ethnic groups. The number is 5.7 times that of non-Latino whites and 7 1/2 times that of Japanese Americans, who have the lowest rate (5.8 cases per 100,000), according to the National Cancer Institute.

Although little research has been conducted to determine the cause for the high rate among Vietnamese, experts often point to low cancer screening rates for this population.

“Most Vietnamese people believe that cancer is a death sentence. They don’t know that early detection can increase one’s chance of survival,” said Trang Phan, program coordinator of the Orange County Asian and Pacific Islander Community Alliance.

Such misconceptions, coupled with language gaps and unfamiliarity with the concept of preventive care, may be responsible for the relatively low numbers of Vietnamese American women who have routine screening, experts say.

Invasive cervical cancer is almost totally preventable by early detection through screening with the Pap test, which can detect cervical abnormalities before they develop into life-threatening cancers.

Yet, the cervical cancer rate among Vietnamese Americans today is nearly identical to the overall rate among U.S. women (44 per 100,000) in 1947, before Pap screening was available, said Dr. Eric Suba, executive director of the Viet American Cervical Cancer Prevention Project in San Francisco.

A UCLA School of Public Health study published in the journal Cancer recently reported that Asian Americans and Pacific Islanders have the lowest cervical cancer screening rates of all ethnic groups in the United States.

Using data from the National Health Interview Survey, the study’s authors broke down the screening rates for Asian Americans and Pacific Islanders (a catchall category for more than 60 nationalities) into six subgroups, including Vietnamese.

This breakdown revealed that Vietnamese Americans had the worst screening rate. Thirty-six percent had never had a Pap test, compared with 5% of whites and 8% of Japanese Americans.

And because the national health survey, like most national studies, had excluded non-English-speaking Asian Americans, the figures cited are probably an underestimate of the poor screening rates, the UCLA study noted.

Some studies have shown that non-English-speaking Asian American women, especially recent immigrants, tend to have even lower screening rates because they have a difficult time finding physicians who speak their language, said UCLA public health professor Marjorie Kagawa-Singer, lead author of the study.

However, having a language-matched physician doesn’t guarantee higher screening rates. In fact, a 1997 UC San Francisco study found that having a Vietnamese doctor was negatively associated with getting a Pap test.

Doctors May Not Encourage Preventive Care

“Preventive care in Third World countries is a luxury. In Vietnam, you only see a doctor when in dire straits,” said Dr. Thomas Quach, an obstetrician and gynecologist in the heart of Orange County’s Little Saigon.

Unless they have symptoms, Vietnamese women see no point in going to the doctor. Physicians trained in Vietnam may still be holding on to this mentality, Quach added.

The fact that most of these doctors are men may also discourage Vietnamese women from getting Pap tests because the women are often modest, the study reported.

At the same time, many mainstream providers and the public mistakenly believe that Asian Americans rarely get cancer. Yet Asian American and Pacific Islander women and black men are the only ethnic groups in which cancer rates are not significantly decreasing, said Karen Rezai, program coordinator at the Assn. of Asian Pacific Community Health Organizations in Oakland.

Although Vietnamese Americans face screening barriers that are similar to those of other ethnic groups--such as poverty, inadequate health insurance and lack of education--poor and underinsured Asian American women have Pap tests even less commonly than do their white counterparts.

Cultural beliefs about the nature of cervical cancer affect screening practices, said Thoa Nguyen, project director of the Vietnamese Community Health Promotion Project at UC San Francisco.

Notions that there is little one can do to prevent cancer, that the disease is caused by poor hygiene or bad karma, or could be contagious are not uncommon, according to a 1992 study by the UC San Francisco project. Further, the study pointed out, many Vietnamese do not know that abnormal vaginal bleeding could be a sign of cervical cancer or that having multiple sexual partners is a risk factor.

Some women fear the Pap smear itself.

Women who aren’t married are afraid that it will ruin their virginity or their reputations, Quach said. Married women think only prostitutes or women who sleep around need to get such tests. Some are afraid they are painful, while others believe the test itself can cause illness.

Several community groups in California and other states with large Vietnamese populations are attempting to change these false beliefs and to address other barriers to screening by creating services tailored to their needs.

Last year, the UC San Francisco-based project received a $290,000 grant from the national Centers for Disease Control and Prevention to devise a cancer prevention plan for Santa Clara County. Among other activities, the plan includes a media campaign to raise awareness about cancer screening.

Rezai sums up the message that he says needs to be sent to Vietnamese American women: “Cervical cancer is something that no woman should die from. Early detection is key.”

For low-cost cervical cancer screenings:

* Asian Pacific Health Care Venture (East Hollywood): (323) 644-3880

* Vietnamese Community of Orange County Asian Health Center (Santa Ana): (714) 418-2040

HEAD Recommendations

The American Cancer Society recommends that women have Pap smears and a pelvic examination when they become sexually active or turn 18, whichever occurs first. Annual smears are recommended until three consecutive tests are interpreted as normal. Subsequently, Pap tests can be performed less frequently if the woman does not have the following risk factors: human papilloma virus infection, early age at first intercourse, multiple sexual partners, a history of smoking or a weakened immune system. For women ages 18 through 40, pelvic exams should be performed every one to three years; women over 40 should have them annually .

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Women’s Health Risks

Percentage of women 18 and older who have never had a Pap smear

Over one-third of Vietnamese American women have never had a Pap test, compared with only *

5% of non-Latino white women and 8% of Japanese Americans.

By ethnicity, 1994-95

Chinese: 28

Filipino: 15

Japanese: 8

Korean: 25

Vietnamese: 36

Non-Latino Whites: 5