Cervical Cancer Screening among Cambodian-American Women 1 Victoria M. Taylor, 2 Stephen M. Schwartz, J. Carey Jackson, Alan Kuniyuki, Meredith Fischer, Yutaka Yasui, Shin-Ping Tu, and Beti Thompson Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109 [V. M. T., S. M. S., A. K., M. F., Y. Y., B. T.]; Departments of Health Services [V. M. T., B. T.], Epidemiology [S. M. S.], and Medicine [J. M. J., S-P. T.], University of Washington, Seattle, Washington; and International Medicine Clinic, Harborview Medical Center, Seattle, Washington [J. M. J., S-P. T.] Abstract Southeast Asian women have higher invasive cervical cancer incidence rates and lower Pap testing frequencies than most other racial/ethnic groups in the United States. However, there is little information about the cervical cancer screening behavior of Cambodian-American women. Cambodian residents of Seattle were surveyed in person during late 1997 and early 1998. The PRECEDE model was used to guide the development of items that assessed predisposing, reinforcing, and enabling factors associated with cervical cancer screening participation. The estimated overall survey response was 72%. Four hundred thirteen women completed our questionnaire. Approximately one-quarter (24%) of the respondents had never had a Pap test, and over one-half (53%) had not been screened recently. The following variables were positively associated with a history of at least one Pap smear: younger age, greater number of years since immigration, belief about Pap testing for postmenopausal women, prenatal care in the United States, and physician recommendation. Women who believed in karma were less likely to have ever been screened for cervical cancer than those who did not. Six variables independently predicted recent screening: age; beliefs about regular checkups, cervical cancer screening for sexually inactive women, and the prolongation of life; having a female doctor; and a previous physician recommendation for Pap testing. The study findings indicate that culturally specific approaches might be effective in modifying the cervical cancer screening behavior of immigrant women. Programs targeting Cambodian-Americans are likely to be more effective if they are multifaceted and simultaneously address predisposing, reinforcing, and enabling factors. Introduction By 1990, census data indicated there were over 1 million Southeast Asians (including 150,000 Cambodians) living in the US 3 (1). The majority of Cambodians were forced to flee their country because of the political and personal persecution imposed by the Khmer Rouge regime during the mid-1970s and were relocated to North America from refugee camps in Thai- land and the Philippines (2, 3). Cambodia is a largely agrarian society, and before the revolutionary period, the majority of Cambodians lived in rural or semirural settings (4). Therefore, immigrants from Cambodia are particularly unfamiliar with Western culture, institutions, and biomedical concepts of early detection (5, 6). There is little information concerning the cancer prevention behavior of Cambodian-American women. Although the effectiveness of Pap testing has never been evaluated in a randomized controlled trial, observational studies have consistently shown dramatic reductions in mortality rates after the implementation of population-based cervical cancer screening programs (7, 8). Consequently, the American Cancer Society, the National Cancer Institute, and physician specialty organizations uniformly recommend the routine use of Pap testing for all women who have been sexually active or have reached 18 years of age (8 –10). Furthermore, the National Cancer Institute’s year 2000 objectives specify that cervical cancer mortality should be no more than 1.3 per 100,000, that 95% of women should have had at least one Pap smear, and that 85% of women should be receiving regular screenings (11, 12). The California cancer registry has recently published race- specific data showing that Southeast Asians (Cambodian, Hmong, Laotian, and Vietnamese combined) have markedly elevated invasive cervical cancer incidence and mortality rates. Between 1988 and 1992, age-adjusted incidence rates (per 100,000) were as follows: Southeast Asians, 35.2; Latinas, 17.1; Koreans, 14.7; non-Latina blacks, 12.5; Filipinos, 11.8; Chinese, 8.0; non-Latina whites, 7.5; and Japanese, 5.7. Pat- terns were similar with respect to the likelihood of dying from cervical cancer: mortality rates varied from 2 per 100,000 among non-Latina whites and Japanese to 8.9 per 100,000 among Southeast Asian women (13). In addition, national Sur- veillance Epidemiology and End Results data for the same time period suggest that cervical cancer is the most commonly occurring malignancy among Vietnamese-American women (incidence rate of 43.0 per 100,000 compared to 37.5 per 100,000 for breast cancer; Ref. 14). The Pathways to Prevention project recently conducted surveys of five racial/ethnic communities in the San Francisco Bay area. Nearly all of the white (99%) and black (98%) respondents reported at least one Pap smear, compared with 76% of Latina, 67% of Chinese, and 42% of Vietnamese respondents; and the proportions of women reporting Pap test- ing within the last 3 years ranged from 36% for Vietnamese to 88% for blacks (15). Other population-based studies, conducted Received 11/3/98; revised 2/22/99; accepted 3/19/99. The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked advertisement in accordance with 18 U.S.C. Section 1734 solely to indicate this fact. 1 Funded by National Cancer Institute Grant CA70922. 2 To whom requests for reprints should be addressed, at Fred Hutchinson Cancer Research Center (MP-702), 1100 Fairview Avenue North, Seattle, WA 98109. Phone: (206) 667-5114; Fax: (206) 667-5977; E-mail: vtaylor@fhcrc.org. 3 The abbreviation used is: US, United States. 541 Vol. 8, 541–546, June 1999 Cancer Epidemiology, Biomarkers & Prevention on August 5, 2016. © 1999 American Association for Cancer Research. cebp.aacrjournals.org Downloaded from