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Impact of Asian Ethnicity on Colorectal Cancer Screening: A Population-Based Analysis

Homayoon, Babak BHK; Shahidi, Neal C. BSc; Cheung, Winson Y. MD, MPH, FRCPC

American Journal of Clinical Oncology:
doi: 10.1097/COC.0b013e3182439068
Original Articles: Gastrointestinal

Objectives: Although research shows that African Americans and Hispanics frequently receive less colorectal cancer screening (CRCS) than whites, few studies have focused on CRCS among Asians. The aims of this study were to compare CRCS between Asians and whites and to evaluate for clinical predictors of CRCS.

Methods: From the 2007 California Health Interview Survey, we identified all Asian and white respondents who were eligible for CRCS. Logistic regression was performed to evaluate for differences in CRCS. We used stratified and interaction analyses to examine whether associations between race and CRCS were modified by insurance status, birthplace, or language skills, while controlling for other confounders.

Results: Baseline characteristics were similar between Asians and whites. Only 58% of Asians and 66% of whites reported undergoing up-to-date CRCS (P < 0.01). In multivariate analyses, visiting a physician more than 5 times produced the highest odds of being up-to-date with screening. When compared with whites, Asians had decreased odds of being up-to-date with screening. Stratified analyses showed that this disparity existed mainly in the insured, but not in the uninsured, and it was not modified by place of birth or English language proficiency.

Conclusions: Despite its ability to reduce mortality, CRCS is suboptimal in our US population-based cohort of Asians when compared with whites. A contributing factor to this problem for the Chinese and Koreans may be a lack of awareness regarding CRCS, whereas the source of the problem in the Vietnamese seems to be related to healthcare access.

Author Information

Division of Medical Oncology, British Columbia Cancer Agency, University of British Columbia, Vancouver, Canada

The authors declare no conflicts of interest.

Reprints: Winson Y. Cheung, MD, MPH, FRCPC, Division of Medical Oncology, British Columbia Cancer Agency, 600 West 10th Avenue, Vancouver, BC V5Z4E6, Canada. E-mail:

© 2013 by Lippincott Williams & Wilkins, Inc