Patient and provider characteristics associated with colorectal, breast, and cervical cancer screening among Asian Americans

Cancer Epidemiol Biomarkers Prev. 2014 Nov;23(11):2208-17. doi: 10.1158/1055-9965.EPI-14-0487.


Background: Routinely recommended screening for breast, cervical, and colorectal cancers can significantly reduce mortality from these types of cancer, yet screening is underutilized among Asians. Surveys rely on self-report and often are underpowered for analysis by Asian ethnicities. Electronic health records (EHR) include validated (as opposed to recall-based) rates of cancer screening. In this article, we seek to better understand cancer screening patterns in a population of insured Asian Americans.

Methods: We calculated rates of compliance with cervical, breast, and colorectal cancer screening among Asians from an EHR population and compared them with non-Hispanic whites. We performed multivariable modeling to evaluate potential predictors (at the provider- and patient-level) of screening completion among Asian patients.

Results: Aggregation of Asian subgroups masked heterogeneity in screening rates. Asian Indians and native Hawaiians and Pacific Islanders had the lowest rates of screening in our sample, well below that of non-Hispanic whites. In multivariable analyses, screening completion was negatively associated with patient-physician language discordance for mammography [OR, 0.81; 95% confidence interval (CI), 0.71-0.92] and colorectal cancer screening (OR, 0.79; CI, 0.72-0.87) and positively associated with patient-provider gender concordance for mammography (OR, 1.16; CI, 1.00-1.34) and cervical cancer screening (OR, 1.66; CI, 1.51-1.82). In addition, patient enrollment in online health services increased mammography (OR, 1.32; CI, 1.20-1.46) and cervical cancer screening (OR, 1.31; CI, 1.24-1.37).

Conclusions: Language- and gender-concordant primary care providers and culturally tailored online health resources may help improve preventive cancer screening in Asian patient populations.

Impact: This study demonstrates how the use of EHR data can inform investigations of primary prevention practices within the healthcare delivery setting.

Publication types

  • Editorial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Asian / statistics & numerical data*
  • Breast Neoplasms / diagnosis*
  • Colonography, Computed Tomographic / statistics & numerical data
  • Colonoscopy / statistics & numerical data
  • Colorectal Neoplasms / diagnosis*
  • Communication Barriers
  • Cross-Cultural Comparison
  • Cultural Competency
  • Early Detection of Cancer / statistics & numerical data*
  • Electronic Health Records
  • Female
  • Health Behavior / ethnology
  • Humans
  • Internet
  • Language
  • Male
  • Mammography / statistics & numerical data
  • Middle Aged
  • Occult Blood
  • Papanicolaou Test / statistics & numerical data
  • Patient Compliance / ethnology*
  • Physician-Patient Relations
  • San Francisco
  • Sex Factors
  • Uterine Cervical Neoplasms / diagnosis*
  • White People / statistics & numerical data
  • Young Adult