Issues in Lung Cancer Screening Among Asian American Immigrants.

Abstract

Lung cancer is the second most common cancer in both men and women in the United States (US), accounting for approximately 27 % of all cancer deaths [1]. It is estimated about 221,200 new cases of lung cancer are diagnosed, and 158,040 estimated lung cancer deaths (86,380 male; 71,660 female) in 2015 alone [1]. According to the 2007–2011 cancer incidence data from 18 Surveillance Epidemiology and End Results (SEER) areas, incidence rate for the lung and bronchus cancer in Asian/Pacific Islander men accounted for 49.4/100,000 (vs. 28.1/100,000 in women) [2]. Cigarette smoking is an independent risk factor for lung cancer and active smoking was found to be responsible for almost 90 % of lung cancer cases [3]. Cigarette smoking kills more than 480,000 Americans each year [4] and smoking-related illness in the US costs more than $289 billion a year [4]. In many Asian countries, such as Korea and Vietnam, smoking is an accepted social behavior for men and often seen as necessary for social and business interactions. Smoking is therefore highly prevalent among Asian men [5]. The National Survey on Drug Use and Health conducted between 2002 and 2005 reported the highest smoking behavior in Korean American men (37.4 %), followed by Vietnamese men (32.5 %), and Filipino men (25.5 %) compared with 29.7 % among nonLatino Caucasians [6]. According to the 2011–2012 California Health Interview Survey, Vietnamese and Korean men had a high prevalence of current smoking rate (24.9 %, 23.3 %) compared with 16 % among non-Latino Caucasian men. In addition, Korean men had the highest prevalence of former smoking (34.9 %) compared with 32.2 % among non-Latino Caucasian men. Because of the high smoking rate, lung cancer is the most common cancer among Vietnamese American men and the third most common cancer among Korean American men, according to California Cancer Registry data from 2004 to 2008 [2]. Whereas, lung cancer is the first leading cause of death among Korean men in Korea (11,819 deaths/45,356 cancer deaths from all sites) [7]. Cultural pressure, social norms, and gender were found to be the major sociocultural factors influencing smoking behavior among Asian men [8, 9]. Confucianism is an ethical and philosophical system influencing many Asian countries such as Korea and Vietnam. Confucianism posits that men are the authority figures and this authority and macho-style mentality encourages men to choose smoking as a coping mechanism to relieve stress [10]. One of the central tenets of Confucian philosophy is collectivism, which is a highly valued trait in both Korean and Vietnam culture [8, 11]. Collectivism fosters strong committed relationships among family members and peers. For example, many young Korean men learn to smoke while engaged in their 2 years of mandatory military service in Korea [5]. In Vietnamese culture, smoking is an ingrained social behavior used to promote good will and kinship among men [9]. A cross-sectional self-report survey conducted among 26 randomly selected Asian American organizations from the seven counties in the Delaware Valley reported that Asian American men were more likely to be current smokers if they had a current & Mo-Kyung Sin sinm@seattleu.edu