Colorectal Cancer in the United States and a Review of Its Heterogeneity Among Asian American Subgroups

The data aggregation problem and health disparities

• Third most common cancer in the U.S
• Asian American subgroups vary widely -> problem of data registries and research aggregating them into one group
  • Discussed by Wailoo’s book How Cancer Crossed the Color Line -> historically race and ethnicity has been defined arbitrarily by the dominant group (white) -> all other groups are aggregated in terms because they are ‘other’ to the white group, therefore being blind to each group’s own internal diversity
• Heterogeneity in incidence -> related to country of origin, diet, screening, and lifestyle choices
  • Japanese Americans have the highest incidence, and all incidence are increasing among other groups except for Korean Americans

• CRC incidence is highest among non-Hispanic black populations, lowest among Asians/Pacific Islanders
• SEER program only started collecting data on Hispanic Americans and Asians/Pacific Islanders since 1990
  • What does this say about missing data and inability to create historical trends?
• Gap between mortality rates among Black and White Americans have increased over the last 3 decades
  • Disparities exist between races but also within
• Screening prevalence lower among ages younger than 65, non-White, less educated, without insurance, recent immigrants, Hispanic people, and those with language barriers
  • Asians are less likely to screen than non-Hispanic whites

Once again, the ‘Western’ diet as a risk factor?

• Another paper discussed this common theme here
• A study found “the Western diet increases colon cancer by deregulating bile acid homeostasis, and activating colon cell proliferation”

• Dietary chemoprevention -> cultural aspects of diet and lifestyle in Asian Americans in cancer prevention
  • unpolished Thai rice and reduced CRC risk because of high phytochemical contents
  • Sea cucumbers, abalones are both Asian delicacies are shown to have anti-tumor properties
• Risk factor: Risk increases among Asian Americans as their diet becomes ‘Westernized’
  • Asians with longer immigration history parallel cancer risk patterns of U.S natives
  • Asians with more recent immigration history parallel cancer risk patterns of home countries

• Reflections/questions
  • Emphasizes the need for more complete data (Flaws in databases and data collection methods: Primarily in English, did not capture populations with low English proficiency, vary in time frame/sample size/geography, SEER data is more recent on Asians)
  • Perhaps more data on cultural and behavioral factors that influence prevention and screening?
    • Echoing Jain’s argument that an alternative way of collecting data is needed in Malignant: How Cancer Becomes Us
  • Potential: culturally tailored screening for subgroups, policy revisions and advocacy for immigrants dealing with insurance