Vietnamese Women ranked Number One in Incidence of Mortality from Cervical Cancer
By Jackie Bong-Wright
The alarming words in the title come from Dr. Thuy Ho, a gynecologist and an attending physician at INOVA Fairfax Hospital. She was speaking at a one-day, July 16 conference on cervical cancer among Vietnamese-American women, and her topic was “New Research and Technologies in the Management of Cervical Cancer.” She told the audience of 150, mostly Vietnamese, that 43 per 100,000 Vietnamese women in the U.S. were diagnosed with cervical cancer between 1988 and 1992. The good news is that Vietnamese-American women can easily prevent death from cervical cancer by participating in regular Pap smear screening to detect this “silent killer of women” in its early and very curable stages.
The Conference was co-sponsored by the National Asian Women Health Organization (NAWHO); Boat People SOS; the Vietnamese Medical Society, Northeastern Region; the American Cancer Institute; the Fairfax County Department of Systems Management for Human Services, Region II; the National Cancer Institute’s Cancer Information Service; and the Virginia Department of Health Breast and Cervical Cancer Early Detection Program.
Richard Thorp, President & CEO of Medical Informatics, also spoke. He said that cervical cancer incidence increases to 56.4 per 100,000 for women aged 30-54, and peaks at an incredible 181.6 in the 55-69 age group. “This medically underserved minority suffers from an unequal burden of cervical cancer, with rates of 5 to 7 times higher incidence than other U.S. populations,” Thorp claimed.
HPV: Cause of Cervical Cancer
Another speaker, Hong Nguyen, manager of the cancer program at the Greater Southeast Community Hospital, wrote her Master’s thesis on “ Preliminary Study of Demographic Characteristics and HPV prevalence among Cytologically Screened Vietnamese Women.” She said that the cause of the high incidence rate was unknown, but that it had been established that Human Papilloma Virus (HPV) was a sexually transmitted factor in cervical cancer, and HPV infection, like HIV infection, played a central role in cervical cancer pathology. Early onset of sexual activity, high lifetime number of different sexual partners, smoking, and oral contraceptives all contributed to a high risk for HPV genital infections.
Both Dr. Thuy Ho and Dr. Jeffrey Lin, Director of Gynecologic Oncology, George Washington University, described different kinds of treatment for HPV, ranging from surgery (like hysterectomy) to radiation and chemotherapy. It takes a decade for abnormal cervical cells to develop into invasive cancer, and that is treatable if detected in the pre-cancerous stage. Unlike HIV, HPV can be cured.
Dr. Diane Solomon of the National Institutes of Health could not have agreed more. She said that in the 1950s, the rate of cervical cancer among American women was 44 per 100,000, even higher than that of Vietnamese women nowadays. But the death rates from cervical cancer had declined by more than 70 % over the last 50 years, in large part due to early Pap smear tests.
And yet, 14,000 women develop cervical cancer and 4,500 die of the disease each year. Why are Vietnamese such a high proportion of these? Because cancer screening of Southeast Asian women in the U.S. is very low: only 58% have ever had a Pap test compared to 83% of all women generally.
Belief Systems and Other Cultural Barriers to Health Care
Dr. Thu Tam Tran, board-certified in internal medicine, stated flatly that “no woman should die of this preventable disease, especially here in the U.S. in the year 2000, given the advanced techniques that exist for early detection and more effective treatment.” She cited existing belief systems and other cultural barriers to health care as reasons for the low screening rate among Vietnamese. She said that, traditionally, Vietnamese attribute illness to a yin/yang imbalance, and tend to use Chinese herbal medicine and other treatments such as “coin rubbing,” herbal sauna, and acupuncture before seeking care from a western doctor. Some believe that cancer is a “death sentence” visited upon people who violate religious and moral principles. That adds to the reluctance of patients to seek health care.
Other obstacles to health care are poverty (resulting in lack of insurance), ignorance, and embarrassment at undergoing a check-up by a male, or even by a woman, doctor. Lack of transportation and poor English are also common obstructions that need to be addressed. Priscilla Coudoux, Program Director, Community Health Connect at the Northern Virginia Area Health Education Center, who runs a translation/interpreting program, said that health service providers should ensure that trained interpreters are available to patients as guaranteed under Title VI of the Civil Rights Act of 1964.
Conference participants discussed what could be done to increase awareness and access. Audrey Butler, Acting Director of the Virginia Breast and Cervical Cancer Early Detection Program (BCCEDP), proposed a partnership development strategy: health agencies should work closely with Vietnamese community-based organizations, and train Vietnamese community health advisors to reach low-income Vietnamese women and get them screened.
There were two workshops at the Conference, and they resulted in several recommendations: secure funding for similar conferences in Vietnamese twice a year; develop an Information and Referral Resource center to disseminate educational materials in Vietnamese; use the media to campaign for early screening; get Vietnamese physicians to participate in Question and Answer sessions; establish a focus group composed of health providers and Vietnamese community members, and create a website with information on cervical cancer in Vietnamese.
Richard Thorp proposed developing a Cervical Cancer Outreach “Toolbox” of medical intervention and education materials to inform Vietnamese-American women of the importance of regular screening for early cervical cancer detection. The toolbox would give community outreach organizations and health departments the media and educational tools required to communicate the importance of regular screening for cervical cancer to Vietnamese-American women.
Finally, Jackie Bong-Wright, the Conference organizer, will establish a support group for any Vietnamese-American who is interested in health-related issues. For further information, call her at (703) 731-5335.