The differences -- attributed to cultural, education, language and other barriers -- persist even when comparing like income levels or health insurance status across racial and ethnic groups. Lower screening rates reduce the odds of early detection for hundreds of thousands of Californians and survival rates for those who contract cancer.
The report was based on data from the 2001 California Health Interview Survey (CHIS 2001) and funded by The California Endowment. Researchers examined screening rates for cervical, breast, colorectal and prostate cancer among whites, Latinos, Asians, blacks, American Indian/Alaska Natives, and Native Hawaiian and other Pacific Islanders.
"Our findings underscore the reality that racial and ethnic disparities in cancer screening and other important health services can be found even within similar socioeconomic groups, such as low-income families and Medi-Cal beneficiaries," said author Ninez A. Ponce, a center researcher and assistant professor of health services at the UCLA School of Public Health, and a member of the Jonsson Comprehensive Cancer Center at UCLA.
"Clearly, targeting investment wisely toward the specific racial and ethnic groups most at risk remains a necessary step to save lives in California and reduce the burden of late-stage cancer care on the state's health care system," said author Susan H. Babey, a researcher at the UCLA Center for Health Policy Research.
"Improving the health of California's diverse communities is dependent on this critical information that helps identify the gaps that exist in health care and provides health leaders and community organizations with the information to improve access to preventive care for ethnic and racial minorities," said Alicia Lara, vice president of program for the endowment.
Screening saves lives by detecting cancer or pre-malignancies at a time when treatment typically is most successful. Five-year relative survival rates for breast, prostate, colorectal and cervical cancer rise above 90 percent if the tumor is discovered before it spreads to other parts of the body. Once a tumor is metastasized, survival rates drop to 34 percent for prostate cancer, 23 percent for breast cancer, 15 percent for cervical cancer and 9 percent for colorectal cancer.
The report includes detailed screening rates for the four cancers by 1) race/ethnicity alone, 2) income and race/ethnicity, and 3) Medi-Cal coverage and race/ethnicity. Among key findings in the report:
- Asians report lower rates of screening than whites for all four cancers.
- Latinos report lower screening rates than whites for breast, colorectal and prostate cancer.
- Native Hawaiians and other Pacific Islanders consistently report some of the lowest screening rates in the state.
- American Indian and Alaska Natives are less likely to have been screened for breast or prostate cancer than whites.
The UCLA research team focused on the use of cancer screening tests among adults who have not been diagnosed with the site-specific cancer: Pap testing for cervical cancer; mammography for breast cancer; fecal occult blood test, colonoscopy or sigmoidoscopy for colorectal cancer; and the PSA (prostate specific antigen) test for prostate cancer.
Other report authors are E. Richard Brown, director of the UCLA Center for Health Policy Research and professor of public health; Neetu Chawla, a center researcher; David A. Etzioni of the David Geffen School of Medicine at UCLA; and Benjamin A. Spencer of the Greater Los Angeles VA Healthcare System.
CHIS 2001 data were compiled from interviews of more than 55,000 randomly selected adults drawn from every county in California. A collaboration of the UCLA Center for Health Policy Research, the California Department of Health Services and the Public Health Institute, this biennial survey is the largest of its kind conducted in any state and one of the largest in the nation.
In addition to releasing the report on cancer screening in California, the Center for Health Policy Research announced Sept. 18 the launch of CHIS 2003, funded in part by a $3.9 million grant from The California Endowment and through major support from the California Department of Health Services, the National Cancer Institute and the Robert Wood Johnson Foundation.
The UCLA Center for Health Policy Research, established in 1994, is one of the nation's leading health policy research centers and the premier source of key health-policy information for California. It is based in the UCLA School of Public Health and is also affiliated with the UCLA School of Public Policy and Social Research.
The Woodland Hills, Calif.-based California Endowment is a nonprofit organization dedicated to expanding access to affordable, quality health care for underserved individuals and communities, and to promote fundamental improvements in the health status of all Californians.