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Janet H. Bates, MD, MPH 1 Brenda M. Hofer, MA 1 Sandy L. Kwong, MPH 2

Going Against the Tide: The Increasing Incidence of Colorectal Cancer among Korean Americans in California, 1988-2007. Janet H. Bates, MD, MPH 1 Brenda M. Hofer, MA 1 Sandy L. Kwong, MPH 2 1 Public Health Institute, California Cancer Registry

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Janet H. Bates, MD, MPH 1 Brenda M. Hofer, MA 1 Sandy L. Kwong, MPH 2

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  1. Going Against the Tide: The Increasing Incidence of Colorectal Cancer among Korean Americans in California, 1988-2007 Janet H. Bates, MD, MPH1 Brenda M. Hofer, MA1 Sandy L. Kwong, MPH2 1 Public Health Institute, California Cancer Registry 2 Cancer Surveillance Section, California Department of Public Health

  2. Objectives • Highlight increasing rate of colorectal cancer (CRC) incidence among Koreans in California • Discuss characteristics of this population that may help explain why their rates of CRC incidence are increasing • Reinforce the importance of analyzing cancer data for individual Asian subgroups • Discuss collaborations for disseminating this information

  3. Background • Colorectal cancer (CRC) incidence has declined markedly in the United States • Declines experienced by men of all major racial/ethnic groups AND • Women of all major racial/ethnic groups, except for Hispanics

  4. To What is the Decline in CRC Incidence Attributed? • 50% - uptake in screening • 50% - changes in the prevalence of modifiable risk factors • Smoking • Obesity • Lack of physical activity

  5. Colorectal Cancer Incidence by Race/Ethnicity, California, 1988-2007

  6. Colorectal Cancer Incidence by Race/Ethnicity, California, 1988-2007

  7. Colorectal Cancer Incidence by Race/Ethnicity, California, 1988-2007

  8. Colorectal Cancer Incidence by Race/Ethnicity, California, 1988-2007

  9. Colorectal Cancer Incidence by Race/Ethnicity, California, 1988-2007

  10. Trends in Colorectal Cancer Incidence by Race/Ethnicity, California From 1988-2007 rates decreased by: 28% among non-Hispanic whites 20% among African Americans 13% among Asian/Pacific Islanders 8% among Hispanics

  11. Bucking the Trend • Colorectal cancer incidence rates are on the rise among some Asian population groups

  12. Colorectal Cancer Incidence Trends Among Asian Subgroups, California, 1988-2007 *Annual percent change (APC) is statistically significant

  13. Colorectal Cancer Incidence Trends Among Asian Subgroups, California, 1988-2007 *Annual percent change (APC) is statistically significant

  14. Colorectal Cancer Incidence Trends Among Asian Subgroups, California, 1988-2007 *Annual percent change (APC) is statistically significant

  15. Colorectal Cancer Incidence Trends Among Asian Subgroups, California, 1988-2007 *Annual percent change (APC) is statistically significant

  16. Colorectal Cancer Incidence Trends Among Asian Subgroups, California, 1988-2007 *Annual percent change (APC) is statistically significant

  17. Colorectal Cancer Incidence Trends Among Asian Subgroups, California, 1988-2007 *Annual percent change (APC) is statistically significant

  18. Colorectal Cancer Incidence Trends Among Asian Subgroups, California, 1988-2007 *Annual percent change (APC) is statistically significant

  19. CRC Risk Factors among Koreans • How do Koreans compare to other Asian subgroups in regards to CRC risk factors? • Obesity • Lack of physical activity • Smoking • Not getting screened

  20. Risk Factors: Obesity Among Asian Subgroups, California, 2007

  21. Risk Factors: Physical Activity Among Asian Subgroups, California, 2007

  22. Risk Factors: Smoking Among Asian Subgroups, California, 2007 Source: 2007 California Health Interview Survey (CHIS)

  23. Colorectal Cancer Screening Among Asian Subgroups, California, 2007

  24. Proportion of Californians Age 50 Years and Older Ever Screened by Endoscopy or FOBT, 2001-2005 (CHIS*) *California Health Interview Survey data Maxwell & Crespi, 2009

  25. Barriers to CRC Screening among Koreans • Rapid and recent immigration • No usual source of health care • High uninsured rates • Not receiving recommendation by a physician

  26. Collaboration • C4’s mission is to save lives and reduce suffering from colorectal cancer in all Californians • Plans for media outreach campaign

  27. Summary • In stark contrast to all other racial/ethnic groups, CRC incidence is increasing among Koreans in California • Increasing rates in CRC incidence among Koreans may in part be explained by the fact that they are not getting screened • Analyzing cancer data for Asian/Pacific Islanders collectively masks important differences that exist among Asian subgroups

  28. Acknowledgements Janet H. Bates, MD, MPH Chief, Cancer Surveillance Section California Cancer Registry Sandy L. Kwong, MPH Acting Chief, Cancer Surveillance Research Unit California Cancer Registry

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