Mee Yang knows what happens when Hmong women in the Sacramento region don't have access to cancer education, screening, diagnosis and treatment. She's journeyed with many women who died because a lack of knowledge about cancer, language barriers, fears about medicine or cultural beliefs kept them from getting care before it was too late.
She also has found signs of hope that these tragedies can be prevented. As cancer program coordinator at the Hmong Women's Heritage Association, Yang is now assisting one such ray of hope: a 55-year-old Hmong woman who came to the United States in 2006 and survived stage-three breast cancer, without understanding her diagnosis.
When Yang met the woman 18 months ago, "she just thought she had some bad disease – that she was a guinea pig for a procedure," she recalls.
"She didn't speak English… she just went along without questioning anything," Yang says. "So we explained what cancer is, helped her navigate medical appointments, provided her interpreting and translation services, and acted as an advocate when she needed one. We started at ground zero for her, and today, after treatment, she's doing well, and there's no recurrence of her cancer."
The barriers to cancer care – lack of regular cancer screenings, not recognizing early cancer symptoms, and when cancer occurs, not undergoing effective treatment – are all too common in the Hmong community, as well as Hispanic, Asian and American Indian populations in California.
The significant growth of ethnic populations in California, and, particularly, Sacramento, called the most culturally diverse city in the U.S. by Time Magazine several years ago, magnifies the need to resolve cancer health disparities.
"Cancer disparities were not created in a day, so we need to start from the very beginning to understand why the cancer burden is disproportionately greater among various racial and ethnic populations, says Moon Chen Jr., associate director of population research and cancer disparities at the UC Davis Cancer Center.
"Our efforts are helping us understand our constituent populations, gain their trust and offer programs that are scientifically sound, as well as culturally competent and linguistically appropriate for their needs, Chen says.
Chen and his colleagues design, conduct and disseminate research they hope will reduce and ultimately eliminate cancer health disparities for every one of UC Davis' constituency populations. A major part of their effort is building partnerships and conducting research with community- based organizations.
Since 2002, the cancer center has taken the lead in a national effort to reduce cancer in Asian Americans, the only racial group in the United States for whom cancer is the leading cause of death. Through a National Cancer Institute-funded cooperative agreement known as AANCART – for Asian American Network for Cancer Awareness, Research and Training – Chen leads an unprecedented effort to address the unique, unusual and unnecessary cancer burden facing Asian Americans in California, Hawaii and Washington.
In Sacramento, AANCART, in collaboration with the Hmong Women's Heritage Association, initiated "Cancer Awareness 101. The course covers the basics of what is cancer and what can be done to reduce one's risks. The awareness course has been such a success that it has been transformed from a community presentation facilitated by translation to being part of the Hmong radio talk-show circuit.
The Hmong Women's Heritage Association also conducted a baseline measurement of Pap testing among Hmong women in partnership with the cancer center. The study found that only 53 percent of Hmong women had seen a physician for their annual Pap test, the lowest proportion of any racial or ethnic group in California. Twenty-eight percent have never even had a Pap test.
"Some very deep-seated cultural factors prevent the women from going for screening, including the reluctance among Asian Americans to see a physician in the first place, Chen notes. "These are challenging issues, and there isn't a ‘one-size-fitsall' answer.
May Ying Ly, co-founder of the Hmong Women's Heritage Association, who collaborates with Chen on research projects on cervical and liver cancer, says UC Davis' partnership with the Hmong community on cancer awareness, screening and care has grown beyond what she envisioned when she met Chen in 2002.
"We work with some of the most respected experts in the field of Asian American health and cancer, she says. "We are experts on our ethnic community and … we've been able to combine the two with great success.
More at-risk populations
Providing information about breast cancer to American Indian women, a population with a high breastcancer death rate and low screening rates, is another aspect of the cancer center's disparities program. California is home to some 110 American Indian tribes, a group with the poorest cancer survival rate in the United States.
Grants from the Susan G. Komen Breast Cancer Foundation enabled UC Davis Cancer Center's outreach director Marlene von Friederichs-Fitzwater to form a UC Davis American Indian Advisory Council representing 13 different tribes to increase breast cancer awareness, breast self-exams and mammograms, and healthier lifestyles among American Indian women.
"The results have been rewarding, she says. "When programs are culturally appropriate, American Indian women share the information with their families and friends and often change their attitudes about getting a mammogram and healthy eating and exercise.
Along with researcher Deborah Paterniti, she also is working with the Slavic Community Center and Slavic Assistance Center to explore the beliefs and attitudes of newly immigrated Slavic men and women about cancer prevention and treatment as the basis for developing culturally appropriate outreach programs for some 100,000 Slavic immigrants in Sacramento County.
All these efforts make UC Davis Cancer Center a leader in collaborations with at-risk populations to reduce cancer disparities and to foster the development of the next generation of cancer-disparities researchers, says Kurt Snipes, chief of the Cancer Surveillance and Research Branch of the California Department of Public Health and a principal investigator for the Sacramento region of AANCART.
Collaborative efforts between AANCART and the California Department of Public Health, which administers the California Cancer Registry, have included implementing a colorectal cancer screening and prevention program for California's Asian American and Latino populations. In addition, AANCART and the Department of Public Health have worked with the California division of the American Cancer Society to target similar outreach to the state's African American population.
"UC Davis Cancer Center is the hub for so many unique research efforts, Snipes says. "It's a win-win – a great synergistic effort between public, community and academic sectors that helps all of us build a comprehensive approach to addressing cancer health disparities.