Cervical cancer among Asian Americans

Abstract

Cervical cancer is a leading cause of female cancers worldwide. Infection with one or more of the carcinogenic types of human papillomavirus (HPV) is considered to be a necessary, but insufficient cause of cervical cancer. Other coinfections, cigarette smoking, and hormonal influences of pregnancy and oral contraceptive use appear to synergistically increase the risk of HPV-associated cervical cancer progression. Geographical and ethnic variation in cervical cancer incidence may thus reflect differences in exposure to HPV due to different sexual mores or susceptibility to infection, differences in prevalence of cofactors, or differences in the availability or effectiveness of cervical cancer prevention programs such as Pap smear and HPV screening. Although the incidence of cervical cancer in Asian Americans is lower than the other racial/ethnic groups in the USA, incidence rates are heterogeneous among different Asian ethnic groups, which may be related to the level of endemicity of high-risk HPV types in the Asian countries of origin, with some variation in findings potentially related to selective socioeconomic migration of immigrants. It is unclear how screening influences cervical cancer survival because Asian Americans lag systematically behind the general US population in screening uptake. The lack of knowledge of the benefits of early detection and screening guidelines, cultural factors, and access barriers is associated with the low screening rates. Similar disparities, and their driving forces, result in insufficient HPV immunization, similar to the low screening coverage reported in Asian-American communities. Future dissemination of effective culturally appropriate educational intervention programs for the reduction of access barriers shows great promise in reducing previous cervical cancer disparities in Asian-American women.