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Cancers set to 'explode' in Latino/a populations, expert says

July 30, 2009

CHAMPAIGN, Ill. - The Latino/a population in the United States is expected to triple by 2050, according to projections from the U.S. Census Bureau. And along with that growth, says University of Illinois professor Lydia Buki, will come a rise in the number of individuals from that population who are diagnosed with cancer.

In particular, based on current statistics, Buki expects that diagnoses of breast and cervical cancers among Latinas will increase significantly.

"It's just going to explode," she said. "It's really a train wreck waiting to happen, and we're not doing enough to anticipate women's needs. Even right now, we are not doing a good job of providing services for these women."

To better serve the physical and mental health needs of this population, with respect to cancer prevention, detection and treatment, Buki said, improvements must be made in two areas: knowledge and access.

"It's women knowing the importance (of cancer screening), and at the same time being able to access information and screening services," she said. "Also, we need to provide information and access to support services to women already diagnosed."

A licensed psychologist and professor of community health, Buki is a co-author with U. of I. doctoral student Melissa Selem of "Cancer Screening and Surviorship in Latino Populations: A Primer for Psychologists," a chapter in the "U.S. Handbook of Latina/o Psychology" (recently published by Sage).

Buki, who also has appointments in educational psychology, medicine and
Latino/a studies, will present the work at the annual meeting of the American Psychological Association in Toronto Aug. 6-9.

The U. of I. researcher, who chairs the APA's Committee on Women in Psychology, began studying issues related to cancer detection and treatment among Latinos in 1996 when she worked for the National Hispanic Council on Aging on a federally funded cancer-screening project. She said a number of "psychosocial and institutional factors" often combine to deter prevention, detection and treatment in Latino populations.

"These include low levels of health insurance, limited proficiency with the English language, low levels of formal education, low income, cultural factors and institutional racism."

In addition to making psychologists and other therapists aware of specific cultural and other barriers characteristic of this population, Buki and Selem identify and provide incidence and mortality rates for four types of cancer that are prevalent within Latino populations: breast, cervical, colorectal and prostate.

Breast cancer, they note, ranks No. 1 among all cancers afflicting U.S. Latinas, and the five-year survivorship rate for Latinas is lower than that for non-Latina whites. Incidence rates of cervical cancer are up to three times higher than those for non-Latina whites.

Among Latinas and Latinos, incident rates for colorectal cancer rank second, and mortality, third.

"Evidence suggests that Latinos develop greater risk for this type of cancer across generations, given the changes in diet that take place across generations in the United States," according to Buki and Selem. "As Latinos spend more time in the United Sates, their eating habits become more like those of non-Latino whites, with diets higher in fat and lower in fiber, fruits and vegetables." And they note, Latinos are more likely than non-Latino whites to present with larger tumors or at more advanced stages of the disease.

Among Latino males, the authors indicate that prostate cancer is the most frequently diagnosed cancer, accounting for the second highest mortality rate of all cancers.

Much of Buki's past research has focused on breast and cervical cancer prevention and control, diagnosis and treatment among Latina populations. From that work, the U. of I. professor has taken away a key piece of knowledge, which she believes is critical for psychologists, therapists, social workers, doctors and other health-care practitioners providing care for this population to take into account. That is, the "Latina" label is not a one-size-fits-all descriptor.
And Latinas from different geographic regions may have very different cultural beliefs regarding the body, disease and health practices.

For example, in a 2004 study focusing on immigrant women of Mexican, Puerto Rican, Cuban, Salvadoran and South American ancestry, Buki found that Mexican women were not only highly embarrassed when touching or showing their breasts, they also were embarrassed about being ill. In addition, they exhibited extreme fear of even visiting a doctor, because of fatalistic beliefs about cancer.

"Many of the participants from Mexico did not want to go to the doctor for fear that they will be told they will die," she said.

On the other hand, only some of the Puerto Rican women surveyed in that study reported embarrassment in regard to touching their breasts as part of breast-cancer self-exams. South American women were not embarrassed when performing breast self-exams; however, some believed it would be embarrassing to reveal themselves to health-care practitioners during a clinical breast exam.

With respect to communicating the importance of breast and cervical cancer screening, Buki noted that the use of promotoras de salud - or peer role models - can be effective in "helping women navigate the health-care system to obtain the exams."

"Moreover, by discussing cancer, a topic that has been taboo in traditional Latino culture, promotoras are helping create a dialogue in the community around cultural issues such as cancer stigma, fatalism and fear," she noted. "These discussions, in turn, have the potential to break down barriers to screening."

Again, protocols and strategies followed when employing promotoras varies from group to group within the U.S. Latina immigrant population.

In another study examining the effectiveness of peer-based programs in four cities in diverse regions of the U.S., Buki found that Mexican women benefited most from health fairs that encouraged participation by entire families.

"For Puerto Rican women, door-to-door (campaigns) seemed to work best, along with attending community events," she said.

In Washington, D.C., Buki was surprised to find that after advertising free mammograms on a Spanish radio program, within two days, "we had more women than the 80 slots we had available. That was unprecedented."

Conversely, she said, getting women of Mexican ancestry in Dallas to take advantage of a similar program was "very difficult."

The key to the success in Washington, according to Buki, was that the Spanish radio station featured a five-minute daily program by Dr. Elmer Huerta, a trusted physician from Peru who was known nationally and internationally for his expertise and advice on health promotion.

"The mechanism behind it is the same as with the promotoras - someone who is trusted, who speaks their language, knows their culture and tells them, 'this is what you need to do.' "

In addition to cultural barriers, those posed by language, low education and incomes also must be addressed by providing additional, better and more innovative forms of access to social services and psycho-social programming, Buki said.

"Among Latina women, those who have immigrated experience the most language barriers and limited access to health care," she said.

And while some may argue that an emphasis on English-language learning might be a critical place to start, in terms of ameliorating problems related to lack of knowledge and information, Buki said the issue is not so clear cut.

"Do you feed people fish, or do you teach them how to fish? That's a conversation I've had with other Latina breast-cancer-survivor advocates," she said. "I think the women should take some responsibility for their own condition and for learning English.

"But that's not going to happen overnight. We need to provide them with support to enable them."

If that doesn't happen, she said, the outcome is certain.

"We're headed down a road where we're going to lose a lot of human potential in this country if we don't start addressing the needs of this population."

University of Illinois