Colorectal cancer is a condition caused by an uncontrolled tumor growth in the colon or rectum that often causes symptoms like rectal bleeding, uncontrolled weight loss, or anemia. It is a serious public health problem because it accounts for 9.4 percent of all health cases and 7.9 percent of disease mortality cases worldwide (Vainio & Miller, 2003). Vainio and Miller (2003) indicate that colorectal cancer is mainly prevalent in North America, Europe, Australia, and New Zealand while Africa and Asia have lower incidences of colorectal cancer, which suggests environmental conditions significantly predict colorectal cancer rates.
Primary preventions in public health rely on prevention therapy that aims to eliminate causes of colorectal cancer in healthy individuals with average risk for developing the disorder. For example, chemoprevention with non-steroidal anti-inflammatory drugs is a form of colorectal prevention, but the toxicity risks and low lifetime cancer risks in healthy populations often do not justify the use of those interventions (Vainio & Miller, 2003).
A better alternative to prevention in the healthy population is through physical exercise and nutrition guidelines. According to a meta-analysis by Wolin, Yan, Colditz, and Lee (2009), physical activity can reduce the risk for colorectal cancer up to 24 percent. A literature review by Chan and Giovannucci (2010) shows that a diet based on fish, poultry, unsaturated fats, unrefined grains, unrefined grains, and fruits will reduce the risk of colorectal cancer while red meat, processed foods, sugars, and refined grains and legumes will increase the risk for colorectal cancer.
Secondary prevention applies a screening test to identify individuals with high risks for developing colorectal cancer and creating interventions aimed at reducing those risks. However, it is important to note that screening tests are always inconclusive. Even in a positive test, a diagnostic test needs to confirm the findings. The most effective screening tests in colorectal cancer include an annual faecal occult blood test (FOBT) with a 33 percent decrease in mortality and sigmoidoscopy with a 60 – 80 percent decrease in mortality (Vainio & Miller, 2003).
Like the general population, the Asian American population barriers to screening also include fear of positive results, negative attitudes towards the tests, and lack of social support (Ma et al., 2012). However, screening barriers for the Asian American population, prevention strategies are often difficult because of language barriers, lack of health insurance, transportation problems, employment status, education, and acculturation (Ma et al., 2012).
In developing a suitable prevention strategy, it is important to consider that the incidence of colorectal cancer is the highest among Chinese and Japanese in the US when compared to other Asian Americans (McCracken et al., 2007). Therefore, a mandatory screening should be introduced for the Chinese and Japanese population. It is also possible to notice Asian Americans who took at least one test in their life experience lower fear from positive results (Ma et al., 2012). Therefore, a community presentation explaining the benefits of screening tests that offers free voluntary screening may remove some of the most significant barriers among the Asian American population.
In order to overcome language and cultural barriers, it is important to note that patient satisfaction is lower and distrust higher when hospitals use untrained translators, such as family members, other patients, or untrained staff (McCracken et al., 2007). Therefore, the local community aiming to reduce the incidence should also provide the patients with a trained translator that also understand the cultural preferences of each population and knows how to overcome their lack of education or health literacy.
References
Chan, A. T., & Giovannucci, E. L. (2010). Primary prevention of colorectal cancer. Gastroenterology, 138(6), 2029-2043.
Ma, G. X., Wang, M. Q., Toubbeh, J., Tan, Y., Shive, S., & Wu, D. (2012). Factors associated with colorectal cancer screening among Cambodians, Vietnamese, Koreans and Chinese living in the United States. North American Journal of Medicine & Science, 5(1), 1-8.
McCracken, M., Olsen, M., Chen, M. S., Jemal, A., Thun, M., Cokkinides, V., & Ward, E. (2007). Cancer incidence, mortality, and associated risk factors among Asian Americans of Chinese, Filipino, Vietnamese, Korean, and Japanese ethnicities. CA: A Cancer Journal for Clinicians, 57(4), 190-205.
Vainio, H., & Miller, A. B. (2003). Primary and secondary prevention in colorectal cancer. Acta Oncologica, 42(8), 809-815.
Wolin, K. Y., Yan, Y., Colditz, G. A., & Lee, I. M. (2009). Physical activity and colon cancer prevention: A meta-analysis. British Journal of Cancer, 100(4), 611-616.
