UCSF Fights Cervical Cancer Among Vietnamese in Santa Clara County

October 26, 2000
News Office: Twink Stern (415) 502-6397

UCSF's Vietnamese Community Health Promotion Project has been awarded more than $900,000 annually for four years from the Centers for Disease Control and Prevention (CDC) to improve screening and management of breast and cervical cancer among Vietnamese women in Santa Clara County.

The award is part of the CDC's initiative "Racial and Ethnic Approaches to Community Health" or REACH 2010, a national project targeting six health areas with the goal of eliminating disparities in health status experienced by racial and ethnic minority populations by the year 2010. The six target health areas are: infant mortality, improving breast and cervical cancer screening and management, cardiovascular disease, diabetes, improving child and/or adult immunization levels, and HIV/AIDS.

"Vietnamese-American women have the highest cervical cancer rate of any ethnic group in the United States," according to Dr. Stephen McPhee, an internist at UCSF Medical Center, a UCSF professor of medicine and principal investigator of the project. "The rate of cervical cancer in this population is five times the rate of Caucasian women."

In recent studies by the National Institutes of Health, Vietnamese women in America had a rate of 43 cases of cervical cancer per 100,000 compared to a rate of 8.7 cases per 100,000 in the general population. "No one knows the reason for the high rate of cervical cancer to date; no one has done a study to explain it," McPhee said. "It's such a tragedy because Pap smears to detect this cancer are so simple to do."

Although there has been little research to determine the cause for the high rate among Vietnamese, experts believe the low cancer screening rates for this population is a factor. Some Vietnamese believe that cancer is a death sentence, and don't know that early detection can greatly increase chances of survival. Misconceptions combined with language gaps could be a factor in the low numbers of Vietnamese-American women who have routine Pap smears, experts have said.

Cultural beliefs about cervical cancer affect screening practices, said Thoa Nguyen, director of the project. Notions that there is little one can do to prevent cancer, and that the disease is caused by poor hygiene or bad karma are not uncommon, according to a UCSF study. Further, the study pointed out that many Vietnamese don't know that abnormal vaginal bleeding could be a sign of cervical cancer or that having multiple sexual partners is a risk factor.

Last year, a preliminary project began to raise awareness about cancer screening. With a grant of $290,000 from the CDC, the UCSF Vietnamese Community Health Promotion Project made contact with 10 Santa Clara County organizations to form a coalition and worked closely with local health care providers in the community, McPhee said. After placing ads in local Vietnamese newspapers, large community forums were held where Vietnamese women could gather and provide feedback to the coalition. Using smaller, intensive focus groups, community members were asked about the barriers to cervical cancer screenings and the coalition developed intervention strategies.

Several approaches have been used by the UCSF Vietnamese Community Health Promotion Project to communicate the need for Pap smears, McPhee said. These include the distribution of calendars with reminders to get Pap smears, billboards with cervical cancer prevention information, newspaper articles on cervical cancer prevention, posters designed by Vietnamese artists and training lay people to educate the community with culturally appropriate materials in the Vietnamese language. McPhee said that the National Cancer Institute has requested some of the materials prepared for these outreach efforts for national use in other Vietnamese communities.

Over the next four years, the new phase of the plan will include six activities implemented by the coalition. The organization will:

Conduct a media campaign about cervical cancer, Pap smear screenings and health care services on Vietnamese radio, TV, billboards and newspapers. The coalition will organize, print and distribute educational materials at large community gatherings, community-based organizations and shopping centers where Vietnamese women gather.

Train lay health workers (about 50 women from the community) about cervical cancer, the importance of Pap smears and where to get low-cost or free Pap smears. Each of these women will contact 20 other women and provide information about and support to those getting Pap smears.

Establish a Vietnamese clinic (1/2 day a month) to provide Pap smears for under-insured or uninsured women in Santa Clara County. The coalition will assist women in applying for public health insurance to ensure that no woman will be refused a Pap smear due to lack of health insurance.

Establish a Pap smear registry with a system to remind providers and patients when Pap smears are due.

Restore a Breast and Cervical Cancer Control Program clinic in Santa Clara County to provide free Pap smears to all women, even if they have no health insurance.

Conduct continuing medical education seminars for Vietnamese doctors with courses that encourage them to recommend Pap smears to female patients.

McPhee said that the goals for REACH 2010 are ambitious. By March 2004, its major objectives include ensuring that 95 percent of the Vietnamese-American women in San Clara County know that they should have an annual Pap smear; 50 percent of the uninsured Vietnamese-American women know where to get a low-cost or free Pap smear; and 85 percent will have had at least one Pap smear.

Other organizations that have joined the coalition include the Asian Americans for Community Involvement, Blue Cross of California, Catholic Charities' Youth Empowered for Success (Y.E.S), Community Health Partnership, Indochinese Resettlement and Cultural Center, Kaiser Permanente, Santa Clara County Public Health Department, Southeast Asian Community Center, Vietnamese Physicians Association of Northern California and the Vietnamese Voluntary Foundation Inc.