Needs Assessment for Colorectal Cancer in the Vietnamese community

Colorectal cancer (CRC) is the leading cause of cancer-related deaths among Vietnamese
Americans and yet utilization of screenings are staggeringly low. Between 2000 and 2010, the
Vietnamese population had gained a numeric increase of 425,921, or 37.9%, compared with the
total Asian population growth at 43.2% in the United States (United States Census, 2011). The
top four cities that have the largest Vietnamese population concentration are San Jose, Garden
Grove, Westminster, and Houston City (U.S Census Bureau, 2010). The 2010 Census shows that
the Vietnamese population is the fourth largest among Asian population groups in the United
States, however rank highest in rates for unemployment, low socioeconomic status, and limited
education (US2010, 2013). A large percentage of the Vietnamese population resettled in the
United States as refugees and were unable to reestablish their pre-immigration economic disposi-
tion. Vietnamese immigrants are more likely to be Limited English Proficient (LEP) than the
overall U.S foreign-born population. Vietnamese Americans have a lower than average
attainment of a bachelor’s degree and approximately 30% of Vietnamese adults lack a high
school diploma (Migration Policy Institute, 2018). There is an evident correlation in terms of low
educational attainment and the utilization of colorectal screening. These findings indicates the
necessary need for language appropriate and culturally competent interventions.
Contributing factors that remain key constraints to the uprise of this phenomenon in the
community consist of low acculturation, limited access to health care, and lack of knowledge
(Lee et al.,2014). In a study conducted by the Oregon Health & Science University (OHSU) part-
nering with the Asian Health and Service Center (AHSC), investigators surveyed 199 Vietnam-
ese Americans (75 men and 124 women) to measure the differences in knowledge, attitudes, be-
liefs, and perceived risks of colorectal cancer (Le et al., 2014). The results showed that 45% Vi-
etnamese subjects had a regular health care provider but were more commonly needed of a trans-
lator. Despite nearly half of the Vietnamese subjects reporting to have a regular health care pro-
vider, 34% of those reported to have no memory of discussion in regards to CRC screening and
modalities with providers. In another study conducted, 47% of individuals reported to have en-
gaged in shared decision making (SDM) about CRC screening during their provider visit, how-
ever within the same study only 1 out of 363 visits included all components of SDM in which
patients: understands the risk or seriousness of the disease or condition, the preventive services,
opportunity to weigh his or her values regarding the potential benefits and harms associated with
the service, and has engaged in decision making at a level at which he or she desires and feels
comfortable (Christy & Rawl, 2013). In terms of preventative measures, 61% of Vietnamese sub-
jects were more likely to believe that certain foods and herbs could prevent cancers, but also ex-
pressed fatalistic views that death is inevitable with a cancer diagnosis (Lee et al., 2014).
Colorectal cancer is the third most common type of cancer and second most common
cause of death from cancer in California. According to the American Cancer Society, CRC
screening is significant to cancer control because regular screening examinations can result in
early detection and removal of precancerous lesions before they develop to a malignant stage
(American Cancer Society, 2018). The recommended adult age to have a colorectal screenings is
between 50 to 75 and those at an increased risk of developing colorectal cancer should discuss
testing and further treatment plans with their health care provider. Vietnamese Americans con-
tinue to be the largest ethnic group to have the lowest CRC screening ratings (CDC, 2013). Viet-
namese Americans have reported to have later CRC diagnosis than any other Asian subgroup for
both men and women (Miller et al., 2008). It is essential to have improved development of
language appropriate and culturally competent CRC screening methods. A randomized con-
trolled trial was conducted by the University of Minnesota and the Vietnamese Social Services of
Minnesota (VSSM) to evaluate a culturally tailored DVD intervention and Vietnamese language
brochure (Lee et al., 2014). Both methods played an important role in increasing awareness and
the use of CRC screening. A similar study was done at a local hospital in the U.S, where Viet-
namese brochures and telephone counseling increased CRC screenings (Walsh, et al., 2010).
The Fecal immunochemical test (FIT) or immunochemical fecal occult blood test
(iFOBT), is one way to screen for colorectal cancer. According to the American Cancer Society,
blood vessels within larger colorectal polyps or cancerous lesions are often very fragile and can
be easily damaged by stool movement. Detection of blood will be traceable as it passes through
the colon or rectum within a stool sample. This noninvasive test is executed by collecting a stool
sample and can be done in the comfort of one’s home. There are no drug or dietary restrictions
and testing should be done on a yearly basis for early prevention (American Cancer Society,
2018). In 2016, the United States Prevention Services Task Force concludes in their recommen-
dation summary that there is a high certainty of benefit for adults age 50 to 75 years to get
screened for colorectal cancer by utilizing the FIT or iFOBT test. The following regimens that
will likely increase life-years gained are: annual high-sensitivity fecal occult blood testing, sig-
moidoscopy every 5 years combined with high-sensitivity fecal occult blood testing every 3
years, and screening colonoscopy at intervals of 10 years. Screening programs that incorporate
fecal occult blood testing, sigmoidoscopy, and colonoscopy procedures will be effective in re-
ducing mortality rates (United States Prevention Services Task Force, 2016).
The board and staff of the Vietnamese American Cancer Foundation (VACF) are fully
committed to serving and reaching out to the Vietnamese community in order to help spread
awareness and importance of colorectal cancer screenings — as well as other services related to
cancer to meet the unique needs of the community. The organization’s mission is a dedicated to
preventing cancer, improving patient quality of life, and saving lives through cancer education,
research, advocacy, and services in the Vietnamese community. VACF provides various pro-
grams to address the needs and concerns of the community through care coordination, free
screenings, patient navigation and outreach education. As an organization, we believe that it is
our duty to tackle this phenomenon that is occurring within this underserved community.

References

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Center for Disease Control and Prevention (2018). Colorectal (Colon) Cancer. Retrieved from
https://www.cdc.gov/cancer/colorectal/basic_info/screening/tests.htm

Centers for Disease Control and Prevention. (2014). Colorectal cancer screening guidelines.
Retrieved from http://www.cdc.gov/

Christy, S. M., & Rawl, S. M. (2013). Shared decision-making about colorectal cancer screening:
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Americans to obtain colorectal cancer screening:Evaluation of a culturally tai-
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USPSTF Assessment
The USPSTF concludes that, for fecal occult blood testing, flexible sigmoidoscopy, and colonos-
copy to screen for colorectal cancer, there is high certainty that the net benefit is substantial for
adults age 50 to 75 years.The USPSTF concludes that, for adults age 76 to 85 years, there is
moderate certainty that the net benefits of screening are small.
The USPSTF concludes that, for adults older than age 85 years, there is moderate certainty that
the benefits of screening do not outweigh the harms.
Screening programs incorporating fecal occult blood testing, sigmoidoscopy, or colonoscopy will
all be effective in reducing mortality. Modeling evidence suggests that population screening pro-
grams between the ages of 50 and 75 years using any of the following 3 regimens will be approx-
imately equally effective in life-years gained, assuming 100% adherence to the same regimen for
that period:8 1) annual high-sensitivity fecal occult blood testing, 2) sigmoidoscopy every 5 years
combined with high-sensitivity fecal occult blood testing every 3 years, and 3) screening colon-
oscopy at intervals of 10 years

1. Do colorectal cancer screening programs have demonstrated benefit in reducing colorectal

cancer mortality?
2. What is the efficacy of newer screening technologies—the high-sensitivity guaiac fecal occult
blood test, the fecal immunochemical test, the fecal DNA test, and CT colonography?
3. What is the effectiveness of optical colonoscopy and flexible sigmoidoscopy in community
practice?
4. What are the harms of newer screening technologies and optical colonoscopy and flexible sig-
moidoscopy in community practice?