1. Going Against the Tide: The Increasing Incidence of Colorectal Cancer among Korean Americans in California, 1988-2007 Janet H. Bates, MD, MPH 1 Brenda M. Hofer, MA 1 Sandy L. Kwong, MPH 2 1 Public Health Institute, California Cancer Registry 2 Cancer Surveillance Section, California Department of Public Health

2. Objectives Highlight increasing rate of colorectal cancer (CRC) incidence among Koreans in California Discuss characteristics of this population that may help explain why their rates of CRC incidence are increasing Reinforce the importance of analyzing cancer data for individual Asian subgroups Discuss collaborations for disseminating this information

3. Background Colorectal cancer (CRC) incidence has declined markedly in the United States Declines experienced by men of all major racial/ethnic groups AND Women of all major racial/ethnic groups, except for Hispanics

4. To What is the Decline in CRC Incidence Attributed? 50% - uptake in screening 50% - changes in the prevalence of modifiable risk factors –Smoking –Obesity –Lack of physical activity

5. Colorectal Cancer Incidence by Race/Ethnicity, California, 1988-2007

10. Trends in Colorectal Cancer Incidence by Race/Ethnicity, California From 1988-2007 rates decreased by: 28% among non-Hispanic whites 20% among African Americans 13% among Asian/Pacific Islanders 8% among Hispanics

11. Bucking the Trend Colorectal cancer incidence rates are on the rise among some Asian population groups

12. Colorectal Cancer Incidence Trends Among Asian Subgroups, California, 1988-2007 *Annual percent change (APC) is statistically significant

13. Colorectal Cancer Incidence Trends Among Asian Subgroups, California, 1988-2007 *Annual percent change (APC) is statistically significant

14. Colorectal Cancer Incidence Trends Among Asian Subgroups, California, 1988-2007 *Annual percent change (APC) is statistically significant

15. Colorectal Cancer Incidence Trends Among Asian Subgroups, California, 1988-2007 *Annual percent change (APC) is statistically significant

16. Colorectal Cancer Incidence Trends Among Asian Subgroups, California, 1988-2007 *Annual percent change (APC) is statistically significant

17. Colorectal Cancer Incidence Trends Among Asian Subgroups, California, 1988-2007 *Annual percent change (APC) is statistically significant

18. Colorectal Cancer Incidence Trends Among Asian Subgroups, California, 1988-2007 *Annual percent change (APC) is statistically significant

19. CRC Risk Factors among Koreans How do Koreans compare to other Asian subgroups in regards to CRC risk factors? –Obesity –Lack of physical activity –Smoking – Not getting screened

20. Risk Factors: Obesity Among Asian Subgroups, California, 2007

21. Risk Factors: Physical Activity Among Asian Subgroups, California, 2007

22. Risk Factors: Smoking Among Asian Subgroups, California, 2007 Source: 2007 California Health Interview Survey (CHIS)

23. Colorectal Cancer Screening Among Asian Subgroups, California, 2007

24. Proportion of Californians Age 50 Years and Older Ever Screened by Endoscopy or FOBT, 2001-2005 (CHIS*) Ethnic group 200120032005 Japanese71%72%77% Chinese59%64% Filipino56%54%66% Vietnamese53%63%60% Korean49%43%33% *California Health Interview Survey data Maxwell & Crespi, 2009

25. Barriers to CRC Screening among Koreans Rapid and recent immigration No usual source of health care High uninsured rates Not receiving recommendation by a physician

26. Collaboration C4’s mission is to save lives and reduce suffering from colorectal cancer in all Californians  Plans for media outreach campaign

27. Summary In stark contrast to all other racial/ethnic groups, CRC incidence is increasing among Koreans in California Increasing rates in CRC incidence among Koreans may in part be explained by the fact that they are not getting screened Analyzing cancer data for Asian/Pacific Islanders collectively masks important differences that exist among Asian subgroups

28. Acknowledgements Janet H. Bates, MD, MPH Chief, Cancer Surveillance Section California Cancer Registry Sandy L. Kwong, MPH Acting Chief, Cancer Surveillance Research Unit California Cancer Registry