Many Latinos Avoid Tests, Fail to Treat Cancer Early

The cancer rate for Latinos is lower than in the general population, but a greater proportion of Latinos who get the disease in the L.A. area are likely to die of it.

“A patient’s outcome has a lot to do with the stage at which their cancer is diagnosed,” said Dr. Aliza Lifshitz, president of the California Hispanic-American Medical Assn. By the time cancer is detected, it is often difficult to treat and “so advanced we can only take palliative measures,” she said.

Second only to heart disease as a cause of death nationwide, cancer will affect more than 80 million Americans now living--one in every three persons.

Los Angeles County statistics compiled by the Kenneth Norris Jr. Comprehensive Cancer Center indicate that prostate, lung and colon cancers are the three most common cancers among Latino males, while Latinas are most susceptible to breast, cervical and colon cancers.

The cancers killing many Latinos are also those that can most easily be prevented or found at an early stage through regular screenings, physicians say.

These early detection screenings include Pap tests for cervical cancer, mammographies and physical exams for breast cancer, and rectal exams for colon and prostate cancer.

Surveys show that many Latinos either are not aware of the tests or are not using them because of a lack of regular health care, language barriers and other personal reasons.

In many cases, embarrassment turns patients away from testing, said Lifshitz, recalling an occasion when she showed an educational video on colon cancer and rectal examinations to a group of uneasy men. “Afterward, several men came up and asked: ‘Isn’t there any other way I could be tested?” she said.

According to state statistics, among men over 50, about half of the Anglos have had a digital rectal exam, which is the standard screening test for prostate cancer. But the rate drops to about 25% for Latinos and 35% for blacks.

Women similarly shy away from pelvic and breast exams, Lifshitz noted.

Communication barriers between Latinos and their doctors may also keep patients from reporting symptoms and requesting testing, said Dr. Sarah Fox, a UCLA assistant medical professor conducting research on minority cancer screening access.

“A physician who can communicate is a powerful motivator for women to get to a cancer screening,” Fox said. But oftentimes doctors who are only somewhat bilingual cannot communicate well enough to build relationships with patients and persuade them of the need for regular testing, she said.

Some Latinos avoid testing because they are afraid to discover they have a life-threatening illness. Latinas often have more anxiety about having cancer than other women, said Fox, and generally are more likely to cite fear as a major reason for not undergoing gynecological or breast cancer exams.

“They’re afraid of cancer, the big ‘C.’ They don’t want to know about it, and they fear knowing that they have it,” said Maria Gutierrez, KMEX production operations manager, who is a volunteer for the American Cancer Society Low Cost Mammography Project.

Doctors stress that regular testing can detect altered cells before they become cancerous tumors or before they spread to other organs.

“But the idea of paying money to have a test done just to prevent disease” seems unnecessary to many Latinos, said Dr. Raquel Arias, director of the USC Center for Women’s Health.

Maria Gutierrez, a nurse practitioner at Los Angeles County-USC Medical Center, agreed. “Cervical cancer is the most treatable of cancers--in its beginnings,” she said. “But too few Latinas are being tested.”

Both the 40-year decline in cervical cancer cases and the reduction of cervical cancer deaths by more than 70% in Los Angeles County are thought to stem directly from increased use of the Pap test. However, more than 15% of Latinas across the nation were unaware of the exam.

Latinas get cervical cancer more often than any other group in Los Angeles County, averaging more than 22 cases in every 100,000 women. Latina immigrants are at especially high risk, according to the Norris Cancer Center.

Studies are under way to determine why cervical cancer rates are higher among certain ethnic groups. Researchers indicate that the disease has been linked to the presence of a sexually transmitted virus, and sexual activity at an early age or with many partners adds to the chance of contracting the cancer.

Breast cancer, expected to cause more than 1,400 deaths among California women this year, can also be found early through breast exams and mammograms. This year, more than 5,000 women in California will have contracted the disease--more than 900 Latinas in Los Angeles County alone.

State statistics show that 65% of breast cancer cases in Anglos and Asians are diagnosed at early stages, compared to 54% in blacks and 53% in Latinas.

Despite the dangers, seven out of every 10 Los Angeles County Latinas have never had a mammogram, a UCLA study reported, and almost one-third of Latinas surveyed nationwide were unfamiliar with the procedure.

“Once a Year. . .For a Lifetime,” a Spanish-language TV drama featuring Cristina Saralegui, Edward James Olmos and others, was produced earlier this year by the National Cancer Institute and the Revlon/UCLA Women’s Cancer Research program to inform Latinas about breast cancer and testing. It is available on videotape through the National Cancer Institute.

For six years, the American Cancer Society’s Project Outreach has provided free screenings for uninsured low-income women through monthly clinics held in East and South-Central Los Angeles, San Fernando Valley and other sites. The project will end this month because corporate grants have run out, said Socorro Davis, cancer control manager with the American Cancer Society.

The society will refer needy women to individual clinics that still offer free exams, Davis said.

Mammograms regularly cost between $100 and $200, but efforts such as the Low-Cost Mammography project make the tests available for $65 to $95. Responding to publicity in Spanish media and businesses, more than 40,000 women called the society in 1991 to request informational packets containing coupons for the low-cost exams.

Although prostate cancer afflicts almost 60 of every 100,000 Latinos in Los Angeles County each year and can also be detected early, low-cost examinations for men are harder to find.

Low-cost prostate and colon cancer tests are occasionally available through area hospitals. Men and women over 50 may also be eligible for free colon, prostate, breast and other cancer testing programs publicized at senior citizen centers in their area.

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Besides undergoing regular medical exams, people can improve their chances of living cancer-free by giving up smoking, said Arias. Although 30% of Latino males use cigarettes--almost equal to the national average--only 18% of Latinas smoke.

“Relatively few women of Mexican and Central-American origin smoke here,” said Arias. But with increases in Spanish-language tobacco advertising, she added, “I can only expect that incidences of lung cancer and other cigarette-associated cancers will increase.”

A 1990 survey indicates that, while smoking among Anglos and African-Americans has been declining, smoking has been increasing among young Latinos since the mid-1970s. Almost one-third of the nation’s Latino high school students smoke.

More than two-thirds of the Latino respondents in a 1991 American Cancer Society survey said they were trying to reduce their risks by cutting smoking, improving eating habits or exercising, said Carmen Ulmer, a public relations officer of the American Cancer Society.

Most Common Types of Cancer

These rates are annual averages per 100,000 Latinos from 1972-87 in Los Angeles County

Men Prostate Incidences: 59 Deaths: 18.3 Lung Incidences: 43.2 Deaths: 35.6 Colon Incidences: 23.2 Deaths: 12.6 Women Breast Incidences: 61.2 Deaths: 19.1 Cervix Incidences: 21.7 Deaths: 5.5 Colon Incidences: 18.1 Deaths: 9