Divan (2003) reviewed the incidence of cancer in Asian Indians residing in U.S.. 61% of South Asian women 40 years and older had regular breast exam which was nearer to the target goal of 70% by the year Healthy People 2010; and about 73% had a pap test in last 3 years—which was less than the Healthy People 2000 target of 85%. A recent study on Indian and Pakistani immigrants in U.S.A shows that cancer incidences vary form those living in their native country. The three most common cancers in Indian and Pakistani immigrants are:
• prostate cancer (30%)
• lung cancer (10%)
• colorectal cancer (9%)
In women, the three most common are:
• breast cancer (38%)
• genital cancer (15%)
• colorectal cancer (7%) (Hossain, 2008)
In addition, Indian and Pakistani immigrants have better survival rate compared to Non-Hispanic Whites (Hossain, 2008).
Unique Trends in California
Unique trends as observed by Jain et al (2005) amongst the south Asian population in California:
1. Lower median age as at the time of diagnosis – 58 years compared to 68 years for other races.
2. As noted in Table 2, the most commonly occurring cancers in the South Asian population in California were quite different from those seen in Indian sub-continent.
3. Incidence/Risk of Cancers in comparison to those living in their native country (India):
a. Four time of increased risk in developing colorectal cancer—in both male and females
b. decrease incidence of gall bladder cancer
c. Cancer of Stomach increase in South Asian females
d. Lung and Bronchus cancer- five fold increase in females
e. NHL: 3–6 time increased risk
According to the California Cancer Registry, the California Department of Public Health, 2002–2004 reports the most common cancers amongst south Asians immigrants (see Table 3). Breast Cancer In India only 1 in 40 women gets breast cancer, but in United States, one out of every eight Asian Indian women will get the disease, the highest incidence in the world. According to the American Cancer Society, South Asian women have the second highest incidence of cancer among Asian Pacific Islanders (Hossain, 2003). Oral Cancer Chewing of non-smoking tobacco and areca nut is widely prevalent in the south Asian immigrants lead to oral cancer and pre-cancerous conditions (Changrani et al 2006). The Indian Sub-continent (India, Pakistan, Bangladesh, and Sri Lanka) accounts for 40 % of the oral cancer diagnosed worldwide (Changrani et al 2006; Ahluwalia, 2005). Consequently, increasing number of immigrants from the Indian subcontinent oral cancer poses a threat U.S. public health (Changrani et al 2006; Ahluwalia, 2005). A pilot study by Changrani et al (2006) on the use of paan and gutka (see definitions below) amongst Indian- Gujarati immigrants and Bangladeshis in New York city showed that either these immigrants continued to use paan and gutka as they used to or developed the habit after immigration due to easy availability or lesser restrictions from the society. However, there are reports that paan and gutka use are less prevalent amongst those residing in California, which could be due to their higher educational levels (Jain et al, 2005). Paan and Gutka: Definitions Paan is a mixture of spices including, Areca catechu (areca palm or areca nut palm), betel leaves (Piper betle) belonging to the Piperaceae family, menthol, cardamom, calcium hydroxide (lime) and optionally chewing tobacco. The areca nut contains the alkaloid arecoline, which promotes salivation (the saliva, gums and teeth are stained red). It is thought to aid digestion, freshen the breath and also have aphrodisiac properties. Chewing paan is a social activity and has both ceremonial and symbolic value in the Asian Indian culture. Gutka (also spelled gutkha, guttkha, guthka) is a powdery, granular light brownish substance made from crushed areca palm nut, tobacco, calcium hydroxide, betal leaf extract and sweet or savory flavoring. When consumed gutkha begins to dissolve in the oral cavity and turn deep red in color. It is a stimulant and has addictive properties. Gutka (also spelled gutkha, guttkha, guthka) is a powdery, granular light brownish substance made from crushed areca palm nut, tobacco, calcium hydroxide, betal leaf extract and sweet or savory flavoring. When consumed gutkha begins to dissolve in the oral cavity and turn deep red in color. It is a stimulant and has addictive properties.