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Keywords:

  • AANCART;
  • Asian American;
  • cancer;
  • Pacific Islander;
  • cancer mortality

Abstract

  1. Top of page
  2. Abstract
  3. METHODS
  4. RESULTS
  5. DISCUSSION
  6. REFERENCES

We report upper and lower boundary estimates of the 1999–2001 site-specific cancer mortality rates for Asian Indians, Chinese, Filipinos, Koreans, Vietnamese, Native Hawaiians, and Samoans. These rates are for the seven states (California, Hawaii, Illinois, New Jersey, New York, Texas, and Washington) that officially record mortality data for these ethnicities. The rates are based on the 2000 Census, which reports two population counts as follows: persons who identify themselves as belonging to a single ethnic group (which forms the basis for an upper boundary estimate of the rates) and persons who identify themselves as belonging to a single ethnic group or to multiple groups that include the single ethnic group (which forms the basis for a lower boundary estimate for the rates). The top five cancers for each Asian and Pacific Islander ethnic group by gender are reported. In addition, the 1988–1992 cancer mortality rates based on the 1990 Census for Chinese, Filipino, Japanese, and Native Hawaiians are determined. Their 1999–2001 and 1988–1992 rates are compared. Cancer 2005. © 2005 American Cancer Society.

Annual cancer incidence and mortality rates have been determined for five racial/ethnic groups, Whites, African Americans, American Indians/Alaska Natives, Asians and Pacific Islanders (API), and Hispanics since 1990.1 In addition, the cancer deaths for many API ethnic groups, such as Asian Indians, Chinese, Filipinos, Japanese, Koreans, Vietnamese, Native Hawaiians, and Samoans, are determined every year. However, their cancer mortality rates are determined only once every 10 years. This infrequency is due to a lack of population estimates for these ethnic groups until the federal census is taken, once a decade.

With the 2000 Census reporting of age distributions for API ethnic populations, cancer mortality rates can be reported for these ethnic groups. We will report their 1999–2001 cancer mortality rates, using the 2000 Census data and standardizing to the 2000 United States (U.S.) population. Then we will compare these rates to those based on their 1990 Census data. The 1988–1992 cancer mortality rates for Chinese, Japanese, Filipinos, and Native Hawaiians have been reported, based on the 1990 Census and standardized to the 1970 U.S. population.2 Unfortunately, there is no way to compare rates standardized to 1970 with rates standardized to 2000. Thus, we will recalculate the 1988–1992 rates and standardize these to the 2000 U.S. population. This allows us to determine the change in cancer mortality rates from 1988–1992 to 1999–2001 for a number of API ethnic groups.

METHODS

  1. Top of page
  2. Abstract
  3. METHODS
  4. RESULTS
  5. DISCUSSION
  6. REFERENCES

In the 2000 Census, people were allowed to indicate if they classify themselves in more than one racial/ethnic group. Thus, in the reporting of the 2000 Census, two population counts are given, one for persons who classified themselves as being from a single ethnicity (“alone” population), and one for persons who indicated that they are of an ethnicity that is either a single ethnic group or part of a multiple racial/ethnic group (“any combination” population).3 The rates based on the “alone” population form an upper boundary on cancer mortality rates for an ethnicity, whereas rates based on the “any combination” population form a lower boundary on the rates.

The ethnic group for a cancer death is determined from the death certificate. Beginning in 1969, cancer deaths were reported for four API ethnicities, Chinese, Japanese, Filipinos, and Native Hawaiians throughout the U.S. In 1992, seven states (California, Hawaii, Illinois, New Jersey, New York, Texas, Washington), representing the states with the most APIs based on the1990 Census, allowed death certificates to report additional API ethnicities.

The 2000 Census data allows one to calculate 1999–2001 cancer mortality rates in Asian Indians, Koreans, Vietnamese, Samoans, and others.4 For Chinese, Filipino, Japanese, and Native Hawaiians, the rates for 1988–1992, based on their 1990 Census populations for the seven states, can be calculated and compared with their 1999–2001 rates.

Using the 1990 Census populations for Chinese, Japanese, Filipino, and Native Hawaiians, their 1988–92 cancer mortality rates were determined, using the 1990 population for this 5-year period, age-adjusted to the 2000 U.S. standard population. Using the 2000 Census populations, the 1999–2001 cancer mortality rates for these groups were calculated with the upper boundary on the rates based on the number of people in the “alone” population and the lower boundary of the rates based on the “any combination” populations. These data were obtained from the Census 2000 Census Summary File two (SF-2) and accessed using American FactFinder on the Census website.3

For Asian Indians, Koreans, Vietnamese, and Samoans, their annual number of cancer deaths have been reported since 1992 in only seven states, California, Hawaii, Illinois, New Jersey, New York, Texas, and Washington.5 These are the seven states with the greatest API populations from the 1990 Census. Using the 2000 Census, the 1999–2001 cancer mortality rates for these groups were determined in the same manner as for the other groups. For Native Hawaiians, the Hawaii (HI) cancer registry counts the 2000 Census “any combination” population of Native Hawaiians as the estimate of the Native Hawaiian population. The upper boundary of the rates for Native Hawaiians were based on the “any combination” population of Native Hawaiians in HI and the other six states' “alone” populations for Native Hawaiians. For Samoans in HI, the HI cancer registry determined their own estimates of this population. It is intermediate between the “alone” and “any combination” census populations for Samoans in HI. The HI cancer registry estimate of Samoans was used in the determination of the upper boundary on Samoan rates. All rates are age-adjusted to the 2000 standardized U.S. population.

RESULTS

  1. Top of page
  2. Abstract
  3. METHODS
  4. RESULTS
  5. DISCUSSION
  6. REFERENCES

The 1999–2001 cancer mortality rates, representing seven states (California, Hawaii, Illinois, New Jersey, New York, Texas, and Washington), are reported for Asian Indians, Chinese, Filipinos, Japanese, Koreans, Vietnamese, Native Hawaiians, and Samoans in Table 1. The rates for each API ethnicity are the first report on their rates based on the 2000 Census for the seven states. Two rates are presented, the upper boundary of the rates using the Census “alone” populations and the lower boundary of the rates, using the “any combination” populations. We report rates that occurred in at least 10 persons of an ethnicity by gender. For comparison, we report the 1988–1992 cancer mortality rates for Chinese, Filipinos, Japanese, and Native Hawaiians in Table 2. Figure 1 shows the cancer mortality rates for all causes of cancer deaths for the periods 1988–1992 and 1999–2001 by gender. The differences in the 1999–2001 and 1988–1992 all cancers mortality rates are plotted. Positive values indicate an increase in rates from 1988–1992 to 1999–2001, whereas negative values indicate a decrease in rates during these periods.

Table 1. 1999-2001 Cancer Mortality Rates for Asian and Pacific Islander Ethnicities for Seven States (CA, HI, IL, NJ, NY, TX, and WA) Based on 2000 Census Populations
 MaleFemale
Upper boundaryLower boundaryDeathsUpper boundaryLower boundaryDeaths
RateSERateSERateSERateSE
  1. SE = standard error of rate; nr: not reported in table because of < 10 cases. Brain: brain and other nervous system; Endometrium: corpus and uterus not otherwise specified; Kidney: kidney and renal pelvis; Liver: liver and intrahepatic bile duct; Lung: lung and bronchus; Non-Hodgkin: Non-Hodgkin lymphoma; Oral cavity: oral cavity and pharynx (including nasopharynx). Rates are per 100,000 and age-adjusted to the 2000 U.S. (18 age groups) standard. 95% confidence intervals are Rate ± SE.

Asian Indian          
 All cancers81.74.871.24.149766.03.557.43.0477
 Brain3.90.83.40.7372.50.62.20.619
 Breastnrnrnrnrnr11.91.310.41.1109
 Cervix     2.30.62.00.517
 Colorectum4.71.24.11.0315.41.14.61.030
 Endometrium     1.70.51.50.413
 Esophagus4.21.13.71.0222.90.82.50.619
 Gallbladdernrnrnrnrnr1.70.51.50.414
 Leukemia5.31.24.61.0472.80.72.40.626
 Liver5.11.24.41.0322.80.82.40.717
 Lung17.42.115.21.8995.41.04.70.937
 Myeloma1.50.41.40.4152.50.62.20.617
 Non-Hodgkin3.40.93.00.7242.30.62.00.616
 Oral cavity3.00.92.60.821nrnrnrnrnr
 Ovary     4.50.93.90.835
 Pancreas5.71.25.01.1293.70.93.20.723
 Prostate10.02.08.61.734     
 Stomach3.50.93.10.8242.20.71.90.614
 Urinary bladder3.61.23.11.111nrnrnrnrnr
Chinese          
 All cancers170.93.0159.02.83,539109.52.1101.22.02,771
 Brain2.20.32.00.3481.80.31.60.247
 Breastnrnrnrnrnr11.90.710.80.6328
 Cervix     2.10.31.90.353
 Colorectum19.01.017.81.038112.70.711.80.7313
 Endometrium     2.20.32.00.358
 Esophagus3.80.43.60.4840.90.20.80.221
 Gallbladder0.60.20.50.2120.80.20.70.219
 Kidney3.20.42.90.4671.30.21.20.232
 Leukemia6.50.66.00.51373.40.43.10.387
 Liver20.41.018.80.94607.50.66.90.5189
 Lung49.81.646.51.51,01124.51.022.70.9604
 Melanoma0.50.20.50.211nrnrnrnrnr
 Myeloma1.80.31.70.3371.10.21.00.226
 Nasopharynx4.80.44.40.41261.40.21.30.240
 Non-Hodgkin6.20.65.80.51253.90.43.60.498
 Oral cavity6.30.55.80.51602.20.32.00.359
 Ovary     5.40.55.00.4143
 Pancreas8.40.77.90.61737.20.66.70.5175
 Prostate10.50.89.90.8175     
 Stomach12.00.811.20.72517.60.67.00.5189
 Thyroidnrnrnrnrnr0.60.20.60.215
 Urinary bladder3.40.53.20.4591.10.21.00.224
Filipino          
 All cancers154.53.3141.33.02,32495.62.288.02.02,046
 Brain2.80.42.50.4451.40.31.20.229
 Breastnrnrnrnrnr16.70.915.20.8401
 Cervix     2.90.42.60.370
 Colorectum15.11.013.80.92368.80.78.10.6187
 Endometrium     2.90.42.70.366
 Esophagus2.20.42.00.4330.70.20.60.215
 Gallbladder0.70.20.60.2100.70.20.60.214
 Kidney2.50.42.20.4431.40.31.30.231
 Leukemia5.70.65.00.5942.60.32.30.357
 Liver11.60.910.60.81893.80.53.50.473
 Lung46.51.842.61.670817.51.016.20.9360
 Myeloma3.00.52.80.4442.70.42.50.453
 Nasopharynx1.30.31.20.2240.50.10.40.110
 Non-Hodgkin9.70.88.90.81423.70.43.50.474
 Oral cavity3.60.53.30.4591.30.31.20.227
 Ovary     5.90.55.40.5136
 Pancreas7.10.76.50.71046.20.65.70.5121
 Prostate18.61.217.21.1234     
 Stomach4.80.64.40.5743.00.42.80.457
 Thyroid0.80.20.70.2120.90.20.80.218
 Urinary bladder2.00.41.90.4250.80.20.70.213
Japanese          
 All cancers172.84.0161.93.71,992117.62.8109.62.51,971
 Brain1.80.51.40.3181.20.31.00.317
 Breast     15.51.014.20.9237
 Cervix     2.00.41.80.327
 Colorectum24.91.523.31.428315.31.014.30.9253
 Endometrium     2.50.42.30.440
 Esophagus7.00.86.50.7771.20.31.10.321
 Kidney4.10.63.80.6471.30.31.20.321
 Leukemia5.40.74.90.6603.80.53.50.560
 Liver8.90.98.30.81006.60.66.10.6119
 Lung38.41.836.31.746119.41.118.41.0345
 Myeloma1.30.31.30.3171.60.31.50.328
 Non-Hodgkin6.40.86.00.7755.10.64.70.585
 Oral cavity2.20.42.00.4250.80.20.80.214
 Ovary     5.50.65.10.686
 Pancreas12.91.112.11.014810.60.810.10.7190
 Prostate16.21.215.51.2182     
 Stomach18.41.317.31.221110.50.89.90.8179
 Thyroidnrnrnrnrnr0.60.20.50.210
 Urinary bladder5.00.74.80.6571.20.31.20.321
Korean          
 All cancers202.97.0194.76.81,084111.53.8107.53.7962
 Brain1.40.41.30.4121.40.41.30.413
 Breastnrnrnrnrnr7.80.87.50.890
 Cervix     3.00.52.80.531
 Colorectum18.92.218.22.29411.11.210.71.296
 Endometrium     1.60.51.60.414
 Esophagus3.10.83.00.819nrnrnrnrnr
 Gallbladder2.30.72.20.7112.00.62.00.515
 Kidney3.40.83.30.8191.80.51.80.513
 Leukemia6.01.15.71.1372.50.52.30.524
 Liver24.72.223.72.115813.11.312.71.2114
 Lung54.63.752.43.527321.01.720.31.6168
 Myelomanrnrnrnrnr1.50.51.40.411
 Non-Hodgkin6.21.35.91.2303.30.73.20.725
 Oral cavity3.30.83.10.818nrnrnrnrnr
 Ovary     4.60.74.50.743
 Pancreas11.11.610.61.5618.21.17.91.064
 Prostate8.41.78.11.630     
 Stomach32.42.831.12.618715.61.415.01.4135
 Urinary bladder3.81.03.61.016nrnrnrnrnr
Vietnamese          
 All cancers164.96.9155.26.585396.24.490.54.1590
 Brain2.70.82.60.8171.50.51.40.510
 Breast     7.51.17.11.061
 Cervix     4.50.94.30.831
 Colorectum8.51.68.01.5447.51.27.11.246
 Endometium     1.80.61.70.513
 Esophagus3.51.13.31.114nrnrnrnrnr
 Kidney3.01.02.80.913nrnrnrnrnr
 Leukemia7.41.67.01.5324.70.94.40.934
 Liver34.33.032.42.819910.51.59.91.460
 Lung43.03.540.53.322118.82.017.71.9102
 Nasopharynx2.30.72.20.617nrnrnrnrnr
 Non-Hodgkin6.01.35.71.2343.90.93.70.821
 Oral cavity6.21.35.91.2382.20.72.10.713
 Ovary     4.50.94.20.832
 Pancreas7.41.47.01.3396.01.15.61.036
 Prostate6.81.76.41.620     
 Stomach14.12.113.22.0667.01.26.61.143
 Urinary bladder2.50.82.40.713nrnrnrnrnr
Native Hawaiian          
 6+HI          
 All cancers258.911.1226.510.9539197.78.8173.98.1503
 Breastnrnrnrnrnr33.43.529.23.290
 Cervix     7.01.66.11.519
 Colorectum26.23.623.03.55414.62.412.92.236
 Endometrium     5.81.55.11.415
 Esophagus6.61.65.71.516nrnrnrnrnr
 Kidney4.51.33.91.212nrnrnrnrnr
 Leukemia10.32.19.02.2235.61.44.91.316
 Liver10.42.19.12.0257.21.76.41.617
 Lung82.26.472.16.116744.24.239.03.8111
 Myeloma5.61.64.91.4134.81.44.31.311
 Non-Hodgkin8.82.07.72.0195.91.55.21.415
 Oral cavity4.81.34.21.213nrnrnrnrnr
 Ovary     6.61.65.81.517
 Pancreas10.82.19.42.02615.82.513.92.340
 Prostate22.84.020.23.833     
 Stomach16.62.814.52.73512.12.310.72.128
Samoan          
 6+HI          
 All cancers286.825.6250.825.9126197.819.0171.417.9108
 Breast     37.07.732.57.123
 Cervix     nrnrnrnrnr
 Colorectum34.39.528.69.313nrnrnrnrnr
 Liver29.78.626.38.212nrnrnrnrnr
 Lung80.113.071.112.53845.410.738.99.718
 Stomach39.710.634.910.414nrnrnrnrnr
Table 2. 1988–1992 Cancer Mortality Rates for Seven States (CA, HI, IL, NJ, NY, TX, and WA)—Based on 1990 Census Populations
 MalesFemales
RateSECountRateSECount
  1. Rates are per 100,000 and age-adjusted to the 2000 U.S. (18 age groups) standard. SE: standard error of rate; nr: not reported as there were less than 10 cancer deaths for site; Brain: brain and other nervous system; Endometrium: corpus and uterus, not otherwise specified; Kidney: kidney and renal pelvis; Liver: liver and intrahepatic bile duct; Lung: lung and bronchus; Non-Hodgkin: Non-Hodgkin lymphoma; Oral cavity: oral cavity and pharynx (including nasopharynx). 95% confidence intervals are Rate ± SE.

Chinese      
 All cancers1843.33,784116.72.32,764
 Brain2.30.3601.70.343
 Breastnrnrnr140.8360
 Cervix   3.20.483
 Colorectum21.81.241414.90.8333
 Endometrium   2.80.374
 Esophagus5.40.61091.00.222
 Gallbladder1.10.2221.20.228
 Hodgkin1.80.3391.10.228
 Kidney1.10.321nrnrnr
 Leukemia4.70.51082.90.378
 Liver21.21.05126.10.5147
 Lung53.01.81,06326.01.1590
 Melanomanrnrnr0.40.110
 Myeloma1.40.3301.90.341
 Nasopharynx5.90.51541.60.343
 Non-Hodgkin6.90.61503.00.473
 Oral cavity8.00.62032.50.365
 Ovary   4.80.4126
 Pancreas9.00.71766.90.6159
 Prostate10.40.9156   
 Stomach14.20.92837.00.6160
 Thyroidnrnrnr0.80.216
 Urinary bladder2.90.5481.50.330
Filipino      
 All cancers140.82.92,53879.42.21,716
 Brain*1.50.3341.80.343
 Breastnrnrnr14.10.8357
 Cervix   2.90.476
 Colorectum15.71.02797.50.7152
 Endometrium   1.30.233
 Esophagus3.00.4530.70.211
 Gallbladder0.70.2111.00.317
 Kidney2.40.4460.60.210
 Leukemia7.30.61473.40.485
 Liver9.40.71803.10.560
 Lung37.21.468012.40.9261
 Melanoma0.60.210nrnrnr
 Myeloma3.30.4581.30.228
 Nasopharynx2.00.342nrnrnr
 Non-Hodgkin6.30.61193.80.575
 Oral cavity3.60.4712.40.538
 Ovary   3.90.493
 Pancreas6.30.61134.60.686
 Prostate22.61.2356   
 Stomach5.10.5913.40.566
 Thyroid0.60.2111.70.431
 Urinary bladder1.60.3280.60.212
Japanese      
 All cancers175.93.72,727112.12.42,383
 Brain1.40.3261.20.326
 Breastnrnrnr15.00.9335
 Cervix   1.80.339
 Colorectum25.81.442316.40.9342
 Endometrium   2.40.354
 Esophagus6.20.71011.20.325
 Gallbladder0.60.2101.20.322
 Kidney3.10.5491.20.226
 Leukemia5.50.6902.60.449
 Liver7.80.71294.60.5109
 Lung41.71.768114.80.9333
 Melanoma1.30.3211.00.220
 Non-Hodgkin6.40.71004.90.5102
 Oral cavity*2.70.4441.20.326
 Ovary   6.00.5140
 Pancreas11.20.91708.90.7182
 Prostate18.31.3229   
 Stomach24.21.435913.00.8259
 Thyroidnrnrnr1.00.218
 Urinary bladder3.00.5401.80.333
Native Hawaiian     
 All cancers266.710.6765182.77.6643
 Brain3.31.0143.51.112
 Breastnrnrnr28.52.9105
 Cervix   3.10.912
 Colorectum26.63.37714.12.342
 Endometrium   9.11.829
 Esophagus9.82.028nrnrnr
 Kidney3.51.012nrnrnr
 Leukemia7.41.5295.71.224
 Liver9.11.829nrnrnr
 Lung95.96.327545.33.8158
 Myelomanrnrnr4.31.214
 Non-Hodgkin9.71.8354.81.218
 Oral cavity4.11.114nrnrnr
 Ovary   7.51.529
 Pancreas14.62.54011.02.034
 Prostate29.54.258   
 Stomach17.22.84613.52.146
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Figure 1. Upper panels report all cancer mortality rates for 1988–1992 (in black) and the upper boundary estimate of the 1999–2001 rates for males (blue, left graph) and for females (pink, right graph). Lower panel is the difference between 1999–2001 and 1988–1992 cancer mortality rates for all cancers. A positive value indicates that the 1999–2001 rate is greater than the 1988–1992 rate. A negative value indicates that the 1999–2001 rate is less than the 1988–1992 rate. Differences in the male rates are in blue, and differences in the female rates are in pink. Total API: Total Asians and Pacific Islanders; Nat Haw: Native Hawaiians.

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Figure 2 shows differences between 1988–1992 and 1999–2001 site-specific cancer rates for Chinese, Filipinos, Japanese, and Native Hawaiians. Examination of these plots indicates the cancer sites contributing to all cancer mortality rate changes.

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Figure 2. Differences between 2000 (1999–2001) and 1990 (1988–1992) site-specific cancer mortality rates for Chinese, Filipinos, Japanese, and Native Hawaiians. A positive value indicates that the 2000 (1999–2001) rate is greater than the 1990 (1988–1992) rate. A negative value indicates that the 2000 (1999–2001) rate is less than the 1990 (1988–1992) rate. Differences in the male rates are in blue, and differences in the female rates are in pink. Liver*: liver and intrahepatic bile duct; Lung*: lung and bronchus. Asterisks indicate that Lung* includes lung and bronchus; Liver* includes liver and intrahepatic bile duct.

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The top five site-specific 1999–2001 cancer mortality rates are reported in Figure 3 for each API ethnic group.

thumbnail image

Figure 3. Top five 1999–2001 cancer mortality rates by ethnicity and gender.

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DISCUSSION

  1. Top of page
  2. Abstract
  3. METHODS
  4. RESULTS
  5. DISCUSSION
  6. REFERENCES

We see declines in the 1988–1992 to 1999–2001 all cancers mortality rates for both genders of Whites, Total API, and Chinese. However, there are increases for both genders of Filipinos, Japanese females, and Native Hawaiian females. Thus, the total API pattern masks the effects in specific API ethnic groups.

For Filipinos, the increases are principally due to increases in lung and liver cancers for males and increases in lung, breast, pancreatic, ovarian, and colorectal cancers for females. Furthermore, Filipino females do not have a decline in rates for cervical cancer. For Japanese females, increases are due to lung, pancreatic, and liver cancer. Although the “all cancers” mortality rates for Japanese males has declined from the 1990s to the2000s, there are increases in pancreatic and liver cancers. For Native Hawaiian females, there are increases in lung, liver, pancreatic, breast, and cervical cancers.

The cancer sites, lung, liver, breast, colorectum, cervix, and prostate have medical interventions that may reduce the risk of cancer death.6 For lung cancer, there is smoking cessation. For breast cancer, there is mammography and clinical breast examination. For colorectal cancer, there is colorectal cancer screening with fecal occult blood testing, sigmoidoscopy, colonoscopy, and barium scanning. For cervical cancer, there is Papanicolaou smear and human papilloma virus testing. For prostate cancer, there is prostate specific antigen (PSA).6 For liver cancer, there are hepatitis B vaccinations.7

The top five 1999–2001 cancer mortality rates for each API ethnic group by gender are presented in Figure 3. The cancer burdens are unique to each API ethnic group. No group has the same order of the top five cancers. Furthermore, no group has the same order as the total API cancers (except Japanese females). Thus, the total API cancer burden, which is reported annually, does not represent any specific API group, but is a composite of different problems. This speaks to the importance of reporting rates on separate API ethnic groups and the need for cancer prevention and control activities tailored to each group.

Even with this uniqueness, there are several overall themes with regard to cancer prevention and control. The predominant cancer for all API ethnic groups is lung cancer. It is the number one cause of cancer death for each group, except Asian Indian women. For females of most ethnic groups, breast cancer is second. Liver cancer is still a major concern for API groups as well as stomach cancers.

We have presented the cancer mortality rates for API ethnic groups. Hopefully, they will be used to shape the types of cancer prevention and control measures needed for each group. The uniqueness of cancer concerns for each ethnic group represents a challenge to all researchers attempting to serve these communities.

REFERENCES

  1. Top of page
  2. Abstract
  3. METHODS
  4. RESULTS
  5. DISCUSSION
  6. REFERENCES
  • 1
    RiesLAG, EisnerMP, KosaryCL, et al., editors. SEER Cancer Statistics Review, 1975–2001. Bethesda: National Cancer Institute. 2004.
  • 2
    Miller BA, Kolonel LN, Bernstein L, et al. Racial/Ethnic patterns of cancer in the United States 1988–92. NIH Pub. No. 96–4104. Bethesda: National Institutes of Health. 1996.
  • 3
    Bureau of the Census. 2000 Census. Washington, DC: Bureau of the Census. 2004.
  • 4
    Chu KC. Cancer data for Asian Americans and Pacific Islanders. Asian Am Pac Isl J Health. 1998; 6: 130139.
  • 5
    Hoyert DL, Kung HC. Asian or Pacific Islander mortality, selected states, 1992. Mon Vital Stat Rep. 1999; 46: 164.
  • 6
    Smith RA, Cokkinides V, von Eschenbach AC, et al. American Cancer Society guidelines for the early detection of cancer. CA Cancer J Clin. 2002; 52: 822.
  • 7
    Centers for Disease Control. Hepatitis B. Atlanta: Centers for Disease Control and Prevention. 2004.