Patient navigator program to educate Hmong women on cervical cancer

The Asian-American community of Hmong women in California carries a stunning burden of cervical cancer and resulting mortality four times as high as non-Hispanic white women in California do.

In possibly the first study to document a baseline in the Hmong community for women undergoing screening for cervical cancer, researchers found that "only 74 percent have had a Pap test and only 61 percent have had this test within the past three years," said lead author Dao Moua Fang.

"When you compare this with California women overall — at 91 percent and 86 percent respectively — there is great disparity," said Fang, program manager at the Hmong Women's Heritage Association in Sacramento.

Single, often American-born, educated, English-speaking Hmong women were least likely to get a Pap test. "Some are in denial, wanting the Pap test for their mothers — but not themselves." Fang said. "Others are just unaware that they need a Pap test, because they were never advised to get one from their mothers or primary care physicians."

This study, which appears in the August issue of the Journal of Health Care for the Poor and Underserved, includes all 402 women receiving services at the Heritage Association between mid-September and mid-December in 2006.

Many Hmong women avoid screening and even treatment for cervical cancer for numerous reasons, among them cultural barriers and stigma, said Fang, who is herself Hmong. "Older women are shy and find physical exams and invasive therapies embarrassing. But they also are afraid that their spouse might leave them if they are diagnosed with human papillomavirus, an abnormal Pap smear, cervical cancer or anything that suggests they might have been unfaithful. And if women are not unfaithful, then they suspect that their spouse might be."

Because of this study, Fang and her colleagues developed a patient navigator program to make appointments, translate and provide one-on-one education about cervical cancer.

This is an important study, because there is a serious lack of data on Asian American, Native Hawaiian and Pacific Islander health, said Roxanna Bautista, chronic diseases program director at the Asian and Pacific Islander American Health Forum.

"The data that do exist usually lump us all together as Asians," Bautista said. "This study demonstrates that keeping America's women and families healthy starts with outreach and education programs that take into account differences in language and culture."

According to the latest U.S. Census bureau report, about 206,000 Hmong live in the United States at this time.