Prostate Cancer Screening Among Korean American Immigrant Men: Does Modesty Play a Role?

Purpose: Prostate cancer is the most common cancer among men in the U.S. and is the second leading cause of cancer death. Screening has been shown to be an effective measure in detecting prostate cancer at an early stage and is largely responsible for declines in cancer mortality rates in the general U.S. population. Evidence shows that immigrant men from East and South Asia show markedly low rates of prostate cancer screening compared to U.S. born men. Recent research also suggests that Korean immigrant men who have lived several years in the U.S. show increased risk of prostate cancer compared to their counterparts in Korea. However, there is little information about Korean immigrant men's prostate cancer screening behavior. This study seeks to explore factors influencing receipt of such screening in this population—particularly investigating potential cultural barriers to screening—and utilizes items that measure cultural beliefs and attitudes toward screening as well as general health concerns.

Methods: Using convenience and purposive sampling, 205 Korean American immigrants residing in New York City were recruited. Participants were asked to fill out a structured questionnaire that asked about cancer screening, health history, familial cancer history, health access, cultural beliefs and attitudes toward cancer and cancer screening, and acculturation and demographic information. SPSS 17.0 for Windows was used to analyze resultant data.

Results: As expected, results showed low rates of prostate cancer screening among Korean immigrant men. Only 29% of participants had had Prostate-Specific Antigen (PSA) screening within the last year and less than 50% had received a PSA test in the last five years. Logistic regression results (n=182) indicated that modesty was associated with reduced likelihood of PSA screening within the past year (OR=0.50, 95% CI=0.25 - 0.99). Age (OR=1.10, 95% CI=1.05 - 1.16) and possession of health insurance (OR=4.38, 95% CI=1.08=17.71) were also strong correlates of receipt of PSA screening in the past year.

Implications: The findings reiterate that Korean immigrant men are particularly vulnerable to prostate cancer due to underuse of available screening measures. Cultural factors such as modesty were found to be a barrier to screening. Health professionals should be mindful of this when working with Korean immigrant men in order to provide culturally competent care. Ethnic- and culture-specific intervention strategies for increasing prostate cancer screening in this group are discussed, with particular attention to increasing pertinent screening literacy. Physicians also play a critical role in recommending and discussing prostate cancer screening, which may in turn decrease cancer burden in the Asian American immigrant community.