Potential of Prevention: Asian Americans, Western Culture, and Sun Exposure

A new study this week out of Stanford University found that the more acculturated Asian Americans are, the more likely they are to practice unhealthy patterns of sun exposure (study).

Surveying close to 550 individuals of Asian decent living in northern California, the researchers found that those from families who have been in the US longer, or have lived half or more of their lives in the United States, were much more likely to sunbathe and to prize darker skin than those who lived less time in the US or spent most of their lives in Asia. Strikingly, nearly 60 percent of those raised at least half of their lives in the United States reported that they had practiced sunbathing, whereas only 34 percent of those raised largely in Asia said they did so. Attitudes about safe-sun practices (like using sunscreen) tracked very similarly with levels of acculturation.

With sun exposure the major cause of skin cancer, including deadly melanoma, these results could have obvious health implications for the growing Asian American population in the US, especially since skin cancer diagnoses are often delayed, with more serious results, in Asian groups compared to Caucasians. Clearly, better education of individuals and doctors would be a good first step in addressing this issue.

Beyond this, though, this paper further reinforces what we’ve known in public health for years now: that culture can have a large influence on health behaviors and rates of chronic diseases. Previous studies in Asian populations have found that as immigrants to the US adopt its Western culture, their rates of diseases like heart disease and colon cancer rise to match, or even exceed, those of the US average (figure).

While such findings can certainly be viewed through a gloomy lens, they have a positive side as well: they show the potential power of prevention. If population changes in lifestyle that raise the risk of disease can change so quickly, they also have the potential to move in healthful directions as well.

Of course, it takes a concerted effort from government, communities, and individuals alike to effect such changes, even small ones, populations wide. But it can happen with a combination of large and small steps. So, as you put on your sunscreen, buy your fruits and vegetables, and get outside for a walk, remember you’re not only helping yourself but also helping create a culture of healthfulness that will benefit those around you as well.


Articles referenced:
Gorell E, et al. Adoption of western cultures by Californian Asian Americans: Attitudes and practices promoting sun exposure. Arch Dermatol. 145(5):552-556, 2009.

Flood DM, et al. Colorectal cancer incidence in Asian migrants to the United States and their descendants. Cancer Causes and Control. 11: 403±411, 2000.

Related web resources:
Your Disease Risk -- Melanoma

Cancer Prevention -- Google Knol

From the Archives (11-2-06): Don’t Jump the Gun: Lung Cancer Screening with Spiral CT


A recent study in the New England Journal of Medicine on lung cancer screening certainly made a big splash in the news last week.  Whether it actually deserves such attention, though, won’t be known for a while. 

The large study of over 31,000 people at increased risk of lung cancer looked at rates of survival in those found to have earliest stage lung cancer (stage I) using a screening tool called spiral computed tomography, or CT.  Spiral CT provides a more detailed image than chest x-rays so may possibly catch lung cancers in early stages when they may be more curable.

What the researchers found was that spiral CT did in fact find cancers early—85 percent of the cancers found were stage I compared to the national average of only 15-20 percent—and that those subjects with stage I cancer had very good projected survival rates—88 percent for 10 years compared to the national average of 70 percent for 5 years. 

On its face, this seems like an amazing result and a ringing endorsement for widespread lung cancer screening with spiral CT, but this study actually has some important drawbacks. 

First, the reported survival rates are projected estimates, not actual observed survival rates.  This means that they’re extrapolated from a shorter amount of real time follow-up.  So even though the paper reports estimated 10 year survival, the researchers actually only followed cases for an average of 3 years and 4 months.  Although such projections can sometimes be accurate, they can also be wrong, and they’ll never be as exact as following people for the full ten years.

Second, the study did not have a comparison group of people who were not screened using spiral CT.  This means there’s no way to actually know if those who have spiral CT screening actually live longer than those who don’t.  It could be that many of the small tumors spiral CT finds would grow very slowly and never develop into life-threatening tumors within a person’s lifetime.  Or, it could be the opposite, that some serious tumors found early on spiral CT would be just as incurable no matter when or how they were found .

In addition, there are also unanswered questions about the risks of using spiral CT to detect lung cancer in the larger community.  Because spiral CT provides such a detailed image of the lung, it can have a high false positive rate—meaning it can find a lot suspicious masses that turn out not to be cancer. To rule out cancer, though, these masses often have to be followed up with other, sometimes risky tests, like a lung biopsy. Whether such risks are worth the benefits of spiral CT is unclear.

These are the types of issues that can only be resolved by long term randomized  clinical trials that compare spiral CT screening to either standard chest x-rays or no screening at all.  And a number of these trials are currently running in the US and Europe. Only when these studies confirm the overall benefit of spiral CT will we know if it can really live up to its recent headlines as a life saver.