Note: This article was written as a project of the California Endowment Health Journalism Fellowships, a program of the University of Southern California’s Annenberg School for Communication and Journalism. It is one of two articles taking a look at Korean-Americans with cancer in the California Bay Area. Read the other article here. The two articles were later merged together and published as one piece on New America Media.
It means quickly. You will hear it shouted in many places by Korean Americans, in restaurants particularly, because Korean Americans are often busy and have no time to wait. They have businesses to run, children to raise, churches to go to. Prioritizing is important. So, it’s not surprising that getting screened for cancer is often pushed off the list of things to do, again and again.
“Every individual is different, but what we have been observing so far while interacting with Korean American participants is the common notion that cancer prevention is not really on top of their priorities,” said Haera Han, a Korean community health researcher in Maryland and a Johns Hopkins University School of Nursing Associate Professor. “So many Koreans in our research own their own businesses, meaning sometimes they have to work 16-18 hours a day. This makes it difficult for them to focus on their health.”
Korean-American entrepreneurship also often means that Korean Americans don’t have employer medical insurance, and can’t afford to purchase it for themselves. Of any ethnic minority group, Korean Americans are the least likely to have medical insurance, according to the US Department of Health and Human Services in 1998. 42 percent have no health coverage of any kind.
Han said her research shows that Korean Americans don’t get regular checkups and screenings, underutilizing the health resources available to them.
“In Korea, you can see the doctor even if you have a cold,” she said. “Here, it’s very different because if you want to see a doctor and you don’t have insurance, then you have to pay out of pocket, which has severe implications for people using preventive health services. Then if you want to get a cancer screening you have to find a place to do it then figure out where to get the results. There are cultural beliefs and other priorities. … There is also the attitude that if you don’t have any symptoms, you are in good shape. They don’t go to the doctor unless they have some serious symptoms, by which time it may be a little too late.”
That wasn’t the case for Seh Chang Lee, though it was a close call.
“I thought I was very strong so I didn’t go for checkups,” Lee said. “Even when [my wife and I] had insurance, we didn’t go. Why would I go? I was healthy.”
It took multiple symptoms before Lee sought medical care, including early onset of allergies, a hard red lump inside his mouth and difficulty chewing.
“One day it was lunch time and most people finish eating in 10, 15 minutes. I had been eating 30 minutes and I still hadn’t finished lunch,” Lee said. “I added water to the rice to make it easier to eat, but still I couldn’t finish it. I told her I couldn’t eat food well. Finally I thought it was not normal, so I went to the hospital.”
Lee was told he had oral cancer. By the time he was able to unravel the series of tests and preparations he needed to make before treatment, it had begun spreading. By the end of his treatments, Lee had all his teeth removed, and the side effects from the radiation left his stomach so sensitive to pressure that he can’t even wear a shirt over it.
In addition to the physical manifestations of his battle with cancer, there were also financial ones. Lee, who once owned several properties, now no longer owns a car. He uses Medical and Medicare to pay for his medicines.
“I became a broke person to make the medical card. My son speaks good English so he helped me get a Medical card from Valley Medical Center in San Jose. I became a broke person for the card and so they pay for almost everything,” he said.
Han said Lee’s case was not an isolated incident.
“One woman who I personally encountered was afraid of using all her financial resources. Basically, when she came to this country, she wanted to give a certain kind of opportunity and education for her kids. Even though she felt some abnormalities in her body, she was afraid that even if she saw her doctor that might lead to using up the financial resources that she’s been accumulating for her children. So she delayed it.
“By the time she finally saw her doctor it was too late. … She died within two months of the initial diagnosis [of breast cancer].”
Dr. Moon S. Chen, Jr., a UC Davis professor of hematology and oncology, as well as the principal investigator for the Asian American Network for Cancer Awareness Research and Training (AANCART) says that Asian-Americans — regardless of whether they have insurance — see their doctor less frequently than all other ethnic groups, which can prevent them from understanding their increased susceptibility to certain cancers.
“Cancer is the leading cause of death for Korean Americans,” Chen wrote in an e-mail interview. “In comparison to Caucasians, Korean Americans experience the highest proportion of stomach cancer among all US racial/ethnic groups. Along with some other Asian Americans, Korean Americans are more likely to be infected with hepatitis B virus (linked to liver cancer). Hence, the kinds of cancers that Koreans experience differ from Caucasians in that they are also attributed to infectious (contagious) agents, like viruses, unlike for e.g., breast cancer, that may be attributed to non-infectious causes.”
Despite the prevalence of cancer in this minority group, it is hard to get a discussion going on the topic and even harder to evoke action.
Han said Korean immigrants needed more assistance navigating the fragmented American health system.
“It’s not a one-stop shop at all,” she said. “You get prescriptions from one physician, you fill them somewhere else. You have to figure out where to get screened and where to get their results. This is challenging overall, but more so when you are an immigrant.”
Stigmas within the Korean-American community also impact how effectively its members use the health care system, the Maryland researcher said.
“People do not want to talk about cancer because people believe others perceive cancer as something that can be passed on, like from mother to daughter for example,” Han said. “In my research in this region, the Korean community is very small and people know everyone directly or through a friend. And when you are known as someone who has the disease or has been treated for the disease, then eventually people will know, especially if you talk about it. Then people say, ‘Wow, that person has cancer,’ and moms worry that the children of the cancer survivors will carry those cancer genes, which might carry into their offspring as well. This makes cancer patients uncomfortable about talking about whether they had cancer or not.”
Han also said that Koreans find cancer difficult to discuss because they find the disease intimidating.
“I have had groups of cancer survivors where only a couple talk openly about their cancer, but even then only within the group. Not to their friends or at their church.” she said. “Cancer is still very intimidating to these people. Many times, when you hear about cancer, it reminds people of death. The devastating nature of cancer is such a threat, even for survivors…”
Chen says it doesn’t have to be this way. With more awareness, Korean-Americans could be encouraged to quit smoking — rates are higher among the men than among the general California population — and to get regular checkups.
“What can be done is action, not knowledge,” he said. “Bottom line: Get a good doctor and aggressively seek the best care, and be regular about seeing a MD.”