Nikkei Cultural Views Pose Barriers to Cancer Care

BARRIERS TO CARE — Nancy Hikoyeda spoke about cancer prevention at a recent Yu-Ai Kai seminar. Photo by Erin Yasuda Soto/Nichi Bei Weekly

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Mavis Nitta knows firsthand how important early detection is when it comes to cancer prevention.

“My mom is a breast cancer survivor, so she always says, ‘Make sure you get a mammogram.’ I think I may have a greater risk since she had it,” said Nitta, chronic disease program coordinator at the San Francisco-based Asian & Pacific Islander American Health Forum.

Cancer detection and how it relates to the Japanese American culture were among the topics explored at a seminar, “Cancer 101, Japanese American Health and Culture Training,” held at the Yu-Ai Kai senior center in San Jose’s Japantown on Sept. 29-30.

The seminar, designed to train caregivers, included a number of experts in the area of cancer screening, detection and treatment.

Nitta, who has a master’s degree in public health, said that despite the importance of early detection and screening for cancer, many older Japanese Americans do not seek care due to a combination of cultural beliefs and attitudes.

“For some Japanese Americans, cancer is associated with death. Patients must understand that you can live with cancer,” said Nitta, adding that Japanese Americans have the highest incidence rates for colorectal cancer, even surpassing the rate for whites.

Nitta said that besides colorectal cancer, the other common types of cancer among Japanese Americans are: breast, prostate, lung, stomach, bladder and uterine.

Nitta said that barriers to care include a lack of Nikkei health care providers and limited English proficiency among some patients. She added that a lack of materials, education and programs that are culturally relevant also impedes cancer detection.

Rachel Mesia, who also holds a master’s degree in public health, and is the partnership program coordinator with the National Cancer Institute’s Cancer Information Service at the Stanford Cancer Center, agreed with Nitta that there are many barriers to care related to Japanese American views and beliefs.

Making caregivers aware of these cultural barriers, and finding solutions to overcome them, was one of the consortium’s goals, she said.

“It’s multicultural and multigenerational. How will we get people to open up? We need to open up ways and strategies within the culture,” Mesia said.

Barbara Masterson, a registered nurse and the wellness coordinator at Yu-Ai Kai, said that  a belief that is common among some older Japanese Americans — shikata ga nai (it can’t be helped) — is yet another obstacle.

“They think it’s something that they can’t do anything about,” she said. “There is a reluctance to ask for help.”

Nancy Hikoyeda, who holds both a master’s and a doctorate in public health, also cited haji, or shame or disgrace, as a impediment to care.

“They believe it’s shameful to have some conditions,” said Hikoyeda, who is an ethnogeriatric specialist at the Stanford Geriatric Education Center.

She added that the cultural value of gaman, or quiet endurance, is an additional barrier to early cancer detection.

“You are taught to endure pain and hardship, not to show emotions,” she said, adding that many may not seek help although they are not feeling well.

Furthermore, Hikoyeda said that that many Japanese Americans are hesitant to question authority.

“I was raised that you don’t question doctors, professors or other authorities,” Hikoyeda said.

She said that Nikkei patients must be more proactive in their own health care.

“Japanese American patients should ask providers to repeat information if necessary. Also, patients should know that seeking a second opinion is OK,” she said.

Hikoyeda added that health care providers can do their part in reducing the cultural and language barriers among Japanese Americans.

“Health care providers need to develop trust and recognize anxiety resulting from cultural barriers and other issues regarding treatment. They need to be respectful, and to build connections and confidence.”

Some reasons why people don’t receive cancer screenings include a fear of and lack of knowledge about cancer, according to Nancy Morioka-Douglas, MD, clinic chief at Stanford Family Medicine.

“There are early detection screening tests for breast, cervix, prostate and colorectal cancer,” said Morioka-Douglas, who is also the associate director of the Stanford Geriatric Education Center. “At age 40, you should get a baseline mammogram.”

She added that an awareness of body changes may help in the detection of early signs of cancer.

“If someone is getting thinner or wasting away, encourage them to see a doctor and get a cancer screening,” she said. “Ovarian cancer may declare itself in abdominal bloating.”

Seiko Edward, who works for the Ishizue/South Bay Japanese Community Network and is also a volunteer at Yu-Ai Kai, said that the information will be helpful to her.

Edward, who provides referrals for Japanese-speaking people, said, “It was very informative because we get phone calls from cancer patients. We thought it would be good to attend.”

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