Is Colorectal Cancer A Western Disease? Role of Knowledge and Influence of Misconception on Colorectal Cancer Screening among Chinese and Korean Americans: A Mixed Methods Study

  • Lu, Xiaoxiao (Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park) ;
  • Holt, Cheryl L (Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park) ;
  • Chen, Julia C (Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park) ;
  • Le, Daisy (Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park) ;
  • Chen, Jingjing (Department of Epidemiology and Public Health, School of Medicine, University of Maryland) ;
  • Kim, Gil-yong (Department of Public Health Science, School of Public Health, Seoul National University) ;
  • Li, Jun (Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention) ;
  • Lee, Sunmin (Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park)
  • Published : 2016.11.01


Background: Chinese and Korean Americans have lower colorectal cancer (CRC) screening rates than other racial/ ethnic groups, which may be explained by a low level of CRC knowledge and a high level of misconceptions. This study explores the role of knowledge in CRC screening among these groups. Methods: Chinese (N=59) and Korean (N=61) Americans older than 50 were recruited from the Washington D.C. Metropolitan area. They completed a detailed survey and participated in focus groups to discuss their knowledge on CRC and CRC screening. Seventeen physicians, community leaders, and patient navigators participated in key informant interviews. Using a mixed methods approach, data were analyzed quantitatively and qualitatively. Results: Participants lacked knowledge about CRC and CRC screening. More than half did not know that screening begins at age 50 and there are several types of tests available. More than 30% thought CRC screening was not necessary if there were no symptoms or there was nothing they could do to prevent CRC. Focus group findings suggested understanding about CRC was limited by an inadequate source of linguistically and culturally relevant health information. For example, many participants considered CRC a western condition mainly caused by unhealthy diet. This led to under-estimations about their susceptibility to CRC. Knowledge was positively associated with self-reported screening. Participants who had higher knowledge scores were more likely to report ever having had a colonoscopy and confidence in ability to have CRC screening. Conclusions: Mixed-methods analysis provides multi-faceted perspectives on CRC knowledge and its influence on screening. Study findings can help inform interventions to increase CRC screening among Chinese and Korean Americans.


Supported by : National Research Foundation of Korea


  1. Becker MH (1974). The health belief model and personal health behavior, Vol 2, No 4.
  2. Brewer J, Hunter A (1989). Multimethod research: a synthesis of styles, Newbury Park, CA, Sage Publications, Inc.
  3. Centers for Disease Control and Prevention (2013). Behavioral Risk Factor Surveillance Survey System online information [Online]. Atlanta, GA. Available: [Accessed March 19 2013].
  4. Christou A, Thompson SC (2012). Colorectal cancer screening knowledge, attitudes and behavioural intention among indigenous Western Australians. BMC Public Health, 12, 528.
  5. Gomez SL, Noone A-M, Lichtensztajn DY, et al (2013). Cancer incidence trends among Asian American populations in the United States, 1990 to 2008. J Natl Cancer Inst, 105, 1096-110.
  6. Green PM, Kelly BA (2004). Colorectal cancer knowledge, perceptions, and behaviors in African Americans. Cancer Nurs, 27, 206-15.
  7. Holt CL, Roberts C, Scarinci I, et al (2009). Development of a spiritually based educational program to increase colorectal cancer screening among African American men and women. Health Commun, 24, 400-12.
  8. Homayoon B, Shahidi NC, Cheung WY (2013). Impact of Asian ethnicity on colorectal cancer screening: a population-based analysis. Am J Clin Oncol, 36, 167-73.
  9. Howlader N, Noone A, Krapcho M, et al (2013). SEER cancer statistics review, 1975-2010.[Based on the November 2012 SEER data submission, posted to the SEER web site, April 2013.]. Bethesda, MD: National Cancer Institute.
  10. Kim K, Yu ES, Chen EH, et al (1998). Knowledge and practices among Korean Americans. Cancer Pract, 6, 167-75.
  11. Le TD, Carney PA, Lee-Lin F, et al (2014). Differences in knowledge, attitudes, beliefs, and perceived risks regarding colorectal cancer screening among Chinese, Korean, and Vietnamese sub-groups. J Community Health, 39, 248-65.
  12. Ma GX, Shive S, Tan Y, et al (2009). Community-based colorectal cancer intervention in underserved Korean Americans. Cancer Epidemiol, 33, 381-6.
  13. Ma GX, Wang MQ, Toubbeh J, et al (2012). Factors associated with colorectal cancer screening among Cambodians, Vietnamese, Koreans and Chinese living in the United States. N Am J Med Sci (Boston), 5, 1-8.
  14. Rawl SM, Menon U, Champion VL, et al (2000). Colorectal cancer screening beliefs. focus groups with first-degree relatives. Cancer Pract, 8, 32-7.
  15. Suinn RM, Ahuna C, Khoo G (1992). The Suinn-lew asian self-identity acculturation scale: concurrent and factorial validation. Educ Psychol Meas, 52, 1041-6.
  16. Tessaro I, Mangone C, Parkar I, et al (2006). Knowledge, barriers, and predictors of colorectal cancer screening in an Appalachian church population. Prev Chronic Dis, 3, 123.
  17. Tseng T-S, Holt CL, Shipp M, et al (2009). Predictors of colorectal cancer knowledge and screening among church-attending african americans and whites in the deep south. J Commun Health, 34, 90-7.
  18. US Cancer Statistics Working Group (2015). United States cancer statistics: 1999-2012 incidence and mortality web-based report. Atlanta (GA): department of health and human services, centers for disease control and prevention, and national cancer institute.
  19. Walsh JM, Kaplan CP, Nguyen B, et al (2004). Barriers to colorectal cancer screening in latino and vietnamese americans. compared with non-latino white Americans. J Gen Intern Med, 19, 156-66.
  20. Wu T-Y, Kao J, Hsieh H-F, et al (2010). Effective colorectal cancer education for asian americans: a michigan program. J Cancer Educ, 25, 146-52.
  21. Yu ES, Kim KK, Chen EH, et al (2001). Colorectal cancer screening among Chinese Americans: a community-based study of knowledge and practice. J Psychosoc Oncol, 19, 97-112.