Fahmeda Akther, Scarlett Alvarez, Miguel Chavez, Laura De Los Santos

ENG 21003, Sec. A

Research Proposal

November 26, 2018

Ethnic/Racial Disproportionate Prevalence of Liver Cancer among the Asian Immigrant Population in New York City

Abstract

Liver cancer is the fastest increasing cancer in the United States and is one of the leading causes of cancer-related death in New York City (NYC)(Kamath). Although the prevalence of liver cancer is increasing, there are certain groups which have been disproportionately affected on a significantly greater scale. Despite the existence of federal programs such as syringe exchanges and vaccinations, Hepatitis B(Hep. B)  seems to be affecting the Asian American population more than any other ethnic group. Furthermore, it is not only the Asian American population but the immigrant population that seems to have staggering rates of Liver Cancer. There are a plethora of factors that place Asian immigrants at higher risk for Liver cancer such as underdiagnosed Hep. B, language barrier with physicians and a biased medical healthcare system. When liver diseases go untreated is when the development of liver cancer becomes more likely. Some of the highest rates of liver cancer occur in areas with a substantial minority population meanwhile, predominantly Caucasian neighborhoods of a higher social class have dramatically fewer rates of liver cancer, despite being a train ride away. The main focus of this systematic literature review is to determine whether your ethnicity and zip code put you at greater risk of developing liver cancer. It is the goal of this research to examine how the main contributors to this health crisis: ignorance to healthcare due to language and cultural implications, availability of healthcare, and the quality of healthcare- affect the Asian immigrant population and what things can be done to lessen the impact of these factors.  

Introduction:

Liver cancer is the growth and spread of unhealthy cells in the liver. Mostly liver cancer is secondary or metastatic; starting somewhere else in the body, such as colon and lung cancer that eventually spread to the liver. However, the most common type of liver cancer is hepatocellular carcinoma, which begins in the hepatocyte; main type of liver cell. Some symptoms of having liver cancer are the loss of appetite, upper abdominal pain, jaundice; yellow discoloration of one’s skin and white, chalky stool. There are many factors that increase the risk of primary liver cancer, chronic infection with hepatitis B virus or hepatitis C virus, individuals who have diabetes and who consume excessive amounts of alcohol daily. According to the national cancer institute, liver cancer strikes Filipino, Japanese, Korean, Chinese and Vietnamese population 1.7 to 11.3 times higher than Caucasian Americans. This is because they are less likely to seek out cancer screening services than any other ethnic group. We should be able to educate and encourage individuals more about cancer who are in low poverty communities in order to lower rates.

 

Research Question/Thesis:

The aim of this study is to determine why Asian immigrants in NYC have a higher prevalence of infections such as the hepatitis B virus, which causes them to be more likely to develop liver cancer. In addition, by conducting necessary research, we will examine what caused liver cancer mortality rates to decrease among Asian Americans. While the U.S. Census Bureau shows that Asian Americans have a high poverty rate on a national average and have limited access to healthcare, they are actually becoming more cautious and alert, which is decreasing mortality rates due to liver cancer among this group.  

Research methodology:

We will begin with preliminary research. This includes statistics on deaths of Asian immigrants and Caucasians caused by liver cancer. From here we will delve deeper and look into poverty rates between the two groups and where these groups are primarily concentrated in New York. This research will mostly be from credible sites and peer reviewed journals that can accurately provide this information. We can then look into why Asian immigrant mortality rates are steadily decreasing and see if we can find a cultural factor. Using this information, we can begin looking for other researchers and authors that have looked into this topic and see their views on it. From here, using critical thinking skills we can come to a conclusion as to why Asian immigrants are more likely to develop cancer and why their mortality rates are decreasing.

 

Bibliography

Kamath, Geetanjali R., et al. “Liver Cancer Disparities in New York City: A Neighborhood View of Risk and Harm Reduction Factors.” Frontiers in Oncology, Frontiers Media S.A., 14 June 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC6011126/.

• In addition to examining liver cancer in certain neighborhoods, this study also describes its association with risk factors. This is a useful source because it allows us to look at what is causing liver cancer mortalities in certain neighborhoods over others. We can use this information to format our research paper.

Mead, Holly. Racial and Ethnic Disparities in U.S. Health Care: a Chartbook. Commonwealth Fund, March 2008.  https://www.commonwealthfund.org/sites/default/files/documents/___media_files_publications_chartbook_2008_mar_racial_and_ethnic_disparities_in_u_s__health_care__a_chartbook_mead_racialethnicdisparities_chartbook_1111_pdf.pdf

• This chartbook is very beneficial because it focuses on several types of disparities. It looks at the demographics of America, disparities in health status and mortality, disparities in access to health care and disparities in health insurance coverage. Even though the chartbook doesn’t talk about liver cancer, it will help us determine what populations are at a disadvantage in regards to health care access and insurance.  

Miller, Sara G. “Liver Cancer Death Rate Rises as Overall Cancer Death Rates Fall in US.” Live Science. 17 July 2018, https://www.livescience.com/63077-liver-cancer-mortality-rates.html.

• This article discusses liver cancer death rates in America. We can use this information for the background of our research paper, and base our research on it. It also discusses that the rate of liver cancer due to hepatitis B decreased, but the rate due to obesity-related cirrhosis has increased. We can use this information to further our research in why some causes of liver cancer are decreasing, while others are increasing.

Pollack, H J, et al. “Chronic Hepatitis B and Liver Cancer Risks among Asian Immigrants in New York City: Results from a Large, Community-Based Screening, Evaluation, and Treatment Program.” Cancer Epidemiology, Biomarkers & Prevention : a Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology., U.S. National Library of Medicine, 23 Nov. 2014, www.ncbi.nlm.nih.gov/pubmed/25368398/.

• This article gave a figure detailing what percent of Asians living in New York City were more likely to get Hepatitis B which can then progress into liver cancer. It calculated the information of Chinese and Korean Americans from different provinces in their countries and their gender. This will give us a broad range of information to use in our arguments and show the disparity between those who contract liver cancer and those who don’t.

Reeves, J Terrance. “We the People: Asians in the United States”. Census 2000 Special Reports. US Department of Commerce Economics and Statistics Administration. Dec. 2004, https://www.census.gov/prod/2004pubs/censr-17.pdf.

• This source gives approximate numbers of the Asian American population living in the US in 2004. This also divides their population into those from specific countries such as Korea or Pakistan. It gives numbers of those that work and those that don’t. Though the numbers are from 2004, they are very detailed and can give us an indication of how big the Asian population is today in terms of the categories they have outlined. This information will help give us perspective so we better understand who is being affected by liver cancer and how many.

“Liver Cancer.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 6 Mar. 2018, www.mayoclinic.org/diseases-conditions/liver-cancer/symptoms-causes/syc-20353659.

• This site gives us a broad overview of what is liver cancer and how it can be treated. This simple background information will help us further understand how liver cancer progresses from Hepatitis B or C. We can also use this information to also be able to write a quick summary of what liver cancer is and its treatments from which we can then transition into arguments about the disparities in race and cancer treatments.