Page 48 - Cultural Competence in Health Education

26 Cultural Competence in Health Education and Health Promotion

position to begin to address these disparities. Much of the risk for developing cancer
can be addressed by lifestyle modifications, including changes in diet and nutrition,

exercise, and tobacco use. Tobacco use is estimated to be responsible for at least one -
third of all cancer deaths (National Cancer Institute, 2007), and diet, weight control,
and exercise can reduce cancer incidence by 30 to 40 percent (Dwyer, 2001; Antman
et al., 2002; Freeman, 1989). Health educators are trained in theories of behavioral
change, have excellent skills in communication, and are trusted members of the com-
munity. They need to help and support their clients in making lifestyle changes that
will reduce cancer risk.
In addition to promoting lifestyle changes, health educators need to offer addi-
tional support to low - income and minority communities to bring their cancer - screening
rates to a level of parity with rates for non - Hispanic whites. An important program for
health educators to know about is the National Breast and Cervical Cancer Early
Detection Program (CDC, 2007f) that provides low - income, uninsured women with
access to screening services to detect breast cancer and cervical cancer at their earliest
stages. Since 1991, this program has screened more than 2.9 million women, provided
more than 6.9 million screening examinations, and diagnosed more than 29,000 breast
cancers, 94,000 pre - cancerous lesions, and 1,800 cervical cancers.
Additional age - appropriate cancer - screening guidelines are important for health
educators to communicate to their clients. A general cancer - related checkup is recom-
mended every three years for all people aged 20 to 39 years and annually for people
over 40. This checkup should include examination for cancers of the thyroid, testicles,
ovaries, lymph nodes, skin, and oral cavity and “ health counseling about tobacco, sun
exposure, diet and nutrition, risk factors, sexual practices and environmental and occu-
pational exposures ” (American Cancer Society, 2007). Health educators are the ideal
health care workers to provide this health counseling to patients because they are
trained in discussing sensitive topics that may engender fear or be extremely personal.
There is not much that is more anxiety provoking for a patient than talking with some-
one he or she does not know very well about his or her cancer risks, especially if the
discussion is going to probe areas such as dietary choices, physical activity levels,
weight control measures, and sexual practices. Specifi c screening tests recommended
are a colonoscopy for all patients over 50 years old or, alternatively, a fecal blood test

every year and a flexible sigmoidoscopy every five years. Mammograms are recom-
mended for women over 40, combined with regular breast self - exams each month and
a clinical exam by a health care professional, close to and preferably before the mam-
mogram. Pap smears are recommended for all women over the age of 18, and if this
test is normal for three years in a row, then the woman ’ s health care provider will tell
her how often to get this test. Digital rectal exams to screen for prostate cancer in men
and rectal cancer in both genders are also recommended, along with prostate specifi c
antigen tests for men starting at age 50, but some men who are at higher risk, including
African American men and those with a fi rst - degree relative diagnosed at a relatively
young age, should consider earlier screening for prostate cancer. All men should be
taught to practice regular testicular self - examinations.

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