Young Native Hawaiians and Pacific Islanders May Face Highest Rates of Cancer Mortality

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Investigators have found that young Native Hawaiian and Pacific Islander patients may experience the highest rates of cancer mortality of any racial group in the United States among those aged 20 to 49 years. The new data were published by Haque et al in the Journal of the National Cancer Institute.

“These disparities clearly demonstrate the importance of disaggregation of Asians and [Native Hawaiians and Pacific Islanders] from one another,” explained Brenda Hernandez, PhD, MPH, Adjunct Assistant Professor of Pathology at the John A. Burns School of Medicine at the University of Hawaiʻi at Mānoa as well as Co-Director of the Pathology Shared Resource and the principal investigator of the Hawaiʻi Tumor Registry at the University of Hawaiʻi Cancer Center.

Background and New Study Findings

Until recently, race-based reporting at the federal level in the United States lumped Americans of Asian and  Native Hawaiian and Pacific Islander ancestry into a single category. It wasn’t until 1997 that the “Asian/Pacific Islander” category was split into “Asian” and “Native Hawaiian or other Pacific Islanders.” It took another 10 years to fully transition to using the updated race list on individual states’ death certificates, so statistics like cancer mortality rates for this new set of racial groups have only been reportable since 2018.

Because of Hawaiʻi’s unique multiethnic composition, the Hawaiʻi Tumor Registry—responsible for cancer surveillance in the state of Hawaiʻi—has long collected and reported these more granular statistics.

“In Hawaiʻi, Asian [and] Native Hawaiian and Pacific Islander ethnic communities have experienced dramatically different cancer burdens,” Dr. Hernandez stressed.

In 2022, a report from the registry revealed that between 2014 and 2018, Native Hawaiian female patients had higher death rates from breast cancer and lung cancer compared with  Chinese, Filipino, Japanese, other Asian, and White female patients in Hawaiʻi.

In the new study, the investigators discovered that between 2018 and 2020, Native Hawaiians and Pacific Islanders aged 20 to 49 years had the highest mortality rate from any cancer type compared with American Indian/Alaska Native, Asian, Black, Latino, and White patients in the same age group.

Addressing Disparities From Multiple Angles

Under the new leadership of Naoto Ueno, MD, PhD, Director of the University of Hawaiʻi Cancer Center, the institution is currently taking a multifactorial approach to addressing these cancer disparities. This includes the construction of the Early Phase Clinical Research Center—which would allow researchers to conduct innovative trials in Kakaʻako—as well as the intense efforts led by the University of Hawaiʻi Cancer Center in collaboration with the state, legislators, local health-care systems, advisory boards, patient advocacy groups, and others.

“We are trying to establish more robust clinical research so that we can provide more clinical trials that would allow people to stay in state,” Dr. Ueno emphasized. “We need to make a collective impact with the various stakeholders, and the [University of Hawaiʻi] Cancer Center could be the driving force to make these changes,” he noted.

Dr. Ueno underscored that the new study is timely, since May is Asian American, Native Hawaiian and Pacific Islander Heritage Month. However, this is not expected to change the University of Hawaiʻi Cancer Center’s philosophy or general direction because the center is already focused on serving the needs of the residents of Hawaiʻi and the U.S. Affiliated Pacific Islands—which includes large Asian and Native Hawaiian and Pacific Islander populations. Nonetheless, Asian American, Native Hawaiian and Pacific Islander Heritage Month might raise awareness at the national level. This then provides more opportunities for funding future studies related to patients with unique, diverse ethnic backgrounds.

“Even for clinical trials, if we can determine the genomic and molecular connection between the kind of aggressive disease you have, we can potentially personalize treatment based on racial or ethnic background. There are many different opportunities with pharmaceutical companies and more,” Dr. Ueno concluded.

Disclosure: For full disclosures of the study authors, visit

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.