The American Cancer Society (ACS) has detailed disparities in the mortality rates for preventable cancer types among Asian American, Native Hawaiian, and other Pacific Islander patients in a new Cancer Facts & Figures report published by Wagle et al.
Background
In this report, the Asian group—referring to individuals with origins in the Far East geographic region, Southeast Asia, or the Indian subcontinent—included, but was not limited to, Asian Indian, Cambodian, Chinese, Filipino, Hmong, Japanese, Korean, Pakistani, and Vietnamese individuals. The Native Hawaiian and Other Pacific Islander group included individuals with origins in Hawaii, Guam, Samoa, Tonga, or other Pacific Islands throughout Polynesia, Micronesia, and Melanesia.
In 2021, approximately 24 million Asian American and 1.7 million Native Hawaiian and Other Pacific Islander individuals of single or mixed race lived in the United States, representing about 8% of the population. Excluding multiracial individuals, Asian Americans are currently the fastest-growing population in the United States, with the size projected to double between 2016 and 2060, predominantly through international migration.
Findings From the ACS Report
In the new report, investigators analyzed data from the National Cancer Institute, U.S. Centers for Disease Control and Prevention, and North American Association of Central Cancer Registries.
Despite limited disaggregated data, the report demonstrated a wide variation in the cancer burden among Asian American, Native Hawaiian, and Other Pacific Islander patients. Cancer was the second leading cause of mortality in the United States but was found to be the leading cause of mortality among Chinese, Filipino, Korean, and Vietnamese patients—with lung cancer the leading cause of mortality in male patients in every Asian American, Native Hawaiian, and Other Pacific Islander ethnic group. The mortality rates for other preventable cancer types such as hepatic cancer, gastric cancer, and cervical cancer was two to three times higher in Native Hawaiian and Other Pacific Islander patients compared with White patients.
“The reasons behind variations in the cancer burden among Asian American and Pacific Islander populations are multifactorial,” explained lead report author Nikita Wagle, PhD, MBBS, MHA, a principal scientist of Cancer Surveillance Research at the ACS. “These populations, specifically Asian American [patients], consist of many ethnic groups that are diverse in terms of immigration patterns, behavior, exposures in countries of origin, and social determinants of health. Additionally, the use of screening and other preventative services varies between these groups,” she added.
The investigators also found that lung cancer was the leading cause of cancer-related mortality in female patients who identified as Chinese, Japanese, Vietnamese, Korean, and Native Hawaiian; whereas breast cancer was the leading cause of cancer-related mortality in female patients who identified as Guamanian, Samoan, Filipino, and Asian Indian. Only about 50% of breast cancer cases in Guamanian, Samoan, Pakistani, Tongan, Laotian, and Hmong female patients were diagnosed at an early stage compared with about 67% of cases in White female patients and 75% in Japanese female patients—reflecting potential challenges in access to care.
Further, breast cancer was the most commonly diagnosed cancer type among female patients of every Asian American, Native Hawaiian, and Other Pacific Islander ethnic group—ranging from 17% of all cancer cases among Hmong female patients to 44% among Fijian female patients. The most commonly diagnosed cancer type in Asian American, Native Hawaiian, and Other Pacific Islander male patients was prostate cancer, which mirrored the overall U.S. male population. However, lung cancer was the most common cancer diagnosis among Chinese, Vietnamese, Laotian, and Chamorro/Guamanian male patients; and colorectal cancer was the most common cancer diagnosis among Korean, Hmong, and Cambodian male patients.
The investigators discovered that the 5-year relative survival rate for breast cancer ranged from 72% to 74% in Tongan, Chamorro/Guamanian, and Samoan female patients to 94% in Japanese female patients vs 93% in White female patients. The 5-year survival rate for colorectal cancer ranged from 48% in Cambodian patients to 71% in Pakistani patients vs 65% in White patients.
Despite Asian Americans overall having a 40% lower overall cancer mortality rate than the White population, the hepatic and gastric cancer mortality rates were nearly 40% and 100% higher, respectively.
Conclusions
“Although disaggregated data are still extremely limited, we hope that these startling disparities will spur local communities and health-care providers to increase awareness of cancer symptoms and opportunities for cancer prevention and early detection through screening,” emphasized senior report author Rebecca Siegel, MPH, Senior Scientific Director of Surveillance Research at the ACS.
“It’s essential that we acknowledge the diversity of the Asian American, Native Hawaiian, and Other Pacific Islander population. Consideration of cultural appropriateness, translation into native languages, improved access to health care, and patient navigation could help increase knowledge and uptake of cancer screening and preventive services. Further research is also needed among the ethnic groups of this highly diverse population to better understand the cancer burden and help save lives,” underscored co–study author Ahmedin Jemal, DVM, PhD, Senior Vice President of Surveillance and Health Equity Science at the ACS.
The ACS Cancer Action Network (CAN) currently supports sustainable funding for patient navigation services designed to enhance health outcomes for diverse populations through community outreach and targeted care coordination as well as policies that promote the timely collection and publication of disaggregated demographic data—which can help identify disparities to improve health equity in cancer prevention, detection, and treatment among various groups within a population.
“As this report shows, cancer affects everyone, but not equally. We urge lawmakers to support policies that increase access to quality, culturally appropriate cancer care by funding patient navigation services and ensuring that detailed race and ethnicity data are available, accurate, objective, and impartial. Such policies are critical to making sure that everyone has a fair and just opportunity to prevent, detect, treat, and survive cancer,” concluded Lisa A. Lacasse, MBA, President of the ACS CAN.
