May is Asian American and Pacific Islander (AAPI) Heritage Month, which celebrates the histories of Americans from across the Asian continent and the Pacific islands of Melanesia, Micronesia, and Polynesia.
The Asian American community is the fastest growing demographic group in the United States, increasing by more than 35% over the last decade, and Native Hawaiians and Pacific Islanders (NHPI) are the third-fastest growing population. In fact, from 2000 to 2020, U.S. Census data shows the AAPI population in the U.S. has roughly doubled to 24 million people, which is more than 7% of the total population. As with many, if not all, racial and ethnic minority groups in the United States, the AAPI population faces significant health disparities, and some of the greatest disparities relate to cancer.
While, generally speaking, Asian Americans experience lower cancer rates when compared to the non-Hispanic White population in the United States, there are cancer disparities for certain types of cancer and among certain AAPI subgroups.
Here are some facts:
- Stomach cancer: Asian and Pacific Islander men are 70% more likely to have stomach cancer and twice as likely to die from it, as compared to non-Hispanic White men. Asian and Pacific Islander women, while 20% less likely to have breast cancer, are twice as likely to have stomach cancer and 2.5 times more likely to die from it, as compared to non-Hispanic White women.
- Liver and IBD cancer: Both Asian and Pacific Islander men and women experience almost twice the incidence of liver and IBD cancer, as compared to the non-Hispanic White population.
- Lung cancer: Among AAPI people with cancer, lung cancer causes the highest number of deaths every year. Yet more than half of Asian women with lung cancer do not smoke.
Understanding disparities
Preventative screenings and other health care measures are vital for early detection of cancer, when it is usually easiest to treat and defeat.
Asian Americans are the only racial or ethnic group in the United States for whom cancer is the leading cause of death in men and women. For all other tracked groups, the leading cause is heart disease. Despite this fact, people in the AAPI community are screened for cancer at lower rates than the majority of Americans, and the high death rates due to cancer seem contradictory when we also know that Asian Americans generally have lower rates of cancer than the non-Hispanic White population.
Cancer screening disparities among Asian Americans compared with non-Hispanic White Americans are not well explained by socioeconomic factors like access to health care, education, or income—a fact that remains true for each AAPI subpopulation.
Here are some key areas that may exacerbate existing disparities:
- Health care visit disparities: Statistics indicate that Asian Americans are the least likely among all racial and ethnic groups to have seen a physician in the last 12 months.
- Cancer screening disparities: According to 2018 National Health Interview Survey data, Asian American persons were “less likely than non-Hispanic White or non-Hispanic Black or African American persons to be up to date with colorectal cancer testing, pap smears, or mammograms.”
- Breast and cervical cancer screening disparities: An evaluation of the impact of COVID-19 on the number of breast and cervical cancer screening tests in April 2020 showed breast cancer screening among Asian and NHPI women dropped 97% and cervical cancer screening declined by 92% when compared to their previous 5-year averages.
Want to learn more? An overview on cancer disparities and influencing factors among AAPI subgroups shared on the Centers for Disease Control and Prevention (CDC) website is a great place to start—and so is this Oncologist paper on Asian American cancer care disparities.
Addressing disparities
The disparities listed above have many different origins. So how do we address them?
So far, most studies have not accounted for the huge differences in culture, geographical location, number of languages spoken, and other varying factors among AAPI subpopulations. There are at least 200 different languages or dialects spoken within the AAPI population, for example, and the geographical range spans over 40 countries.
Such diversity means there can be extreme differences among subgroups. A Pew Research Center analysis of U.S. Census data reveals stark differences across factors like highest and lowest household incomes ($119,000 for Indian households compared with $44,400 for Burmese households), poverty rates (7% for Filipino and Indian groups compared with 25% for Burmese and Mongolian groups), and education levels (from 15% among Bhutanese individuals to 75% among Indians having attained bachelor’s degrees or more education). This shows how aggregate data of Asian Americans often fails to capture the broad range of experiences as well as risk factors within this group.
Looking at these numbers, you can see how it would be difficult to use the combined data to direct culturally and linguistically relevant programs addressing health disparities and cancer prevention.
These particularities also mean that AAPI people among different subgroups may handle health concerns in different ways. Some individuals may be less information‐seeking than other groups and/or be less forthcoming about symptoms or concerns, including mental health concerns, and less accepting of screening for disease given absence of symptoms, an Oncologist paper advises. Some may have an aversion to the word “cancer” itself due to its cultural stigma.
In addition, many Asian cultures follow a “family-centric model where health care decisions” are “discussed with the family before decisions are made,” the paper continues. If a poor prognosis is received, it is common for some to “shield” older relatives from this information that could be “related to cultural beliefs that the stress could lead to worse outcomes,” or because of a desire to limit health care expenses.
There can also be specific barriers to screening in men and women of AAPI communities due to cultural perceptions of modesty among women and preserving masculinity and sexual function in men.
Your unique risks and your cancer screening needs
Asian Americans have many significant differences from other racial and ethnic groups that require physicians to provide tailored cancer screening recommendations based on the diverse backgrounds that make up this group. For this reason, it is important for people in AAPI communities to know how their cancer risk and mortality rates, including among particular subgroups that they may belong to, can differ from the general U.S. population.
Asian Americans generally have higher rates of liver and stomach cancer, which are often related to exposure to the hepatitis B virus (HBV) or H. pylori bacteria, respectively. Cancers of the nose and throat in Asian populations are often related to the Epstein-Barr virus, whereas in non-hispanic White Americans, these types of cancer are more commonly related to the human papillomavirus (HPV). This makes it important for Asian Americans to understand the benefits of vaccination for HBV and HPV. Women in this group have a higher risk for cervical cancer, so they need to ask their health care providers if screening will look for Asian-prevalent high-risk HPV variants.
Men of Japanese or Chinese descent may be at a higher risk for colon cancer, so they should ask their doctors about starting colon cancer screening earlier than recommended for other populations.
These important and possibly life-saving facts are not widely known or advertised, so it is critical that better guidelines are developed for both cancer screening and treatment for Asian Americans.
Paths forward
One way that the Centers for Disease Control and Prevention (CDC) has addressed cancer disparities is with the development of resources such as the Breast Cancer Disparities Toolkit. Although a step in the right direction, this online tool, like others, is not tailored to specific populations.
The tool kit does encourage sustainable implementation from trusted messengers and evaluation to address social determinants of health and reduce mortality, but as we’ve learned, there is a greater need for culturally and linguistically appropriate programs if we really want to reach AAPI populations with information and resources that can help individuals reduce their cancer risks.
Research has shown that culturally appropriate educational campaigns reaching Asian Americans in their communities have been effective, and making such programming available across languages spoken by AAPI subpopulations is important in making these initiatives successful. Engaging community members who speak English fluently to connect and share information with those who may not be can also be helpful.
Ideally, the Oncologist paper notes, many major cancer centers will partner with community health centers to develop pathways from screening and diagnosis to “appropriate oncology care and access to clinical trials.”
Aided by more research into the specific needs and genetic differences of AAPI subgroups and continued education and community outreach initiatives, hopefully we can begin to close the gap on AAPI cancer disparities to ensure better health outcomes for all.