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Even as treatments grow more effective, cancer remains a growing problem in the United States, particularly in Asian Americans. As of 2021, there are 24 million Asian-identifying residents in the United States, according to the U.S. Census Bureau. Pew Research projects that number will pass 35 million by 2060.
As the population increases, a rise in cancer rates has also been observed in Asian Americans. Between 1999 and 2018, breast cancer incidence increased by 21 percent in the Asian American population, according to the Centers for Disease Control and Prevention (CDC). A study published in 2022 in Cancer Causes & Control found that Japanese Americans’ breast cancer rates rose by 2.9 percent from 1994 to 2014, while a 1 percent increase occurred among non-Hispanic white women.
“Asians are the only racial group in the U.S. for whom the leading cause of death in both men and women is cancer, not heart disease,” says Julie Kang, MD, a radiation oncologist at Yale Cancer Center. According to the CDC, cancer accounts for just over 25 percent of deaths in the Asian American community. In contrast, about 23 percent of deaths in non-Hispanic white Americans are caused by cancer.
Disparities and Aggregated Data Create Barriers for Asian Americans
The disparity in cancer rates for Asian Americans may come from less screening and a lack of education in certain ethnic communities, according to a study published in the Oncologist in 2021.
Despite being the fastest growing racial group in the United States, Asian Americans have lower screening rates than their white counterparts for a variety of cancer types, including cervical cancer (75 percent versus 83 percent) and breast cancer (64 percent versus 72 percent).
And, at 49 percent, Asian Americans have the lowest colorectal cancer screening rate of any other racial or ethnic group in the United States, according to a study published in 2021 in Preventing Chronic Disease.
Underrepresentation in research and aggregated health data also contribute to the problem. According to a report published in 2022 in the Journal of the National Cancer Institute (JNCI), less than 0.2 percent of the NIH research budget between 1992 and 2018 was earmarked for Asian Americans.
Although cancer rates in Native Hawaiian, Asian, and Pacific Islanders appear to be much lower than any other ethnicity, according to the American Cancer Society (ACS), because these statistics lump many different Asian American racial groups together, these rates don’t show the whole picture.
For example, the ACS reports Asian Americans have much lower rates of cervical cancer than any other racial group. But Vietnamese Americans are diagnosed with cervical cancer five times more than non-Hispanic white women, according to the National Cancer Institute (NCI).
This kind of generalization can cause a false sense of security with regard to cancer in the Asian American community, and lead to a lack of education, screening, and research opportunities, according to the 2022 JNCI study.
Mortality rates can also be misleading. Research published in the July 2023 JNCI suggests Asian Americans have a higher cancer survival rate than any other racial group. But much more study is needed before we can come to the conclusion that Asian Americans have a lower cancer or mortality risk, says Edward Kim, MD, a medical oncologist at City of Hope Orange County in Los Angeles.
Some data may overestimate survival rates because of “salmon bias,” Dr. Kang says, which happens when Asian Americans who are terminally ill return to their hometowns, resulting in their deaths not being recorded in the United States, and could be part of the reason why cancer survival rates among the Asian American community appear to be higher than other populations.
“When we look more carefully, we find important nuances that could lead to helping more minority communities access the lifesaving care they need,” Dr. Kim says.
Cancers That Affect Asian Americans
Liver
High rates of liver cancer in the Asian American community often come from hepatitis B infection, according to the 2022 JNCI study. The same study found that while Asian Americans make up about 6 percent of the U.S. population, they account for 60 percent of the country’s chronic hepatitis B infections.
Asian Americans may be at higher risk for hepatitis B infection because of low vaccination rates, according to a study published in the American Journal of Public Health in 2018, which found that only 33 percent of more than 25,000 study participants were vaccinated against hepatitis B.
In another study, published in 2018 in JNCI, researchers found that while liver cancer rates declined in Chinese Americans from 1988 to 2012, they increased in Filipino and Japanese men and in Vietnamese and Laotian women. In this study, the Japanese group had a higher proportion of people older than 70, which may have increased their numbers.
The study also found that Vietnamese, Cambodians, and Laotians were diagnosed with liver cancer eight to nine times more often than non-Hispanic white people, and more than twice as often as other Asian Americans.
Stomach
Stomach cancer ranks the highest among Korean Americans, according to the 2022 JNCI study. Also known as gastric cancer, this type of disease is often related to infection by a bacteria called Helicobacter pylori (H. pylori), Kang says, and is more common in not just Korean, but also Japanese Americans.
The 2021 study in the Oncologist suggests Asian Americans may be exposed to more risk factors for H. pylori infection, which include crowded living conditions, smoking, and consumption of salt-preserved foods. Another study, published in August 2021 in Food Control, found that participants who ate a lot of highly fermented foods — like kimchi, a staple in some Korean American diets — had a higher stomach cancer risk.
Current ACS data show a higher stomach cancer mortality rate in Asian Americans as a whole. A study published in June 2020 in Cancer Medicine found stomach cancer mortality was two to three times higher in Asian Americans than non-Hispanic whites.
Nasopharyngeal
Nasopharyngeal cancer is abnormal cell growth anywhere from your nose down to your throat. Chinese and Laotian Americans are 10 to 14 times more likely than their white counterparts to be diagnosed with nasopharyngeal cancer, according to the American Association for Cancer Research.
As with liver and stomach cancer, this type of growth can follow a viral infection. Nasopharyngeal cancer can develop after an Epstein-Barr virus (EBV) infection, Kang says, which is more common in Chinese Americans. According to a study published in 2016 in PLoS One, Chinese culture historically encouraged pre-chewing food for babies and other similar feeding habits. Since EBV is passed through saliva, this could be one cause for the higher incidence.
Cervical
Cervical cancer risk increases after a bout with human papillomavirus, or HPV. HPV-related cancer rates in the Vietnamese and Cambodian American communities are higher than other subgroups, Kang says. HPV can turn the cells in your cervix cancerous by changing the way your cervical cells communicate, causing them to replicate too fast, according to the CDC.
Even with high cancer rates, HPV vaccination has stayed low, according to a study published in 2022 in Cancer Prevention Research. But the same study also found that after education, Vietnamese American mothers who said they would plan to vaccinate their child went from 53 to 74 percent.
Lung
Although lung cancer doesn’t hit the Asian American community as a whole more than other groups, the lung cancer rate in Asian American “never smokers” — those who have never smoked — is much higher than in other groups.
In fact, according to the 2022 JNCI study, lung cancer in never-smokers appears in Asian American women twice as often as non-Hispanic white women. More details may be found as researchers study Asian American subgroups separately.
Breast
Breast cancer rates in Asian American women are on the rise, according to a study published in 2019 in Preventing Chronic Disease. “Breast cancer incidence rates have risen the fastest for Asian Americans at an alarming 2.1 percent per year from 2015 to 2019, compared to 0.5 percent per year for non-Hispanic white [people] and 0.7 percent per year for Black women,” Kang says.
Asian women who immigrated to the United States may be two to three times more likely to develop breast cancer than those born in the United States, according to the 2019 study, though some experts say that there isn’t enough data to make this conclusion.
What Asian Americans Can Do in Response
Participate in Trials
One significant way to lower cancer disparity in the Asian American population is for researchers to study each ethnic group within the community. To get this data, researchers need more involvement from Asian Americans in each subgroup. You can find information on how to participate in clinical trials through the U.S. National Library of Medicine clinical trial database.
“With all this diversity within the population, it is important to disaggregate — or separate — data to get a clearer picture of the health situation among the many people who have been grouped together,” Kim says.
You can also participate in the All of Us Research Program, which is run by the National Institutes of Health and is working to build a diverse and extensive health database.
Get Screened
Proper screening is a vital step in detecting and diagnosing cancer early, allowing for more effective treatment. Screening requirements vary for each cancer type.
Here’s what experts recommend.
- Mammogram This is the most common type of screening for breast cancer. If you are between ages 45 and 54, experts recommend getting a mammogram once a year. After age 54, you can opt to get one every two years or stick with an annual screening.
- HPV test and Pap smear An HPV test can detect this infection, which increases your risk of cervical cancer if left unchecked. It’s recommended that people age 25 through 65 who have a cervix get this test in combination with a Pap smear — which can identify precancerous cells — every five years, according to the ACS. You can also choose to get a Pap smear alone every three years.
- Chest CT If you are at high risk for lung cancer, your provider may want you to have annual CT scans of your chest. CT — or computed tomography — scans can give your provider more information than an X-ray and catch lung cancer early.
- Nasopharyngoscopy Most nasopharyngeal cancers are found during routine examinations or during a provider visit for a sinus infection or cold. But if you are at high risk, your provider may send you to an ear, nose, and throat provider (ENT) to have a nasopharyngoscopy. This procedure uses either light and mirrors or a fiber-optic scope with a camera to see a bit further.
Not sure what screening you need? If you don’t have a primary healthcare provider, it can be difficult to know what you should pursue. The CDC provides a helpful list of important screening tests and information about when to start asking for them.
Get Vaccinated
Since many cancers that affect the Asian American community can develop after a viral infection, one way to lower your risk of certain cancers is to get vaccinated. The HPV vaccine can protect against cervical cancer, the hepatitis B vaccine can protect against the virus of the same name, and a vaccine for the bacteria H. pylori is in development. If you can prevent a viral infection, you can lower your risk for that cancer.
Ask your primary healthcare provider about getting vaccinated. If you don’t have a regular provider or an upcoming appointment, many pharmacies also offer vaccinations.
Visit the U.S. Department of Health and Human Services website to find your local health department and vaccine providers near you.
Advocate for Yourself
If you feel concerned you may be falling through the healthcare cracks, advocate for yourself! If a healthcare provider doesn’t offer a screening you think you may need, ask about it. And if you, or a family member, aren’t comfortable with using English, most hospitals have a translator on hand, and you have the right to request one. Sometimes getting the best preventive cancer care is one question away.
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