Minority subgroup gets far less cancer but has much worse outcomes

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 - Risk-Based Management

Nothing kills more AANHPIs—that’s the population subset comprising Asian-Americans, Native Hawaiians and Pacific Islanders—than cancer. Yet AANHPIs have whopping 30 percent to 40 percent lower incidence and mortality rates than non-Hispanic whites for all cancers combined.

What explains this counterintuitive and troubling equation?

Differences in rates of particular cancer types—and widely varying cancer incidence under the broad AANHPI umbrella—along with disparate behavioral risk factors, exposure to cancer-causing infections, and use of screening and preventive services.

That’s according to a report presented by the American Cancer Society based on its  Cancer Facts & Figures 2016 report and published online in  CA: A Cancer Journal for Clinicians.

One of the most striking findings revealed by the statistics is that the risk of stomach and liver cancers for AANHPIs is double that for non-Hispanic whites.

It’s unclear from the data whether this owes more to cancer biology, lifestyle factors or combinations of these and other factors.

Meanwhile the numbers show plenty of diversity within the AANHPI population.

For example, the overall cancer incidence rate in Samoan men (526.5 per 100,000) is more than twice that in Asian Indian/Pakistani men (216.8).

The report, lead-authored by Lindsey Torre, MSPH, of the cancer society’s surveillance-research group, also lays out stats showing:  

  • Because of differences in smoking, rates of often-fatal lung cancer in Samoan men (98.9 per 100,000) are about 30 percent higher than those in Hawaiian (72.1), non-Hispanic white (71.2) and Laotian (65.2) men—and almost 80 percent higher than in Asian Indian/Pakistani men (21.1).
  • For liver cancer, which also has very high mortality, the incidences in Laotian (66.1 per 100,000) and Vietnamese (51.9) men are 2 to 4 times higher than those in Chinese (21.7), Koreans (26) and Filipinos (16.7), and almost 10 times higher than in Asian Indians and Pakistanis (6.5).
  • The three leading causes of cancer death among AANHPI males combined are lung (27 percent), liver (14 percent) and colon/rectum (11 percent).
  • Among AANHPI women, they are lung (21 percent), breast (14 percent) and colon/rectum (11 percent).
  • Overall cancer incidence rates in males and females are converging due to decreasing prostate and lung cancer rates among males and increasing breast cancer rates among females.
  • There will be 57,740 new cancer cases and 16,910 cancer deaths among AANHPIs in 2016.

Torre et al. conclude by stating that aggregating data for AANHPIs “masks stark differences in cancer risk within this heterogeneous population.”

They point out that Native Hawaiians and Pacific Islanders are small in number but have a higher cancer burden than Asian Americans—and so are “particularly disadvantaged by data aggregation.”

“It is essential that cancer-control strategies acknowledge the diversity of the AANHPI population because tailored interventions have demonstrated success,” the authors write. “These include translation into native languages, consideration of cultural appropriateness, provider recommendation, improved access to healthcare and patient navigation, and improved knowledge about cancer prevention.”

The study is  posted in full for free.