Since 2000, breast cancer rates among Asian American and Pacific Islander (AAPI) women under 50 years old has increased by 50%, and since 2012, that rate has increased every year by 2%, according to a recent report from the American Cancer Society.
The increase among those younger than 50 years old has moved this population from the second lowest in breast cancer incidence to sharing the highest incidence with white women.
The considerable increase in cases is one that has left the puzzled medical community with many questions, but one researcher has made it her mission to find answers.
Dr. Scarlett Lin Gomez, MPH, PhD, co-leader of the Cancer Control Program at the Helen Diller Family Comprehensive Cancer Center at UCSF, has spent the last 25 years conducting surveillance and research of cancer rates, specifically within the AAPI community.
“As a first generation Taiwanese American immigrant, I understood that there are multiple, extremely heterogeneous, ethnic groups that comprise the group commonly lumped into the category of Asian American and Pacific Islander,” she told Flow Space. “I knew that this diversity would certainly translate into very different cancer patterns, and so I spent my career trying to document these distinct cancer patterns and aiming to understand the underlying reasons where we see disparities.”
While there is no one answer to why cases continue to rise among AAPI women, we spoke with Gomez about her own research and two breast oncologists to learn more about the alarming trend and to unpack how future research could help lead to more answers. Here’s what they had to say.
Breast Cancer Rates for AAPI Women Rise Fastest Among the Young
The latest research from the American Cancer Society evaluated breast cancer incidence and mortality in women in the United States using data from the National Cancer Institute and the Centers for Disease Control and Prevention (CDC). They found an increase in cases among all ethnicities, but the fastest increase was noted in AAPI women.
“It is a very real and concerning increase, as we have noted the same patterns,” Gomez explained. “Some have speculated that perhaps the increase is due to more screening; however, our data show that the increases are just as high for later stage disease as for early stage disease, and moreover, breast cancer screening remains among the lowest in some AAPI ethnic groups.”
And data from certain east Asian countries show rapidly increasing trends as well, pointing to a potential cohort effect, and warning that Asian women worldwide are on pace to have the highest breast cancer rates in the world, Gomez added.
While mortality from breast cancer has been decreasing in white, Hispanic and Black women, AAPI women have had stable mortality rates despite improvements in treatments in the last decade.
So, why are we seeing these patterns?
“We don’t know,” said Gomez. “But some of the increases are likely due in part to increases in established risk factors such as delayed childbearing, having fewer children, less breastfeeding, perhaps more alcohol consumption, increase in postmenopausal body size… but, as noted, these changes in established risk factors likely don’t fully explain the trends that we are seeing, and other, as yet unknown, factors may be responsible.”
What Future Research Might Tell Us About Risk Factors
In hopes to understand what specific risk factors are leading to a higher incidence of breast cancer rates in AAPI women, Gomez and her colleagues started the CRANE Study (Breast Cancer Risk among AsiaN AmEricans Study).
“This is the only current study, to our knowledge, focusing on breast cancer risk factors in Asian American females,” she said. “We are also continuing to keep a close eye on the incidence trends and are awaiting the data to be able to update rates for specific ethnic groups.”
And that begins with breaking down the 40-plus ethnic groups that make up the AAPI community. For example, recent immigrants from Southeast Asian countries are different from Japanese Americans who have been here for generations, and lifestyle behaviors or genetics between each group may be different.
“This heterogeneity is further enhanced by unique immigration and settlement patterns,” said Gomez. “I knew that this diversity would certainly translate into very different cancer patterns, and so I spent my career trying to document these distinct cancer patterns, aiming to understand the underlying reasons why we see disparities.”
Another factor is understanding family history, something that is culturally a stigma in most Asian communities, explains Dr. Naomi Dempsey, a board-certified breast medical oncologist at the Miami Cancer Institute, part of Baptist Health South Florida.
“Patients should learn about their family history and seek out genetic testing when there is a strong family history of breast cancer,” she explained. “Although family planning is a very personal decision, delaying childbearing beyond age 30 or never experiencing pregnancy are risk factors for developing breast cancer. If a woman does have a child, breastfeeding has a protective effect against breast cancer.”
Asian women are also more likely to have a higher prevalence of dense breasts, meaning there are more glands and tissue than fat, which is likely due to genetics and lower body mass indexes, and women with dense breasts are four times as likely to develop breast cancer as those with fatty breasts.
But Gomez says the good news is they know a bit about what causes breast cancer in the general population, and that has helped guide their research, which they hope will provide more answers soon.
“Aiming to reduce those risk factors can only help,” she noted. “Certainly, getting screened remains important because screening can pick up cancers at an earlier stage where it is more treatable, and if recommended by a medical professional, testing for inherited genetic variants can help to further determine risk.”
What AAPI Women Can Do to Reduce Their Risk of Breast Cancer
While the climbing breast cancer rates among AAPI women are alarming, it is important to know that the risk is there, says Dr. Melissa Fana, chief of breast surgery at Long Island Community Hospital.
“Discussing a topic that was taboo in some communities is important to dispel myths,” she told Flow Space. “Fear comes from the unknown, but we know that our current treatment strategies and surgical approaches lead to cures.”
She recommends that AAPI women seek information, such as: what the signs and symptoms are of breast cancer, what their lifetime risk is, and what tools and programs are available for screening and risk reduction.
In addition to this, lifestyle modifications, like eating a whole-food diet rich in fruits and vegetables and limiting processed foods, can help. Getting regular exercise and avoiding or decreasing alcohol consumption are all beneficial, along with performing a monthly self breast exam.
“In women who are younger than age 40 and not yet undergoing screening mammography, most breast cancers are detected by the patient themselves, who feel a lump or mass and bring it to the attention of their physician,” said Dempsey. “Be aware of your breasts, what is normal, and get in the habit of checking them regularly. If you still have a period, this self-check should be done in the week after your period.”
Adhering to an annual mammography screening program that starts at age 40 can also help.
And in regards to research, Gomez is grateful that more women are aware of their risk and is hopeful they will participate in studies, like her own, to help advance our knowledge for the next generation.
“Raising awareness among the medical community is important so that doctors understand that we are now considered a high risk population, and should take our symptoms seriously,” said Gomez. “We have heard too many stories of Asian women whose symptoms were dismissed because of a preconception of low risk in these populations. Hopefully that is changing.”