What Asian American, Native Hawaiian, and Pacific Islander People Should Know About Cancer Risk: An Expert’s View

From 2000 to 2021, the Asian American, Native Hawaiian, and Pacific Islander (AANHPI) population in the US doubled to 24 million people. Looking ahead, the AANHPI population is expected to rise to 35 million people by 2040. Combined, these populations make up about 8% of the total US population and include:

• 1.7 million Native Hawaiian and Other Pacific Islander people
• 5.2 million Chinese people
• 4.8 million Indian people
• 4.4 million Filipino people
• 2.3 million Vietnamese people
• 2 million Korean people
• 1.6 million Japanese people
• People from a dozen or so other Asian countries or regions

Tingting Zhang, PhD, is a cancer survivor, well-known researcher, and advocate for better outreach about cancer prevention and screening in AANHPI communities. “For people in AANHPI communities, it is important to know how their cancer risk can differ from the general U.S. population,” says Dr. Zhang. For example:

• Among AANHPI people with cancer, lung cancer causes the highest number of deaths every year. Yet, most Asian and Chinese women with lung cancer do not have a history of smoking.
• Asian American people also have higher numbers of liver cancer and stomach (gastric) cancer. These cancers are often caused by having an infection that is known to lead to cancer. The hepatitis B virus (HBV) and the hepatitis C virus (HCV) are linked to liver cancer and H. pylori bacteria is linked to stomach cancer.
• Cancers in the head and neck area, specifically the nose and throat, are often related to the Epstein-Barr virus (EBV) in middle-aged Asian Americans. However, in White people these cancer types are more commonly related to the human papillomavirus (HPV).

“These types of cancer can often be prevented by managing the risks of infection and disease progression in the AANHPI population," Dr. Zhang says. " And, importantly, different cancer prevention and screening strategies are needed for this ethnically diverse group.” Therefore, understanding and knowing risk factors that can be changed or managed is key, including certain lifestyle behaviors.

What people in AANHPI communities should know about their individual cancer risk

Since the AANHPI population in the US includes many recent immigrants, Dr. Zhang emphasizes the importance of knowing your family history of cancer, infections, and other diseases. Dr. Zhang recommends starting by talking with members of your family. Here are some questions to ask:

• Who in our extended family has had cancer?
• What type of cancer do they or did they have?
• At what age were they diagnosed with cancer?
• What type of treatment did they get and how well did it work?

If your family immigrated to the US, Dr. Zhang says finding key cancer statistics from the country or community that you or your family came from can also be helpful. For example:

• Liver cancer is the number two cause of cancer deaths in Asia, second only to lung cancer. Several East and Southeast Asian countries have the highest rates of death caused by liver cancer in the world, including Mongolia, Cambodia, Laos, Thailand, Vietnam, China, South Korea, and the Philippines. Since liver cancer can be caused by HBV, it’s a good idea for people who have come from these countries to know their hepatitis B status and get the HBV vaccine as recommended.
• Women in Asia have a higher risk for cervical cancer. When getting the HPV test for cervical cancer screening, AANHPI women should ask if the screening will look for Asian-prevalent high-risk HPV types. If they have received the HPV vaccine as recommended in the US, these vaccines cover these high-risk strains so there is a level of protection against the virus.

If you are part of the AANHPI community, Dr. Zhang recommends talking with your doctor about what steps you can take to help lower your cancer risk. As an example, Dr. Zhang adds, “to help lower the risk of gastric cancer, you may be able to change how you share food, which can help lower the risk of spreading H. pylori bacteria. Thankfully, antibiotic treatments can destroy these germs if you test positive for them.”

Dr. Zhang also points out that people with a family history of stomach cancer — especially if a family member was diagnosed before the age of 40 — might also want to ask their doctor about whether to get tested for stomach cancer.

The importance of cancer screening in AANHPI communities

“For people in AANHPI communities, there might be a culture-related tendency for many of us to avoid talking about our cancer risk, as if the topic were a bad omen. Some AANHPI people with cancer even feel ashamed about getting cancer, as if the disease was retribution for their past sins. However, these perceptions are not fact-based. Cancer is just what happens when some random cells in our body have gone wild, and our immune system was unable to detect and kill them. However, it is important that we find these bad cells early to help us live on after a cancer diagnosis,” says Dr. Zhang.

Some cancer types that are common in AANHPI populations are less common in the general US population. Because of this, health care providers may be less familiar with knowing their risk factors. “It is important for people in the AANHPI population to receive cancer screening recommendations  that are specific to their needs, based on personal and family history, and consider their diverse ethnic backgrounds," Dr. Zhang says. "Talk with your doctor about what types of cancer screening are recommended for you, and let your doctor know if you have findings from cancer screening services in other countries. We also need to be vocal about raising awareness around prevention of Asian-prevalent cancers, and we need to ask for resources to create better guidelines for both cancer screening and treatment.”

It's important to note that some insurance policies limit coverage for tests that help detect cancer if the test or type of cancer is not included in widely accepted cancer screening recommendations. Because of this, Dr. Zhang urges that more high-quality, cross-border studies are needed and supported. These studies could be key to providing evidence to support AANHPI-related screening and treatment options.

Addressing barriers for AANHPI people with cancer

One major concern for AANHPI people with cancer when trying to access quality cancer care is when they face a language barrier. In fact, AANHPI people with cancer speak dozens of different languages, if not more dialects.

“It is important to advocate for resources to better reach AANHPI communities and educate them about cancer prevention and screening, and to better help people with cancer and their caregivers navigate our medical and insurance systems. You can also talk with your health care team about what types of translation and interpretation services or resources may be available to you or a loved one,” Dr. Zhang says.

The American Cancer Society provides cancer information in multiple languages with resources available on prevention, screening, early detection, and treatment. Our 24/7 cancer helpline can also assist people who need cancer information, which is available in more than 200 languages.

More Resources from the American Cancer Society

• Understanding Cancer Risk and Prevention
• Cancer Screening
• Cancer Facts & Figures for AANHPI People
• Global Cancer Facts & Figures
• Cancer Disparities Research Highlights

Tingting Zhang, PhD, is a thyroid cancer survivor and a patient advocate member of the American Society of Clinical Oncology (ASCO). Dr. Zhang is the chief executive officer of ONEiHEALTH, a virtual remote care navigation platform. She received her PhD in cancer biology from Columbia University and won a Defense Advanced Research Projects Agency (DARPA) Information Processing Techniques Office special commendation in 2005 for her anti-bioterror work at the Lawrence Berkeley National Laboratory. Dr. Zhang’s work on digital-enabled care management in Asia won a 2019 ASCO Breakthrough award.