The Impact of Racism on the Cancer Burden Facing Asian Americans 

For the previous three censuses, Asian Americans have been the fastest-growing racial group in the United States. Data aggregation of various Asian communities obscures the disparities faced by this subgroup of Americans.  

A commentary written by Moon S. Chen, Jr, Ph.D., MPH, Associate Director of Community Outreach and Engagement at the UC Davis Comprehensive Cancer Center, highlighted the adverse effects cancer inequalities have on Asian American communities.  Dr. Chen believes that the failure to address Asian American cancer disparities is due to different factors. He includes the historical stereotypes against Asian Americans and the notion of Asian Americans as the model healthy minority, exacerbated by language, cultural, and racial obstacles. "Asian Americans are unusual in that they were the first population in the United States to have cancer as the top cause of death," said Dr. Chen. "Bigotry against Asian Americans, which has been prevalent throughout the nineteenth century, and again including during the COVID-19 pandemic, is worsening the cancer disparities that cost Asian Americans their lives." 

Dr. Chen has highlighted a disproportionate incidence of several cancers among Asian Americans, such as cancers caused by an infectious agent, like the human papillomavirus. For example, Vietnamese American women have the highest incidence of cervical cancer in the United States.  Asian and Southeast Asian Americans, notably Hmong Americans, have high incidences of liver cancer caused by chronic hepatitis B virus infection.  Nasopharyngeal malignancies, which develop in the upper region of the neck behind the nose, are common among Chinese Americans.  Stomach cancer is the most common among Korean Americans.  Lung cancer in never-smokers affects Asian American women at a rate that is more than twice that of non-Hispanic White women. 

On July 21, 2021, the Oncology Center of Excellence at the U.S. Food and Drug Administration (FDA) convened a panel discussion entitled "Conversations on Cancer" to address the significant cancer disparities facing Asian Americans. The virtual "conversation" focused on the unfair burden impacting Asian Americans. 

The panel pointed out that an "infinitesimal proportion" of the National Institutes of Health (NIH) budget has been dedicated to Asian American research. Over the last three decades, the population has had the most significant percentage of cancer increase among any U.S. racial group. However, between 1992 and 2018, only 0.17 percent of the NIH's total budget was allocated to Asian American research. A portfolio study of grants sponsored by the National Cancer Institute's Division of Cancer Control and Population Sciences revealed a small number of Asian American-focused studies, with none addressing cancer causes. 

Asian Americans are underrepresented in clinical studies. According to the FDA panel, just 1% of clinical studies prioritize racial and ethnic minority participation during this period. It pointed out that only five such trials focused on Asian Americans, compared to 83 for African Americans and 32 for Hispanics. 

"It is important to classify Black Americans and Hispanic Americans as underrepresented minorities in clinical trials, but it is sad that our national policy precludes classifying Asian Americans as underrepresented minorities, as data in this commentary demonstrate," Dr. Chen stated. "There is a misconception that Asian Americans do not develop cancer, but this is not true." 

Recommendations to Address Cancer Inequity In the Asian American Community

To address disparities, the FDA panel has proposed a call to action that includes the following measures: 

Data for Asian American subgroups should be disaggregated (Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippines, Thailand, and Vietnam). The opinion asks for a specific focus on Native Hawaiians and other Pacific Islanders. 

Examine the impact of personal experiences and historical trauma. 

According to the panel, culturally competent cancer care is essential to enhance access to health insurance and cancer care. The commission argues that it is also necessary to address language and cultural hurdles that impede Asian Americans from receiving essential medical care. 

Pay attention to the voices of the community. Listening to and collaborating with patients and community advocates is the greatest way to understand and respect the rich diversity and unique experiences in Asian American communities. Community representation, buy-in, and participation must be ensured in research. 

"It is also critical to pay attention to the influence of racism on cancer inequalities and prioritize financing resources." Otherwise, we will not take the required measures toward Asian Americans' health equity," Dr. Chen warned.

https://academic.oup.com/jnci/advance-article/doi/10.1093/jnci/djac055/6569869?login=false