Chipping the iceberg: addressing disparities faced by Asian Americans in cancer care

From Dr. Evan Yu, Clinical Research Division
Asian Americans face unique cancer challenges, including higher risk of death by cancer and disparities in screening and preventative care.
Asian Americans face unique cancer challenges, including higher risk of death by cancer and disparities in screening and preventative care. Doctor Office 1 by Subconsci Productions is licensed under CC BY-SA 2.0,

Asian Americans are the only racial or ethnic group for whom cancer is the leading cause of death in the United States. This simple, yet striking, fact has been poorly recognized within both the general public and the field of oncology alike. In a social moment of reckoning for anti-Asian discrimination in America and worldwide, it remains important to address less visible forms of inequity faced by underserved populations within our communities. Dr. Evan Yu, Medical Oncologist in the Fred Hutch Clinical Research Division, Medical Director of Clinical Research Services for the Fred Hutch Cancer Research Consortium and Clinical Research Director of Genitourinary Oncology at the Seattle Cancer Care Alliance, joined colleagues across the country to highlight the challenges faced by Asian Americans in cancer care. Their commentary, recently published in The Oncologist, explores the unique constellation of factors contributing to these disparities and offers thoughtful, practical recommendations for beginning to address them.

The factors contributing to the increased risk of death by cancer to Asian Americans, relative to other racial and ethnic groups (for whom heart disease is the major killer), are myriad and complex. Importantly, the “Asian American” label fails to capture the diversity contained within this group, which encompasses populations with origins from more than 20 countries and who speak more than 200 languages or dialects. Often not considered as part of the medically underserved population, Asian Americans make up about six percent of the American demographic, are the fastest-growing racial/ethnic group in the nation, and often face unique disparity challenges compared to other minority groups.

Dr. Yu and colleagues trace the long history of anti-Asian discrimination in America, including successive institutionalized barriers to immigration –stretching as far back as the 19th century– and the internment of Japanese Americans during the second world war to the current state of affairs. The relative economic successes of some Asian Americans, despite the discriminatory policies and other forms of racism levied against them, lead to the coining of the “Model Minority” label in the mid-1960s.  This label asserted that attributes such as work ethic, family values, and regard for educational excellence enabled the achievements of Asian Americans above other minority groups. This myth undermines social responsibilities to actively foster the successes of disadvantaged minority populations and inappropriately positions Asian Americans as an aggregate group, outside the scope of minority groups worthy of support.

The “Model Minority” myth and the tendency to regard Asian American populations as a monolith have important healthcare implications. Failure to recognize the heterogeneity of factors contributing to disease risk among Asian American subpopulations, including unique cultural and genetic makeups, has lead to an underappreciation of the medical challenges faced by these groups. Perception of Asian Americans as having overcome discriminatory barriers, in an economic sense, undermines the need for consideration of this group as a unique and underserved minority in the realm of healthcare.

Indeed, Asian Americans face diverse and specific sources of cancer risk, including high rates of cancers with infectious etiologies, and unique exposures and sensitivities to carcinogens (such as tobacco use) and other environmental factors, coupled with the acquisition of risks associated with ‘Westernization’ of diet and lifestyle. Further, despite the overall increased risk of death due to cancer, Asian Americans are screened at rates below the national average and receive significantly less smoking cessation counseling. Some of these challenges may, in part, be attributable to unique barriers faced by Asian American subpopulations, such as language (and lack of access to interpreters and translated health information), differential access to insurance, differences in health-seeking behaviors, and cultural perceptions of medical care. Finally, we must acknowledge the role of racism in contributing to cancer disparities for Asian Americans, including the effects of historic institutionalized discrimination and stereotypes on the attitudes and actions of Asian Americans and healthcare workers alike.

“We hope to bring awareness to the fact that the number one cause of death in Asian Americans is cancer,” Dr. Yu said. “There have long been unrecognized disparities for Asian Americans and cancer care. A few contributing factors include the socioeconomic heterogeneity that exists amongst Asian Americans. The “Model Minority” myth is harmful in that it leaves screening, public health and cultural needs masked. To address this crisis, we need to first recognize this challenge and help move us towards eliminating cancer disparities for all racial/ethnic groups through education, improved access to care, and culturally-sensitive health care resources.”

Dr. Yu and colleagues offer recommendations for overcoming hurdles faced by Asian Americans in cancer care, including education for patients and healthcare providers alike and improved access to care. They are careful to point out that, due to the heterogeneity of this group, successful approaches will likely be multifaceted and targeted to specific subpopulations. For example, community outreach efforts and the dissemination of translated educational resources through churches, community centers, and grocery stores can make meaningful differences in the willingness of specific Asian American communities to seek cancer screening and preventative measures. The availability of ‘cancer care navigators’ and translators to educate and facilitate healthcare management can also meaningfully improve cancer care outcomes. The authors encourage the adoption of national guidelines for primary care providers to establish recommendations addressing risk factors for cancers occurring at higher rates in Asian American populations, such as screening, smoking cessation, and vaccinations/testing for infectious risk factors. An increased understanding of cultural perceptions and practices of Asian subpopulations concerning cancer and healthcare, and appropriate strategies for addressing them, will be important tools for physicians treating these patients.

“We have compiled data to bring to light an issue that likely is not well-recognized in the public eye. This work provides attention to an important topic that can only be solved through recognition and admission of potential issues of racism that may have led to this problem. It forces us to ask what we can do to address disparities for Asian Americans and all racial/ethnic groups alike.” Moving forward, Dr. Yu and colleagues are continuing their efforts to shine light on less-recognized forms of discrimination faced by Asian Americans, now turning their focus to those experienced by professionals in their own fields of work. “This work has also led us to consider the implications of Asian Americans in medicine, academics and leadership. Specifically, our group of authors hope to initiate a professional society for Asian American oncologists, and we hope to evaluate whether there may be unique disparities that may exist for Asian American academic oncologists.”

This work was completed on donated time and effort from the authors.

UW/Fred Hutch Cancer Consortium member Evan Yu contributed to this work.

Lee RJ, Madan RA, Kim J, Posadas EM, Yu EY. Disparities in Cancer Care and the Asian American Population. Oncologist. 2021 Mar 8. doi: 10.1002/onco.13748. Epub ahead of print. PMID: 33683795.