By Nina Huang
NORTHWEST ASIAN WEEKLY
As we begin October to recognize Breast Cancer Awareness Month, it is important to note that the cancer rate among Asian women is rising.
Dr. Ani Fleisig, surgical oncologist
No one really knows why there is a rise as more research is needed, but Dr. Ani Fleisig, MD, FACS, a board-certified general surgeon who specializes in oncology at Virginia Mason Franciscan Health, thinks it could be a combination of a few things.
The overall screening numbers have increased. There may be a detection bias, but Fleisig shared an interesting study that came out. Of East and Southeast Asian immigrants, the population that moved to the United States have a much higher screening rate than Asians born in the U.S. That population is probably older and there is a higher rate of breast cancer being detected in older patients.
Fleisig also attributed the Western lifestyle and diet that adds to the higher risk of a number of medical conditions including cancer.
“There are new and different environmental exposures that weren’t present in one’s origin country,” she said.
Fleisig also added that looking at the statistics of women of various ethnicities, the risk of breast cancer actually peaks in the 40-49 age range.
“The breast cancer rate declines and stabilizes in Asians, which is different from what we learned in medical school. Age is a big factor because white women peak around age 70, for Black women, the median age is 60. It might be genetics playing a part when breast cancer peaks in different ethnic groups,” she said.
“The data is hard to interpret because you’re including a lot of the entire population,” she said.
About 11,000 Asian American and Pacific Islander women were diagnosed with breast cancer in 2021 and about 1,500 died. The latest federal data shows the rate of new breast cancer diagnoses in Asian American and Pacific Islander women—a group that once had relatively low rates of diagnosis—is rising much faster than that of many other racial and ethnic groups.
About 55 of every 100,000 Asian American and Pacific Islander women under 50 were diagnosed with breast cancer in 2021, surpassing the rate for Black and Hispanic women and on par with the rate for white women, according to age-adjusted data from the National Institutes of Health. (Hispanic people can be of any race or combination of races but are grouped separately in this data.)
Among the East and Southeast Asian population, another risk factor is that those women who delay childbearing, are at an increased risk for breast cancer. More women are having children in their late 30s and 40s because of education and socioeconomic status.
Fleisig has noticed that in the last five years, there has been an explosion of all kinds of cancers in patients under the age of 50. There have been patients in their 30s, 40s with breast, colon cancer, and melanoma.
“It’s alarming, not just breast cancer, all cancers,” she added.
Dr. Janie M. Lee
Dr. Janie M. Lee, director of Breast Imaging at Fred Hutchinson Cancer Research Center and professor at the department of radiology at the University of Washington School of Medicine, shared that a new national law went into effect in September 2024 that requires patients who have mammograms be notified about whether they have dense or non-dense breasts.
Breast density refers to the amount of fibrous and glandular tissue a woman has, compared with fatty tissue. Breast density is both a risk factor for breast cancer, and also a factor that can make breast cancer harder to detect on mammograms. Many Asian women and younger women have dense breasts, which may be another factor contributing to the increase in breast cancer cases among Asian women who are younger than 50 years of age, Lee shared.
“The United States Preventive Services Task Force (USPSTF) also recently updated their recommendations and now recommend that women start screening at age 40. With the new guidelines comes a requirement that screening mammograms be covered by insurance companies with no cost-sharing for patients. That’s pretty good news,” Lee added.
The USPSTF recommends women at average risk for breast cancer get a mammogram every two years starting at age 40 and continuing through age 74.
“Like many other Asian American women, I have lots of commitments—I work full-time and live in a multigenerational household with my husband and son and also my 84-year-old mom. Staying healthy is an important way for me to do something both for myself and for my family. That includes getting my screening mammogram to look for early breast cancer when it is not yet causing any symptoms. Screening works best when it’s used regularly, regardless of how frequently you return, either annually or every two years. Once you start screening, please plan to return!” Lee said.
Fleisig added that screenings are guidelines, but it doesn’t mean it fits for every single patient. If someone has a family history of cancer, like a first degree relative, or even more remote such as maternal aunts or grandparents, their screening should be sooner and annual.
“They need to be much more rigorous with their surveillance,” she said.
Fleisig shared that lifestyle factors can help when it comes to decreasing or delaying the risk of cancer occurring.
Exercising at least three or four times a week and avoiding the sedentary lifestyle can help people maintain a healthy weight. Diet is another way to decrease risk.
“I tell my patients that your plate should be like a rainbow,” she said.
Foods with antioxidants and a lot of vitamins such as blueberries, tomatoes, and vegetables can help.
She also said that alcohol has been proven to increase the risk for breast cancer in women, but said that everything is about balance, moderation, and quality, not only about quantity.
Fleisig shared that the majority of breast cancer is asymptomatic. She sees patients for breast pain, and while pain can be scary, breast cancer is not usually painful. It can be self-detected, there is usually a palpable mass that grows that doesn’t cause symptoms except for the mass.
The two most common are lobular and ductal breast cancers.
Fleisig added that the majority of Asians tend to be diagnosed with ER positive breast cancers, but it’s gone down for Asian women and the overall survival tends to be better.
Fleisig shared that the overall trend she’s seeing is that there are better therapies available and the screening/imaging technologies are better.
The Asian death rate due to breast cancer has been stable, and still the lowest of the populations.
“Asians tend to have the highest chance of all the races to be diagnosed with stage 1, but also why they have the lowest death rate as well, there may be a rise in detection bias,” she added.
The program includes anything related to screening and prevention related to breast, cervical, and colorectal cancer.
Brendan Lo, population health manager at International Community Health Services (ICHS), oversees a team of population health coordinators and they support the clinic in addressing all things related to screenings, such as getting screening rates up and analyzing where they can do better.
“Being in a primary care setting, our biggest responsibility is getting patients screened or referring them to screening. Early detection promotes the chance of catching it earlier and intervening to get the right resources and treatment. These are all the benefits of early detection, that’s why we advocate that all of our patients get screened if they’re eligible,” Lo said.
ICHS has a 70.9% breast cancer screening rate for their patients who are eligible.
Lo shared that ICHS patients are mostly Asian immigrants and sometimes, a lot of the older generation don’t go to the doctor unless they need to.
“We try to overcome stigma and cultural beliefs to provide that education and importance of preventative health,” he said.
The only way to catch cancer is to detect it early by getting screened when you’re eligible.
Nina can be reached at newstips@nwasianweekly.com.