Bay Area Asian American Immigrant Women more likely to get Breast Cancer

We have written how some doctors would not believe that Asian American women could get breast cancer, but in the past few years, I know a number of Asian American women who were diagnosed with the disease.   Previous studies of women in Asia show a lower occurrence of breast cancer outside of the United States and higher incidence in US born Asian Americans.  In contrast, a recently released study of Asian American women in the San Francisco Bay Area suggests what I have seen anecdotally – immigrant Asian Americans are more likely to get breast cancer than native born Asian Americans.

Of the Asian American women that I know personally that have had breast cancer, all were immigrants and most were in the Bay Area.  The Wife knows even more women who had breast cancer – all are Asian American immigrants too.  Tim’s mother also died of breast cancer,  The only Asian American woman who had breast cancer who was born in the US that I can think of is Ken Jeong’s wife. Is this some acculturation factor, like with South Asian Heart disease?  The authors tried to control for that, looking at BMI and length of time in the US, but controlling those factors left the same result.

Then again, the majority of the Asian American women that The Wife and I know are immigrants in the Bay Area, so my anecdotal sample is biased.  Similarly, the study’s authors mention that one possible shortcoming of the study is that it was limited to the Bay Area population.  One risk factor for breast cancer is higher socioeconomic (measured by income and education) status – this is borne out in studies of populations all over the world and is seen in the rise of breast cancer in parts of Asia and with Asian American women in the Bay Area.   Given the large numbers of affluent Asian immigrants in the Bay area and in certain cases, where the native born children of immigrants earn less than parents, this study might simply be showing the socioeconomic risk factor.

So what to take away from this study?   Given the limits on sample size, the authors suggestion that further cross national studies be done to confirm the results and to narrow down the particular risk factors that generate this result.  If the discrepancy is caused by mainly be income/education differentials, then some of the known breast cancer risk factors that come with affluence, such as a sedentary lifestyle, should be publicized in the affected communities and should be avoided.  The authors suggest that from a public health perspective, doctors should recognize immigrant status as a breast cancer risk factor with Asian American women and increase screenings, which have been low in the past.

(h/t:  John)

The Model Minority Myth applied to Asian-American Health

When I was 34, my doctor refused to biopsy a lump I found in my right breast.  He told me I was too young to get breast cancer and had no family history. Besides, he said, “Asian women don’t get breast cancer.”  He was wrong.   After a second doctor told me with “99.9% certainty” that I didn’t have the disease, I told him I wanted to be 100% certain, so he biopsied the lump.  To his shock, I had breast cancer.

(flickr photo credit: yongjiet)

Susan Matsuko Shinagawa’s experiences with doctors and cancer are not unique.  This NPR discussion with Kathy Ko from the Asian Pacific Islander Health Forum talks about the model minority myth applied to Asian-American health, and breast cancer in particular.  That seems so terribly wrong, as I have known a number of Asian-American women who have gotten breast cancer and Tim’s Mom died from it.

The NPR discussion also talks about health disparities in between Asian-Americans and other Americans and between Asian-American subgroups.   For example, U.S.-born Vietnamese women are four times more likely to die of breast cancer than any other Asian-American ethnic group.  That is in contrast to another study that says that Asian immigrant women as a group are 4 times more likely to die of breast cancer than US born women.  Native Hawaiians experience high rates of diabetes and obesity, and Asian-American childhood obesity is on the rise.

Just as the Asian-American model minority myth applied to academics blurs academic disparities between different Asian-American subgroups, aggregating health data across all Asian-Americans causes important information about subgroups to be lost.  Asian-Americans as a whole are 50% less likely to die of heart disease than non-hispanic whites.  But within that broad group, Native Hawaiians are 40% more likely to be diagnosed with heart diseases than non-hispanic whites.   Asian-American kids are the fittest in California, but Filipinos and Pacific Islanders (actually broken out separately here) are not as fit.

What are Asian-Americans to do?  The NPR discussion mentions some solutions, like encouraging culturally appropriate health care access and increasing health care coverage.  Susan Matsuko Shinagawa suggests that some Asian attitudes about cancer, like not talking about it, need to change.  Other studies suggest that adopting the American diet increases cancer risks, so maintaining good eating habits and not being sedentary can go a long way into staying healthy.