Breast Cancer Research and Treatment

, Volume 164, Issue 1, pp 139–147 | Cite as

Breast cancer in Asian Americans in California, 1988–2013: increasing incidence trends and recent data on breast cancer subtypes

  • Scarlett Lin GomezEmail author
  • Julie Von Behren
  • Meg McKinley
  • Christina A. Clarke
  • Salma Shariff-Marco
  • Iona Cheng
  • Peggy Reynolds
  • Sally L. Glaser



In contrast to other US racial/ethnic groups, Asian Americans (AA) have experienced steadily increasing breast cancer rates in recent decades. To better understand potential contributors to this increase, we examined incidence trends by age and stage among women from seven AA ethnic groups in California from 1988 to 2013, and incidence patterns by subtype and age at diagnosis for the years 2009 through 2013.


Joinpoint regression was applied to California Cancer Registry data to calculate annual percentage change (APC) for incidence trends. Incidence rate ratios were used to compare rates for AA ethnic groups relative to non-Hispanic whites (NHW).


All AA groups except Japanese experienced incidence increases, with the largest among Koreans in 1988–2006 (APC 4.7, 95% CI 3.8, 5.7) and Southeast Asians in 1988–2013 (APC 2.5, 95% CI 0.8, 4.2). Among women younger than age 50, large increases occurred for Vietnamese and other Southeast Asians; among women over age 50, increasing trends occurred in all AA ethnic groups. Rates increased for distant-stage disease among Filipinas (2.2% per year, 95% CI 0.4, 3.9). Compared to NHW, Filipinas and older Vietnamese had higher incidence rates of some HER2+ subtypes.


Breast cancer incidence rates have risen rapidly among California AA, with the greatest increases in Koreans and Southeast Asians. Culturally tailored efforts to increase awareness of and attention to breast cancer risk factors are needed. Given the relatively higher rates of HER2-overexpressing subtypes in some AA ethnicities, research including these groups and their potentially unique exposures may help elucidate disease etiology.


Asian Asian American Breast cancer Subtype Trend HER2–Neu 



Asian American


Hormone receptor




Non-hispanic white


Non-hispanic black


California cancer registry




End results


Annual percentage change


Triple-negative breast cancer



The collection of cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract HHSN261201000140C awarded to the Cancer Prevention Institute of California, contract HHSN261201000035C awarded to the University of Southern California, and contract HHSN261201000034C awarded to the Public Health Institute; and the Centers for Disease Control and Prevention’s National Program of Cancer Registries, under agreement U58DP003862-01 awarded to the California Department of Public Health. The ideas and opinions expressed herein are those of the author(s) and endorsement by the State of California, Department of Public Health the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors is not intended nor should be inferred.

Author’s contribution

SL Gomez and SL Glaser conceived and oversaw the study. M McKinley conducted the data analysis. All authors contributed substantially to the analysis and interpretation of data, revisions of the manuscript, and approval of the final version.


This work was supported by the Stanford Cancer Institute (SL Gomez, SL Glaser) and the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract HHSN261201000140C awarded to the Cancer Prevention Institute of California (PI: SL Glaser & SL Gomez).

Compliance with ethical standards

Conflicts of interest



  1. 1.
    DeSantis CE, Fedewa SA, Goding Sauer A, Kramer JL, Smith RA, Jemal A (2016) Breast cancer statistics, 2015: convergence of incidence rates between black and white women. CA Cancer J Clin 66(1):31–42CrossRefPubMedGoogle Scholar
  2. 2.
    Torre LA, Sauer AM, Chen MS Jr, Kagawa-Singer M, Jemal A, Siegel RL (2016) Cancer statistics for Asian Americans, native Hawaiians, and Pacific Islanders, 2016: converging incidence in males and females. CA Cancer J Clin 66(3):182–202CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Tseng W, McDonnell D, Ho W, Lee C, Wong S (2010) Ethnic Health Assessment for Asian Americans, Native Hawaiians and Pacific Islanders in CaliforniaGoogle Scholar
  4. 4.
    Asian Pacific American Legal Center of Southern California (2005) The diverse face of Asians and pacific Islanders in California: Asian & Pacific Islander demographic profileGoogle Scholar
  5. 5.
    Frisbie WP, Cho Y, Hummer RA (2001) Immigration and the health of Asian and Pacific Islander adults in the United States. Am J Epidemiol 153(4):372–380CrossRefPubMedGoogle Scholar
  6. 6.
    Bateman WB, Abesamis NF, Ho-Asjoe H (2009) Praeger Handbook of Asian American HealthGoogle Scholar
  7. 7.
    Gomez SL, Noone AM, Lichtensztajn DY, Scoppa S, Gibson JT, Liu L et al (2013) Cancer incidence trends among Asian American populations in the United States, 1990–2008. J Natl Cancer Inst 105(15):1096–1110CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Reynolds P, Hurley S, Goldberg D, Quach T, Rull R, Von Behren J (2011) An excess of breast cancer among young California-born Asian women. Ethn Dis 21(2):196–201PubMedGoogle Scholar
  9. 9.
    Gomez SL, Quach T, Horn-Ross PL, Pham JT, Cockburn M, Chang ET et al (2010) Hidden breast cancer disparities in Asian women: disaggregating incidence rates by ethnicity and migrant status. Am J Public Health 100(Suppl 1):S125–S131CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Liu L, Zhang J, Wu AH, Pike MC, Deapen D (2012) Invasive breast cancer incidence trends by detailed race/ethnicity and age. Int J Cancer 130(2):395–404CrossRefPubMedGoogle Scholar
  11. 11.
    Sung H, Rosenberg PS, Chen WQ, Hartman M, Lim WY, Chia KS et al (2015) Female breast cancer incidence among Asian and Western populations: more similar than expected. J Natl Cancer Inst 107(7):djv107CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Anderson KN, Schwab RB, Martinez ME (2014) Reproductive risk factors and breast cancer subtypes: a review of the literature. Breast Cancer Res Treat 144(1):1–10CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Telli ML, Chang ET, Kurian AW, Keegan TH, McClure LA, Lichtensztajn D et al (2011) Asian ethnicity and breast cancer subtypes: a study from the California cancer registry. Breast Cancer Res Treat 127(2):471–478CrossRefPubMedGoogle Scholar
  14. 14.
    Hoeffel E, Rastogi S, Kim M, Shahid H The Asian population: 2010. 2010 Census Briefs 2012Google Scholar
  15. 15.
    Howlader N, Altekruse SF, Li CI, Chen VW, Clarke CA, Ries LA et al (2014) US incidence of breast cancer subtypes defined by joint hormone receptor and HER2 status. J Natl Cancer Inst 106(5):dju055CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Surveillance Research Program: National Cancer Institute. SEER*Stat software ( Scholar
  17. 17.
    Joinpoint Regression Program Version 3.5.1: Statistical Research and Applications Branch of the National Cancer Institute; July 2011Google Scholar
  18. 18.
    Kim HJ, Fay MP, Feuer EJ, Midthune DN (2000) Permutation tests for joinpoint regression with applications to cancer rates. Stat Med 19(3):335–351CrossRefPubMedGoogle Scholar
  19. 19.
    Wang Z, Bao J, Yu C, Wang J, Li C (2015) Secular trends of breast cancer in China, South Korea, Japan and the United States: application of the age-period-cohort analysis. Int J Environ Res Public Health 12(12):15409–15418CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Parise C, Caggiano V (2014) Disparities in the risk of the ER/PR/HER2 breast cancer subtypes among Asian Americans in California. Cancer Epidemiol 38(5):556–562CrossRefPubMedGoogle Scholar
  21. 21.
    Kohler BA, Sherman RL, Howlader N, Jemal A, Ryerson AB, Henry KA et al (2015) Annual report to the Nation on the status of cancer, 1975–2011, featuring incidence of breast cancer subtypes by race/ethnicity, poverty, and state. J Natl Cancer Inst 107(6):djv048CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Althuis MD, Fergenbaum JH, Garcia-Closas M, Brinton LA, Madigan MP, Sherman ME (2004) Etiology of hormone receptor-defined breast cancer: a systematic review of the literature. Cancer Epidemiol Biomark Prev 13(10):1558–1568Google Scholar
  23. 23.
    Yang XR, Chang-Claude J, Goode EL, Couch FJ, Nevanlinna H, Milne RL et al (2011) Associations of breast cancer risk factors with tumor subtypes: a pooled analysis from the breast cancer association consortium studies. J Natl Cancer Inst 103(3):250–263CrossRefPubMedGoogle Scholar
  24. 24.
    Akinyemiju TF, Pisu M, Waterbor JW, Altekruse SF (2015) Socioeconomic status and incidence of breast cancer by hormone receptor subtype. Springerplus 4:508CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Sisti JS, Collins LC, Beck AH, Tamimi RM, Rosner BA, Eliassen AH (2016) Reproductive risk factors in relation to molecular subtypes of breast cancer: results from the nurses’ health studies. Int J Cancer 138(10):2346–2356CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Chen L, Li CI, Tang MT, Porter P, Hill DA, Wiggins CL et al (2016) Reproductive factors and risk of luminal, HER2− overexpressing, and triple-negative breast cancer among multiethnic women. Cancer Epidemiol Biomark Prev 25(9):1297–1304CrossRefGoogle Scholar
  27. 27.
    Gomez SL, Glaser SL (2006) Misclassification of race/ethnicity in a population-based cancer registry (United States). Cancer Causes Control 17(6):771–781CrossRefPubMedGoogle Scholar
  28. 28.
    Clegg LX, Reichman ME, Hankey BF, Miller BA, Lin YD, Johnson NJ et al (2007) Quality of race, Hispanic ethnicity, and immigrant status in population-based cancer registry data: implications for health disparity studies. Cancer Causes Control 18(2):177–187CrossRefPubMedGoogle Scholar
  29. 29.
    Cancer Genome Atlas (2012) N. Comprehensive molecular portraits of human breast tumours. Nature 490(7418):61–70CrossRefGoogle Scholar
  30. 30.
    Parker JS, Mullins M, Cheang MC, Leung S, Voduc D, Vickery T et al (2009) Supervised risk predictor of breast cancer based on intrinsic subtypes. J Clin Oncol 27(8):1160–1167CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    California Health Interview Survey (CHIS). Health Policy Fact Sheet: Asians Below State Average for Timely Mammograms; UCLA Center for Health Policy Research. April 2014Google Scholar
  32. 32.
    Chawla N, Breen N, Liu B, Lee R, Kagawa-Singer M (2015) Asian American women in California: a pooled analysis of predictors for breast and cervical cancer screening. Am J Public Health 105(2):e98–e109CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Scarlett Lin Gomez
    • 1
    • 2
    Email author
  • Julie Von Behren
    • 1
  • Meg McKinley
    • 1
  • Christina A. Clarke
    • 1
    • 2
  • Salma Shariff-Marco
    • 1
    • 2
  • Iona Cheng
    • 1
    • 2
  • Peggy Reynolds
    • 1
    • 2
  • Sally L. Glaser
    • 1
    • 2
  1. 1.Cancer Prevention Institute of CaliforniaFremontUSA
  2. 2.Stanford Cancer InstituteStanfordUSA

Personalised recommendations