Summary
The five major ethnic groups in Hawaii's population of 1.1 million are the Japanese, comprising 23%; Caucasians, 23%; ethnic Hawaiians, 19.9%; Filipinos, 11.3%; and Chinese, 4.8%. Only 14% of the population is foreign born. Breast cancer incidences are 29.2 per 100,000 among Filipinos, 51.3 for Japanese, 64.1 for Chinese, 104.3 for Hawaiian, and 105.6 for Caucasian women. The Caucasian incidence is similar to mainland US rates, but the incidence among Hawaii's Japanese is more than twice the rate in Japan. Japanese in Hawaii have less postmenopausal breast cancer than Caucasians, fewer axillary lymph node metastases, and a greater proportion of non-invasive tumors. Late stage at diagnosis is common among Filipino and ethnic Hawaiian women, and their risk of death is 1.5–1.7 times that of Caucasian, Chinese, and Japanese women with the disease, even after adjustment for age, extent of disease, and socio-economic status. In the BCDDP screening study, only 20% of breast cancers detected in ethnic Hawaiians were not yet palpable and were found by mammography alone. Comparative studies of diet and estrogen levels in the ethnic groups of Hawaii and the parental populations in Japan and the West do not account for the degree of variation observed in breast cancer incidence and tumor pathology. Future research directions are suggested with a view to accounting for these differences.
Similar content being viewed by others
References
Kolonel LN: Cancer incidence and mortality in Hawaii 1973–1977. NCI Monograph No. 57, Surveillance, Epidemiology, and End Results Program (SEER), 1981, pp 791–945
Muir C, Waterhouse J, Mack T, Powell J, Whelan S: Cancer Incidence in Five Continents. Volume V. International Agency for Research on Cancer, Lyon, 1987
Haenszel L, Kurihara M: Studies of Japanese migrants. I. Mortality from cancer and other diseases among Japanese in the United States. JNCI 40: 43, 1968
LeMarchand L, Kolonel LN, Nomura AMY: Relationship of ethnicity and other prognostic factors to breast cancer survival patterns in Hawaii. JNCI 73: 1259–1265, 1984
Stemmermann GN, Catts A, Fukunaga FH, Horie A, Nomura AMY: Breast cancer in women of Japanese and Caucasian ancestry in Hawaii. Cancer 56: 206–209, 1985
Nordyke ED: The Peopling of Hawaii. University of Hawaii Press, Honolulu, 1989, pp 130–131
Hinds MW, Kolonel LN, Nomura AMY, Lee J: Stage-specific breast cancer incidence rates by age among Japanese and Caucasian women in Hawaii, 1960–1979. Brit J Cancer 45: 118–123, 1982
LeMarchand L, Kolonel LN, Nomura AMY: Breast cancer survival among Hawaii Japanese and Caucasian women. Am J Epid 122: 571–578, 1985
LeMarchand L, Yoshizawa CN, Kolonel LN, Nomura AMY: Time trends in characteristics at diagnosis and subsequent survival for Caucasian, Japanese and Hawaiian women with breast cancer in Hawaii. J Chron Dis 40: 1099–1110, 1987
Goodman MJ, Gilbert FI, Grove JS, Catts A, Low G: Breast cancer screening in Hawaii 1974–1980: Results of a six year program. Hawaii Medical Journal 41: 150–153, 1982
Goodman MJ: Barriers to cancer control in rural Oahu. In Advances in Cancer Control: Innovations and Research: Proceedings of the Sixth Annual Meeting on Advances in Cancer Control — A combined meeting of the Association of Community Cancer Centers/Association of American Cancer Institutes, held in Washington, D.C. 3/15–16, 1988, Alan Liss, Inc., N.Y., 1989, pp 331–338
Ito KL: Illness as retribution. Culture Medicine and Psychiatry 6: 385–403, 1982
E Ola Mau: The Native Hawaiian Health Needs Study Medical Task Force Report. Alu Like, Honolulu, 1985, pp I-29–I-30
Goodman MJ, Gilbert FI, Low G: Screening for breast cancer in Hawaii: further implications. Hawaii Medical Journal 43: 356–360, 1984
Nomura AMY, Hirohata T, Kolonel L, Hankin J: Diet and exogenous estrogens in three populations at different levels of risk for breast cancer. NCI Monog 47: 165–167, 1977
Nomura AMY, Lee J, Kolonel LN, Hirohata T: Breast cancer in two populations with different levels of risk for the disease. Am J Epid 119: 496–502, 1984
Hankin JH, Nomura AMY, Lee J, Hirohata T, Kolonel LN: Reproducibility of a diet history questionnaire in a case-control study of breast cancer. Am J Clin Nutr 37: 981–985, 1983
Nomura AMY, Hirohata T, Kolonel LN, Hankin JH, Lee J, Stemmermann G: Breast cancer in Caucasian and Japanese women in Hawaii. NCI Monog 69: 191–196, 1985
Hirohata T, Nomura AMY, Hankin JH, Kolonel LN, Lee J: An epidemiologic study on the association between diet and breast cancer. JNCI 78: 595–600, 1987
Hirohata T, Shigematsu T, Nomura AMY, Nomura Y, Horie A, Hirohata I: Occurrence of breast cancer in relation to diet and reproductive history: a case-control study in Fukuoka, Japan. NCI Monog 69: 187–190, 1985
LeMarchand L, Kolonel LN, Earle ME, Mi MP: Body size at different periods of life and breast cancer risk. Am J Epid 128: 137–152, 1988
Goodman MJ, Bulbrook RD, Moore JW: The distribution of estradiol in the sera of normal Caucasian, Chinese, Filipina, Hawaiian and Japanese women living in Hawaii. Eur J Ca 24: 1855–1860, 1988
Moore JW, Clark GMG, Hoare SAet al.: The binding of oestradiol to blood proteins and aetiology of breast cancer. Int J Cancer 38: 625–630, 1986
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Goodman, M.J. Breast cancer in multi-ethnic populations: The Hawaii perspective. Breast Cancer Res Tr 18 (Suppl 1), S5–S9 (1991). https://doi.org/10.1007/BF02633519
Issue Date:
DOI: https://doi.org/10.1007/BF02633519