Abstract
Background
Asian American (AsAm) women have some of the lowest rates of up-to-date breast cancer screening, and lack of disaggregated racial/ethnic data can mask disparities. We evaluated presentation patterns among AsAms at two hospitals with distinct communities: New York Presbyterian-Queens (NYPQ), in Flushing, Queens and Weill Cornell Medical Center (WCM), on the Upper East Side (UES) neighborhood of Manhattan.
Patients and Methods
Patients with newly diagnosed breast cancer between January 2019 and December 2022 were identified using a prospective database and clinical data collected. Patients were categorized as self-reported Asian versus Non-Asian. The Asian group was disaggregated as Chinese-Asian versus Other-Asian. Physician workforce data were obtained from public records.
Results
A total of 3546 patients (1162 NYPQ, 2384 WCM) were included. More NYPQ patients identified as Asian compared with WCM (49 vs. 14%, p < 0.001). Asian patients were mostly East Asian Chinese (NYPQ 61%, WCM 53%). More Chinese patients at NYPQ reported Chinese as their preferred language (81 vs. 33%, p < 0.001). Greatest differences of screen-detected disease frequency were seen between NYPQ and WCM Chinese patients (75 vs. 59%, p < 0.001). Eighty percent of NYPQ Chinese patients presented with stage 0/I disease versus 69% at WCM (p = 0.007), a difference not observed between Other-Asian patients (75% NYPQ, 68% WCM, p = 0.095). 3% of UES physicians versus 16% in Flushing reported speaking Chinese.
Conclusions
Chinese patients residing in a neighborhood with more Chinese-speaking physicians more frequently presented with screen-detected, early-stage breast cancer. Stage distribution differences were not apparent among the aggregated pool of Other-Asian patients, suggesting cancer disparities may be masked when ethnic groups are studied in aggregate.
Similar content being viewed by others
References
Budiman A, Ruiz NG. Asian Americans are the fastest-growing racial or ethnic group in the U.S. Pew Research Center. Accessed October 6, 2022. https://www.pewresearch.org/fact-tank/2021/04/09/asian-americans-are-the-fastest-growing-racial-or-ethnic-group-in-the-u-s/
Budiman A, Ruiz NG. Key facts about Asian Americans, a diverse and growing population. Pew Research Center. Accessed October 6, 2022. https://www.pewresearch.org/fact-tank/2021/04/29/key-facts-about-asian-americans/
Islam NS, Khan S, Kwon S, Jang D, Ro M, Trinh-Shevrin C. Methodological issues in the collection, analysis, and reporting of granular data in Asian American populations: historical challenges and potential solutions. J Health Care Poor Underserved. 2010;21(4):1354–81. https://doi.org/10.1353/hpu.2010.0939.
Sohn YJ, Chang CY, Miles RC. Current gaps in breast cancer screening among Asian and Asian American women in the United States. J Am Coll Radiol. 2021;18(10):1376–83. https://doi.org/10.1016/j.jacr.2021.06.002.
Fane L, Biswas T, Jindal C, Choi YM, Efird JT. Breast cancer disparities in Asian women: the need for disaggregated research. Int J Environ Res Public Health. 2022;19(16):9790. https://doi.org/10.3390/ijerph19169790.
Eden CM, Johnson J, Syrnioti G, Malik M, Ju T. The landmark series: the breast cancer burden of the asian american population and the need for disaggregated data. Ann Surg Oncol. 2023;30(4):2121–7. https://doi.org/10.1245/s10434-023-13103-4.
Torre LA, Sauer AMG, Chen MS Jr, Kagawa-Singer M, Jemal A, Siegel RL. Cancer statistics for Asian Americans, native Hawaiians, and Pacific Islanders, 2016: converging incidence in males and females. CA Cancer J Clin. 2016;66(3):182–202. https://doi.org/10.3322/caac.21335.
Giaquinto AN, Sung H, Miller KD, et al. Breast Cancer Statistics. CA Cancer J Clin. 2022;72(6):524–41. https://doi.org/10.3322/caac.21754.
American Cancer Society. Breast Cancer Facts & Figures 2019-2020. American Cancer Society, Inc. Published online 2019:44.
Gomez SL, Von Behren J, McKinley M, et al. Breast cancer in Asian Americans in California, 1988–2013: increasing incidence trends and recent data on breast cancer subtypes. Breast Cancer Res Treat. 2017;164(1):139–47. https://doi.org/10.1007/s10549-017-4229-1.
Tuan AW, Davis Lynn BC, Chernyavskiy P, et al. Breast cancer incidence trends by estrogen receptor status among Asian American ethnic groups, 1990–2014. JNCI Cancer Spectr. 2020;4(2):pkaa005. https://doi.org/10.1093/jncics/pkaa005.
El-Bastawissi A. Variation in mammographic breast density by race. Ann Epidemiol. 2001;11(4):257–63. https://doi.org/10.1016/S1047-2797(00)00225-8.
Nazari SS, Mukherjee P. An overview of mammographic density and its association with breast cancer. Breast Cancer Tokyo Jpn. 2018;25(3):259–67. https://doi.org/10.1007/s12282-018-0857-5.
del Carmen MG, Halpern EF, Kopans DB, et al. Mammographic breast density and race. Am J Roentgenol. 2007;188(4):1147–50. https://doi.org/10.2214/AJR.06.0619.
Chawla N, Breen N, Liu B, Lee R, Kagawa-Singer M. Asian American women in California: a pooled analysis of predictors for breast and cervical cancer screening. Am J Public Health. 2015;105(2):e98–109. https://doi.org/10.2105/AJPH.2014.302250.
Oh KM, Zhou QP, Kreps GL, Ryu SK. Breast cancer screening practices among Asian Americans and Pacific Islanders. Am J Health Behav. 2012;36(5):711–22. https://doi.org/10.5993/AJHB.36.5.13.
Paranjpe A, Zheng C, Chagpar AB. Disparities in breast cancer screening between Caucasian and Asian American women. J Surg Res. 2022;277:110–5. https://doi.org/10.1016/j.jss.2022.03.032.
Kandula NR, Wen M, Jacobs EA, Lauderdale DS. Low rates of colorectal, cervical, and breast cancer screening in Asian Americans compared with non-Hispanic whites. Cancer. 2006;107(1):184–92. https://doi.org/10.1002/cncr.21968.
Thompson CA, Gomez SL, Chan A, et al. Patient and provider characteristics associated with colorectal, breast, and cervical cancer screening among Asian Americans. Cancer Epidemiol Biomarkers Prev. 2014;23(11):2208–17. https://doi.org/10.1158/1055-9965.EPI-14-0487.
Jun J. Cancer/health communication and breast/cervical cancer screening among Asian Americans and five Asian ethnic groups. Ethn Health. 2020;25(7):960–81. https://doi.org/10.1080/13557858.2018.1478952.
Kagawa-Singer M, Pourat N, Breen N, et al. Breast and cervical cancer screening rates of subgroups of Asian American women in California. Med Care Res Rev. 2007;64(6):706–30. https://doi.org/10.1177/1077558707304638.
Amin MB, Greene FL, Edge SB, et al. The eighth edition cancer staging manual: continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J Clin. 2017;67(2):93–9. https://doi.org/10.3322/caac.21388.
Sickles EA, D’Orsi CJ, Bassett LW, Appleton CM, Berg WA, Burnside ES. ACR BI-RADS® Atlas, Breast imaging reporting and data system. Published online 39-48 2013.
Individual Provider Network Data: 2021 Quarter 1 | State of New York. Accessed June 19, 2023. https://health.data.ny.gov/Health/Individual-Provider-Network-Data-2021-Quarter-1/3pu3-fqfh
Wen KY, Fang CY, Ma GX. Breast cancer experience and survivorship among Asian Americans: a systematic review. J Cancer Surviv. 2014;8(1):94–107. https://doi.org/10.1007/s11764-013-0320-8.
Islami F, Guerra CE, Minihan A, et al. American cancer society’s report on the status of cancer disparities in the United States, 2021. CA Cancer J Clin. 2022;72(2):112–43. https://doi.org/10.3322/caac.21703.
Elewonibi BR, Thierry AD, Miranda PY. Examining mammography use by breast cancer risk, race, nativity, and socioeconomic status. J Immigr Minor Health. 2018;20(1):59–65. https://doi.org/10.1007/s10903-016-0502-3.
Shon EJ, Townsend AL. Predictors of never having a mammogram among Chinese, Vietnamese, and Korean immigrant women in the US. PLoS ONE. 2019;14(11):e0224505. https://doi.org/10.1371/journal.pone.0224505.
Cano-Ibáñez N, Zolfaghari Y, Amezcua-Prieto C, Khan KS. Physician–patient language discordance and poor health outcomes: a systematic scoping review. Front Public Health. 2021;9:629041. https://doi.org/10.3389/fpubh.2021.629041.
Budiman A. Chinese in the U.S. Fact Sheet. Pew Research Center’s Social & Demographic Trends Project. Accessed January 17, 2023. https://www.pewresearch.org/social-trends/fact-sheet/asian-americans-chinese-in-the-u-s/
Flushing/Whitestone Neighborhood Profile. NYU Furman Center’s CoreData.nyc. Accessed January 3, 2023. https://furmancenter.org/neighborhoods/view/flushing-whitestone
Upper East Side Neighborhood Profile. NYU Furman Center’s CoreData.nyc. Accessed January 3, 2023. https://furmancenter.org/neighborhoods/view/upper-east-side
Park B, Cho HM, Lee EH, et al. Does breast density measured through population-based screening independently increase breast cancer risk in Asian females? Clin Epidemiol. 2017;10:61–70. https://doi.org/10.2147/CLEP.S144918.
Zhao G, Okoro CA, Li J, Town M. Health insurance status and clinical cancer screenings among U.S. adults. Am J Prev Med. 2018;54(1):e11–9. https://doi.org/10.1016/j.amepre.2017.08.024.
Kim E, Moy L, Gao Y, Hartwell CA, Babb JS, Heller SL. City patterns of screening mammography uptake and disparity across the United States. Radiology. 2019;293(1):151–7. https://doi.org/10.1148/radiol.2019190647.
Ko NY, Hong S, Winn RA, Calip GS. Association of insurance status and racial disparities with the detection of early-stage breast cancer. JAMA Oncol. 2020;6(3):385. https://doi.org/10.1001/jamaoncol.2019.5672.
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Eden, C.M., Syrnioti, G., Johnson, J. et al. Breast Cancer Incidence Among Asian American Women in New York City: Disparities in Screening and Presentation. Ann Surg Oncol 31, 1455–1467 (2024). https://doi.org/10.1245/s10434-023-14640-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-023-14640-8