Cancer Risk, Risk Reduction, and Screening and Treatment Access among U.S. South Asians

  • Francesca GanyEmail author
  • Anuradha Hashemi
  • Jennifer Leng
  • Sayyeda Ayesha Ahmed
Part of the Cross-Cultural Research in Health, Illness and Well-Being book series (CCRHIWB)


This chapter is a brief survey of cancer risk, risk reduction, and screening and treatment access among South Asians in the U.S. A combination of biological factors, including genetics, infections and environmental exposures, microbiota, and lifestyle factors shape vulnerability to cancer among South Asians in the U.S., including South Asian immigrant populations. This chapter highlights these as areas that require further, in-depth examination and advises epidemiologically, culturally and linguistically responsive service delivery to improve cancer outcomes among the large and growing U.S. South Asian immigrant communities. This chapter reflects the work of a dedicated group of researchers, service delivery providers, and community members who came together as part of the yearlong effort, South Asian Health: From Research to Practice and Policy, funded by the National Institute on Minority Health and Health Disparities (NIMHD R13 MD007147-01A1).


Cancer Cancer screening Cancer treatment South Asian American 


  1. Alhomidi, M. A., Vedicherla, B., Movva, S., Rao, P. K., Ahuja, Y. R., & Hasan, Q. (2013). Mitochondrial D310 instability in Asian Indian breast cancer patients. Tumour Biology, 34(4), 2427–2432.CrossRefGoogle Scholar
  2. Arbyn, M., Castellsague, X., de Sanjose, S., Bruni, L., Saraiya, M., Bray, F., Ferlay, J. (2011). Worldwide burden of cervical cancer in 2008. Annals of oncology : official journal of the European Society for Medical Oncology, 22(12), 2675–2686. Epub 2011/04/08. doi: PubMed PMID: 21471563.CrossRefGoogle Scholar
  3. Auluck, A., Hislop, G., Poh, C., Zhang, L., Rosin, M. P. (2009). Areca nut and betel quid chewing among south Asian immigrants to western countries and its implications for oral cancer screening. Rural and Remote Health,9(2), 1118. Epub 2009/05/19. PubMed PMID: 19445556; PubMed Central PMCID: PMCPmc2726113.Google Scholar
  4. Bag, A., Jyala, N. S., Bag, N. (2012). Indian studies on genetic polymorphisms and cancer risk. Indian Journal of Cancer, 49(1), 144–162. Epub 2012/07/31. doi: PubMed PMID: 22842182.CrossRefGoogle Scholar
  5. Bhattacharya, G., Schoppelrey, S. L. (2004). Preimmigration beliefs of life success, postimmigration experiences, and acculturative stress: South Asian immigrants in the United States. Journal of Immigrant Health, 6(2), 83–92. Epub 2004/03/12. doi: PubMed PMID: 15014225.CrossRefGoogle Scholar
  6. Borugian, M. J., Sheps, S. B., Kim-sing, C., et al. (2004). Insulin, macronutrient intake, and physical activity: Are potential indicators of insulin resistance associated with mortality from breast cancer? Cancer Epidemiol Biomarkers Prevention, 13(7), 1163–1172.Google Scholar
  7. Boxwala, F. I., Bridgemohan, A., Griffith, D. M., Soliman, A. S. (2010). Factors associated with breast cancer screening in Asian Indian women in metro-Detroit. Journal of immigrant and minority health, 12(4), 534–543. Epub 2009/07/25. doi: PubMed PMID: 19629691; PubMed Central PMCID: PMCPmc4276127.CrossRefGoogle Scholar
  8. Brown, E. R., Ojeda, V. D., Wyn, R., & Levan, R. (2000). Racial and ethnic disparities in access to health insurance and health care. UCLA Center for Health Policy Research.Google Scholar
  9. Chen, G., Wan, X., Yang, G., & Zou, X. (2015). Traffic-related air pollution and lung cancer: A meta-analysis. Thorac Cancer, 6(3), 307–318.CrossRefGoogle Scholar
  10. Chida, Y., Hamer, M., Wardle, J., Steptoe, A. (2008). Do stress-related psychosocial factors contribute to cancer incidence and survival? Nature clinical practice Oncology, 5(8), 466–475. Epub 2008/05/22. doi: PubMed PMID: 18493231.CrossRefGoogle Scholar
  11. Coelho, K. R. (2012). Challenges of the oral cancer burden in India. Journal of cancer epidemiology, 2012, 701932. Epub 2012/10/25. doi: PubMed PMID: 23093961; PubMed Central PMCID: PMCPmc3471448.CrossRefGoogle Scholar
  12. Cohen, C., Caballero, J., Martin, M., Weerasinghe, I., Ninde, M., Block, J.. (2013).Eradication of hepatitis B: A nationwide community coalition approach to improving vaccination, screening, and linkage to care. Journal of community health, 38(5),799–804. Epub 2013/05/30. doi: PubMed PMID: 23715963.CrossRefGoogle Scholar
  13. Croucher, R., Islam, S., Jarvis, M. J., Garrett, M., Rahman, R., Shajahan, S., Howells, G. (2003). Oral tobacco cessation with UK resident Bangladeshi women: A community pilot investigation. Health Education Research, 18(2),216–223. Epub 2003/05/06. PubMed PMID: 12729180.CrossRefGoogle Scholar
  14. Dave, S. S., Craft, L. L., Mehta, P., Naval, S., Kumar, S., Kandula, N. R. (2015). Life stage influences on U.S. south Asian women's physical activity. American journal of health promotion : AJHP, 29(3),e100–e108. Epub 2014/04/11. doi: PubMed PMID: 24717067.CrossRefGoogle Scholar
  15. Dos santos silva, I., Mangtani, P., Mccormack, V., Bhakta, D., Sevak, L., & Mcmichael, A. J. (2002). Lifelong vegetarianism and risk of breast cancer: A population-based case-control study among south Asian migrant women living in England. International Journal of Cancer., 99(2), 238–244.CrossRefGoogle Scholar
  16. Farvid, M. S., Chen, W. Y., Michels, K. B., Cho, E., Willett, W. C., & Eliassen, A. H. (2016). Fruit and vegetable consumption in adolescence and early adulthood and risk of breast cancer: Population based cohort study. BMJ, 353(i2343).Google Scholar
  17. Gathani, T., Barnes, I., Ali, R., et al. (2017). Lifelong vegetarianism and breast cancer risk: A large multicentre case control study in India. BMC Women's Health, 17(1), 6.CrossRefGoogle Scholar
  18. Gomez, S. L., Tan, S., Keegan, T. H., Clarke, C. A. (2007). Disparities in mammographic screening for Asian women in California: A cross-sectional analysis to identify meaningful groups for targeted intervention. BMC Cancer, 7(201). Epub 2007/10/27. doi: PubMed PMID: 17961259; PubMed Central PMCID: PMCPmc2198916.
  19. Graham, D. Y., Lu, H., Yamaoka, Y. (2009). African, Asian or Indian enigma, the east Asian helicobacter pylori: Facts or medical myths. Journal of digestive diseases, 10(2), 77–84. Epub 2009/05/12. doi: PubMed PMID: 19426388; PubMed Central PMCID: PMCPmc2846403.CrossRefGoogle Scholar
  20. Gupta, A., Kumar, A., Stewart, D. E. (2002a). Cervical cancer screening among south Asian women in Canada: The role of education and acculturation. Health Care for Women International, 23(2), 123–134. Epub 2002/03/01. doi: PubMed PMID: 11868960.CrossRefGoogle Scholar
  21. Gupta, M., Shafiq, N., Kumari, S., Pandhi, P. (2002b). Patterns and perceptions of complementary and alternative medicine (CAM) among leukaemia patients visiting haematology clinic of a north Indian tertiary care hospital. Pharmacoepidemiology and drug safety, 11(8), 671–676. Epub 2003/01/07. doi: PubMed PMID: 12512243.CrossRefGoogle Scholar
  22. Hahne, S., Ramsay, M., Soldan, K., Balogun, K., Mortimer, P. (2003). Hepatitis B incidence among south Asian children in England and Wales: Implications for immunisation policy. Archives of disease in childhood, 88(12), 1082–1083. Epub 2003/12/13. PubMed PMID: 14670774; PubMed Central PMCID: PMCPmc1719373.CrossRefGoogle Scholar
  23. Halder, D., Bhowmick, S., Biswas, A., Mandal, U., Nriagu, J., Mazumdar, D. N., Chatterjee, D., Bhattacharya, P. (2012). Consumption of brown rice: A potential pathway for arsenic exposure in rural Bengal. Environmental science & technology, 46(7), 4142–4148. Epub 2012/02/23. doi: PubMed PMID: 22352724.CrossRefGoogle Scholar
  24. Hossain, A., Sehbai, A., Abraham, R., & Abraham, J. (2008). Cancer health disparities among Indian and Pakistani immigrants in the United States: A surveillance, epidemiology, and end results-based study from 1988 to 2003. Cancer, 113(6), 1423–1430. Epub 2008/08/13. Scholar
  25. Inman, A. G., Constantine, M. G., & Ladany, N. (1999). Cultural value conflict: An examination of Asian Indian women’s bicultural experience. Asian and Pacific islander Americans: Issues and concerns for counseling and psychotherapy (pp. 31–41).Google Scholar
  26. Islam, N., Kwon, S. C., Senie, R., Kathuria, N. (2006). Breast and cervical cancer screening among south Asian women in new York City. Journal of immigrant and minority health, 8(3), 211–221. Epub 2006/06/23. doi: PubMed PMID: 16791531.CrossRefGoogle Scholar
  27. Kaduvettoor-Davidson, A., & Inman, A. G. (2013). South Asian Americans: Perceived discrimination, stress, and Well-being. Asian American Journal of Psychology., 4(3), 155.CrossRefGoogle Scholar
  28. Kakarala, M., Rozek, L., Cote, M., Liyanage, S., Brenner, D. E. (2010). Breast cancer histology and receptor status characterization in Asian Indian and Pakistani women in the U.S.–a SEER analysis. BMC Cancer, 10, 191. Epub 2010/05/13. doi: PubMed PMID: 20459777; PubMed Central PMCID: PMCPmc2873947.
  29. Kandula, N. R., Lauderdale, D. S. (2005). Leisure time, non-leisure time, and occupational physical activity in Asian Americans. Annals of epidemiology, 15(4), 257–265. Epub 2005/03/23. doi: PubMed PMID: 15780772.CrossRefGoogle Scholar
  30. Koenig, C. J., Dutta, M. J., Kandula, N., Palaniappan, L. (2012). All of those things we don’t eat: A culture-centered approach to dietary health meanings for Asian Indians living in the United States. Health Communication, 27(8), 818–828. Epub 2012/03/01. doi: PubMed PMID: 22364189; PubMed Central PMCID: PMCPmc4324757.CrossRefGoogle Scholar
  31. Kumar, S., Biswas, M., Jose, T. (2015). HPV vaccine: Current status and future directions. Medical journal, Armed Forces India, 71(2), 171–177. Epub 2015/04/11. doi:; PubMed PMID: 25859081 PubMed Central PMCID: PMCPmc4388981.CrossRefGoogle Scholar
  32. Longman, J. M., Pritchard, C., Mcneill, A., Csikar, J., & Croucher, R. E. (2010). Accessibility of chewing tobacco products in England. Journal of Public Health (Oxf), 32(3), 372–378.CrossRefGoogle Scholar
  33. Maringe, C., Mangtani, P., Rachet, B., Leon, D. A., Coleman, M. P. (2013). dos Santos Silva I. Cancer incidence in south Asian migrants to England, 1986–2004: Unraveling ethnic from socioeconomic differentials. International journal of cancer, 132(8), 1886–1894. Epub 2012/09/11. doi: PubMed PMID: 22961386.CrossRefGoogle Scholar
  34. McCaffery, K., Forrest, S., Waller, J., Desai, M., Szarewski, A., Wardle, J. (2003). Attitudes towards HPV testing: A qualitative study of beliefs among Indian, Pakistani, African-Caribbean and white British women in the UK. British journal of cancer, 88(1), 42–46. Epub 2003/01/31. doi: PubMed PMID: 12556957; PubMed Central PMCID: PMCPmc2376794.CrossRefGoogle Scholar
  35. Menon, U., Szalacha, L., Prabhughate, A., Kue, J. (2014). Correlates of colorectal cancer screening among south Asian immigrants in the United States. Cancer Nursing, 37(1), E19–E27. Epub 2013/05/02. doi: PubMed PMID: 23632468.CrossRefGoogle Scholar
  36. Mishra, G. A., Shastri, S. S., Uplap, P. A., Majmudar, P. V., Rane, P. S., Gupta, S. D.(2009). Establishing a model workplace tobacco cessation program in India. Indian journal of occupational and environmental medicine,13(2), 97–103. Epub 2010/04/14. doi: PubMed PMID: 20386628; PubMed Central PMCID: PMCPmc2847335.CrossRefGoogle Scholar
  37. Mittal, R. D., Srivastava, D. S., A, M., B. M. (2005). Genetic polymorphism of drug metabolizing enzymes (CYP2E1, GSTP1) and susceptibility to bladder cancer in North India. Asian Pacific journal of cancer prevention : APJCP 6(1), 6–9. Epub 2005/03/23. PubMed PMID: 15780023.Google Scholar
  38. Mukherjea, A., Modayil, M. V. (2013). Culturally specific tobacco use and south Asians in the United States: A review of the literature and promising strategies for intervention. Health promotion practice, 14(5 Suppl), 48s–60s. Epub 2013/05/22. doi: PubMed PMID: 23690257.CrossRefGoogle Scholar
  39. Mukherjea, A., Morgan, P. A., Snowden, L. R., Ling, P. M., Ivey, S. L. (2012). Social and cultural influences on tobacco-related health disparities among south Asians in the USA. Tobacco control, 21(4), 422–428. Epub 2011/06/29. doi: PubMed PMID: 21708814; PubMed Central PMCID: PMCPmc3292671.CrossRefGoogle Scholar
  40. Munoz, N., Bosch, F. X., Castellsague, X., Diaz, M., de Sanjose, S., Hammouda, D., Shah, K. V., Meijer, C. J. (2004). Against which human papillomavirus types shall we vaccinate and screen? The international perspective. International journal of cancer, 111(2), 278–285. Epub 2004/06/16. doi: PubMed PMID: 15197783.CrossRefGoogle Scholar
  41. Murukutla, N., Turk, T., Prasad, C. V., Saradhi, R., Kaur, J., Gupta, S., Mullin, S., Ram, F., Gupta, P. C., Wakefield, M. (2012). Results of a national mass media campaign in India to warn against the dangers of smokeless tobacco consumption. Tobacco control 21(1), 12–17. Epub 2011/04/22. doi: PubMed PMID: 21508418.CrossRefGoogle Scholar
  42. National Cancer Institute. (2009). Physical activity and cancer Available from:
  43. Nguyen, L. H., Nguyen, M. H. (2013). Systematic review: Asian patients with chronic hepatitis C infection. Alimentary Pharmacology & Therapeutics,37(10), 921–936. Epub 2013/04/06. doi: PubMed PMID: 23557103.CrossRefGoogle Scholar
  44. Ooi, S. L., Martinez, M. E., Li, C. I. (2011). Disparities in breast cancer characteristics and outcomes by race/ethnicity. Breast cancer research and treatment, 127(3), 729–738. Epub 2010/11/16. doi: PubMed PMID: 21076864; PubMed Central PMCID:PMCPmc3081535.CrossRefGoogle Scholar
  45. Owens, A., Randhawa, G. (2004). It’s different from my culture; they’re very different’: Providing community-based, ‘culturally competent’ palliative care for south Asian people in the UK. Health & Social Care in the Community, 12(5), 414–421. Epub 2004/09/18. doi: PubMed PMID: 15373820.CrossRefGoogle Scholar
  46. Pope, C. A., 3rd, Thun, M. J., Namboodiri, M. M., Dockery, D. W., Evans, J. S., Speizer, F. E., Heath, C. W., Jr. (1995). Particulate air pollution as a predictor of mortality in a prospective study of U.S. adults. American journal of respiratory and critical care medicine, 151(3 Pt 1), 669–674. Epub 1995/03/01. doi: PubMed PMID: 7881654.CrossRefGoogle Scholar
  47. Pope, C. A., 3rd, Burnett, R. T., Thun, M. J., Calle, E. E., Krewski, D., Ito, K., Thurston, G. D. (2002). Lung cancer, cardiopulmonary mortality, and long-term exposure to fine particulate air pollution. JAMA, 287(9), 1132–1141. Epub 2002/03/07. PubMed PMID: 11879110; PubMed Central PMCID: PMCPmc4037163.CrossRefGoogle Scholar
  48. Promotion. (n.d.). OoDPaH. Healthy People 2020 [cited 2016 December 9]. Available from:
  49. Qiu, Y., Ni, H. (2003). Utilization of dental care services by Asians and native Hawaiian or other Pacific islanders: United States, 1997–2000. Advance Data, 2003(336), 1–11. Epub 2003/06/21. PubMed PMID: 12815937.Google Scholar
  50. Ramanathan, K. (1979). Oral precancerous conditions in peninsular Malaysia. The Medical journal of Malaysia, 33(3), 216–221. Epub 1979/03/01. PubMed PMID: 522725.Google Scholar
  51. Ruiz de Luzuriaga, A. M., Ahsan, H., Shea, C. R. (2011). Arsenical keratoses in Bangladesh--update and prevention strategies. Dermatologic Clinics,29(1), 45–51. Epub 2010/11/26. doi: PubMed PMID: 21095527.CrossRefGoogle Scholar
  52. Schaller Consulting. (2004). The changing face of taxi and limousine drivers: U.S., large states and metro areas and new York City. Brooklyn, NY.Google Scholar
  53. Shulman, J. D., Beach, M. M., Rivera-Hidalgo, F. (2004). The prevalence of oral mucosal lesions in U.S. adults: Data from the third National Health and nutrition examination survey, 1988-1994. Journal of the American Dental Association(1939),135(9), 1279–1286. Epub 2004/10/21. PubMed PMID: 15493392.CrossRefGoogle Scholar
  54. Singh, M., Shah, P. P., Singh, A. P., Ruwali, M., Mathur, N., Pant, M. C., Parmar, D. (2008). Association of genetic polymorphisms in glutathione S-transferases and susceptibility to head and neck cancer. Mutation research, 638(1–2), 184–194. Epub 2007/11/24. doi: PubMed PMID: 18035380.CrossRefGoogle Scholar
  55. Smith, A. H., Lingas, E. O., Rahman, M. (2000). Contamination of drinking-water by arsenic in Bangladesh: A public health emergency. Bulletin of the World Health Organization 78(9), 1093–1103. Epub 2000/10/06. PubMed PMID: 11019458; PubMed Central PMCID: PMCPmc2560840.Google Scholar
  56. Sommer, F., Backhed, F. (2013). The gut microbiota–masters of host development and physiology. Nature reviews Microbiology,11(4),227–238. Epub 2013/02/26. doi: PubMed PMID: 23435359.CrossRefGoogle Scholar
  57. Soya, S. S., Vinod, T., Reddy, K. S., Gopalakrishnan, S., Adithan, C. (2007). Genetic polymorphisms of glutathione-S-transferase genes (GSTM1, GSTT1 and GSTP1) and upper aerodigestive tract cancer risk among smokers, tobacco chewers and alcoholics in an Indian population. European journal of cancer (Oxford, England : 1990),43(18), 2698–2706. Epub 2007/08/21. doi: PubMed PMID: 17707637.CrossRefGoogle Scholar
  58. Szarewski, A., Cadman, L., Ashdown-Barr, L., Waller, J. (2009). Exploring the acceptability of two self-sampling devices for human papillomavirus testing in the cervical screening context: A qualitative study of Muslim women in London. Journal of medical screening, 16(4), 193–198. Epub 2010/01/08. doi: PubMed PMID: 20054094.CrossRefGoogle Scholar
  59. Tan, Y. C., Zeigler-Johnson, C., Mittal, R. D., Mandhani, A., Mital, B., Rebbeck, T. R., Rennert, H. (2008). Common 8q24 sequence variations are associated with Asian Indian advanced prostate cancer risk. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for cancer research, cosponsored by the American society of preventive oncology. 17(9), 2431–2435. Epub 2008/09/05. doi: PubMed PMID: 18768513; PubMed Central PMCID: PMCPmc3074274.CrossRefGoogle Scholar
  60. Tong, M. J., Pan, C. Q., Hann, H. W., Kowdley, K. V., Han, S. H., Min, A. D., Leduc, T. S. (2011). The management of chronic hepatitis B in Asian Americans. Digestive diseases and sciences, 56(11), 3143–3162. Epub 2011/09/22. doi: PubMed PMID: 21935699.CrossRefGoogle Scholar
  61. Torre, L. A., Sauer, A. M., Chen, M. S., Kagawa-singer, M., Jemal, A., & Siegel, R. L. (2016). Cancer statistics for Asian Americans, native Hawaiians, and Pacific islanders, 2016: Converging incidence in males and females. CA: A Cancer Journal for Clinicians, 66(3), 182–202.Google Scholar
  62. Uddin, G., Shoeb, D., Solaiman, S., Marley, R., Gore, C., Ramsay, M., Harris, R., Ushiro-Lumb, I., Moreea, S., Alam, S., Thomas, H. C., Khan, S., Watt, B., Pugh, R. N., Ramaiah, S., Jervis, R., Hughes, A., Singhal, S., Cameron, S., Carman, W. F., Foster, G. R. (2010). Prevalence of chronic viral hepatitis in people of south Asian ethnicity living in England: The prevalence cannot necessarily be predicted from the prevalence in the country of origin. Journal of viral hepatitis, 17(5), 327–335. Epub 2009/12/17. doi: PubMed PMID: 20002307.CrossRefGoogle Scholar
  63. van Wyk, C. W., Stander, I., Padayachee, A., Grobler-Rabie, A. F. (1993). The areca nut chewing habit and oral squamous cell carcinoma in south African Indians. A retrospective study. South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 83(6), 425–429. Epub 1993/06/01. PubMed PMID: 8211462.Google Scholar
  64. White, M., Bush, J., Kai, J., Bhopal, R., & Rankin, J. (2006). Quitting smoking and experience of smoking cessation interventions among UK Bangladeshi and Pakistani adults: The views of community members and health professionals. Journal of epidemiology and community health., 60(5), 405–411 Epub 2006/04/15.CrossRefGoogle Scholar
  65. Willis, D., Popovech, M., Gany, F., Zelikoff, J. (2012). Toxicology of smokeless tobacco: Implications for immune, reproductive, and cardiovascular systems. Journal of toxicology and environmental health Part B, Critical reviews, 15(5), 317–331. Epub 2012/08/03. doi: PubMed PMID: 22852812.CrossRefGoogle Scholar
  66. World Health Organization International Agency for Research on Cancer. (2004). Betel-quid and Areca-nut chewing and some Areca-nut-derived nitrosamines. Lyon.Google Scholar
  67. Worth, A., Irshad, T., Bhopal, R., Brown, D., Lawton, J., Grant, E., Murray, S., Kendall, M., Adam, J., Gardee, R., Sheikh, A. (2009). Vulnerability and access to care for south Asian Sikh and Muslim patients with life limiting illness in Scotland: Prospective longitudinal qualitative study. BMJ(Clinical research ed), 338, b183. Epub 2009/02/05. doi: PubMed PMID: 19190015 PubMed Central PMCID: PMCPmc2636416.CrossRefGoogle Scholar
  68. Zhu, Q., Gao, R., Wu, W., Qin, H. (2013). The role of gut microbiota in the pathogenesis of colorectal cancer. Tumour Biology : The journal of the International Society for Oncodevelopmental Biology and Medicine, 34(3), 1285–1300. Epub 2013/02/12. doi: PubMed PMID: 23397545.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Francesca Gany
    • 1
    Email author
  • Anuradha Hashemi
    • 1
  • Jennifer Leng
    • 1
  • Sayyeda Ayesha Ahmed
    • 1
  1. 1.Memorial Sloan Kettering Cancer Center, Immigrant Health and Cancer, Disparities CenterNew YorkUSA

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