UC Davis Comprehensive Cancer Center’s Office of Community Outreach and Engagement (COE) envisions a future free of disparities in cancer outcomes for all. Moon Chen, Jr., the COE’s associate director for community outreach and engagement, is a leading expert in studying the cancer burdens facing underrepresented populations. He has led nationwide programs intended to help identify and mitigate cancer health disparities among various racial and ethnic groups.
Chen presented his most recent findings this past May before the Asian American, Native Hawaiian and Pacific Islander Health Research Conference at the National Institutes of Health (NIH). His presentation focused on characterizing the unique and unusual cancer burden confronting Asian Americans who, Chen said, are significantly underrepresented in cancer clinical trials.
The Asian American population in the U.S. nearly doubled between 2000 and 2019 and is projected to surpass 46 million by 2060. The population group is expected to become the largest immigration group in the country, surpassing Hispanics/Latinos by 2055. The Asian American cancer burden is unique because, among all racial groups in the United States, they were the first to experience cancer as the leading cause of death.
The cancer burden that affects Asian Americans is unusual because, more than any other racial or ethnic group, Asian Americans experience proportionally more cancers of infectious origin, such as cervical, liver, nasopharyngeal and stomach cancers. Asian Americans also experience the highest rates of lung cancer among females who never were smokers.
Chen said that Asian Americans are underrepresented in clinical trials, only 1% of which emphasize racial and ethnic minority participation as a primary focus. Only five such trials in the U.S. focus on Asian Americans, as compared with 83 for African Americans and 32 for Hispanics/Latinos.
“Classifying Blacks and Latinos as underrepresented minorities in clinical trials is helpful, but it is regrettable that our national policy excludes designating Asian Americans as underrepresented minorities,” Chen said. “There is a myth that Asian Americans don’t get cancer, but that is far from the truth.”
Asian Americans are underrepresented in the NIH budget
Chen said that an “infinitesimal proportion” of the NIH budget funds research that includes Asian Americans, even though the population has been growing faster than any other racial group in the U.S. percentage-wise over the past three decades. Between 1992 and 2018, only 0.17% of the total NIH budget funded research on Asian Americans. A portfolio analysis of grants funded by the National Cancer Institute’s Division of Cancer Control and Population Sciences showed a very limited number of studies focused on Asian Americans, with none at the time addressing the causes of cancer.
What must happen to eliminate cancer inequities?
- Partition data for Asian Americans into subgroups (people from Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippines, Thailand and Vietnam). Chen said a separate focus should be created for Native Hawaiians and other Pacific Islanders.
- Assess the impact of lived experiences and historical trauma. Culturally competent oncology care is required to improve access to health insurance and health care, including reducing language barriers that prevent Asian Americans from obtaining the medical help they need.
- Listen to community voices. Rich diversity and unique experiences within Asian American communities are best understood and appreciated by listening to and partnering with patients and community advocates. Research must ensure community representation, buy-in and engagement.