Disparities in Breast Cancer Survival Among Asian Women by Ethnicity and Immigrant Status: A Population-Based Study

Abstract

Objectives-We investigated heterogeneity in ethnic composition and immigrant status among US Asians as an explanation for disparities in breast cancer survival.Methods-We enhanced data from the California Cancer Registry and the Surveillance, Epidemiology, and End Results program through linkage and imputation to examine the effect of immigrant status, neighborhood socioeconomic status, and ethnic enclave on mortality among Chinese, Japanese, Filipino, Korean, South Asian, and Vietnamese women diagnosed with breast cancer from 1988 to 2005 and followed through 2007.Results-US-born women had similar mortality rates in all Asian ethnic groups except the Vietnamese, who had lower mortality risk (hazard ratio [HR]=0.3; 95% confidence interval [CI]=0.1, 0.9). Except for Japanese women, all foreign-born women had higher mortality than did US-born Japanese, the reference group. HRs ranged from 1.4 (95% CI=1.2, 1.7) among Koreans to 1.8 (95% CI=1.5, 2.2) among South Asians and Vietnamese. Little of this variation was explained by differences in disease characteristics. Conclusions-Survival after breast cancer is poorer among foreign-than US-born Asians.Research on underlying factors is needed, along with increased awareness and targeted cancer control.Breast cancer incidence rates have been shown to differ markedly across distinct ethnic subpopulations of US Asian women, 1-3 and studies of outcomes after breast cancer similarly have detected wide variation in stage at diagnosis and survival patterns across groups. [4][5][6][7][8][9] For example, in a population-based study, we reported that 5-year survival probabilities and proportions of late-stage disease were as poor in Filipinas as in African American women and that Japanese women had more favorable stage and survival Correspondence should be sent to Scarlett Lin Gomez, PhD, Northern California Cancer Center, 2201 Walnut Ave, Suite 300, Fremont, CA 94538 (scarlett@nccc.org). Reprints can be ordered at http://www.ajph.org by clicking the "Reprints/Eprints" link. ContributorsS. L. Gomez supervised the collection of data, originated the study, and supervised all aspects of its implementation. S. J. Shema conducted the data analysis. All authors helped to conceptualize ideas, interpret findings, and review drafts of the article.Note. The ideas and opinions expressed herein are those of the authors, and endorsement by the State of California's Department of Health Services, the National Cancer Institute, the Centers for Disease Control and Prevention, or their contractors and subcontractors is not intended and should not be inferred. Human Participant ProtectionThis study was approved by the Northern California Cancer Center institutional review board. NIH Public Access Author ManuscriptAm J Public Health. Author manuscript; available in PMC 2011 May 1. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript distributions than did non-Hispanic White women. 7 Identifying and explaining such disparities are important for public health efforts to ...

Comparative analysis of clinicopathologic features, treatment, and survival of Asian women with a breast cancer diagnosis residing in the United States

“…A higher percentage of Indian/Pakistani patients had stage III and IV disease but had a similar risk of mortality, consistent with a previous study by Moran et al 38 Unlike other studies, we observed that US-born Indian/ Pakistani patients had worse DSS than those born outside the United States. 39,40 Filipino patients had a similar DSS compared with Chinese, Korean, Indian/Pakistani, Vietnamese, and NHW patients, which differed from findings in a previously reported study by Ooi et al, who had a smaller sample size of Filipino patients in their study (4344 vs 10,915 in the current study). 19 The current study has several limitations.…”

A Population-Based Study of Ethnicity and Breast Cancer Stage at Diagnosis in Ontario

“…97-104; doi: http://dx.doi.org/10.3747/co. 22.2359 are among the least likely to participate in cancer screening and might experience worse survival [8][9][10][11][12][23][24][25][26][27] . In the United States, most studies have compared breast cancer screening uptake and clinical outcomes for black, Hispanic, and non-Hispanic white women [28][29][30] .…”

“…When reported, data for heterogeneous Asian populations are often grouped together, for example "Asian-Pacific Islander" in the United States or "Asian," categories that do not distinguish between East, Southeast, and South Asian (sa) ethnicities 31 . Broad classifications of ethnocultural populations could potentially mask important differences in health beliefs, practices, and clinical outcomes 26 . Community-based social science research also describes sociocultural barriers to seeking care for a breast or gynecologic symptom, particularly among sa women 13,22,[32][33][34] .…”

A Population-Based Observational Study of First-Course Treatment and Survival for Adolescent and Young Adult Females with Breast Cancer

“…57,58 Furthermore, we have previously shown that neighborhood SES is also associated with worse survival among Hispanic and Japanese women of all ages with breast cancer, further suggesting that SES is an independent predictor of survival. 53,56 AYAs treated at NCI-designated cancer hospitals had better survival. NCI designation has been shown to associate with better postsurgical outcomes among cancer patients, but associations with long-term survival have been less clear.…”

“…18,[53][54][55] In addition, foreign-born nativity is associated with poorer breast cancer survival among Asian populations, suggesting that nativity is important to consider in future AYA studies. 56 …”