Disparities in Stage at Presentation for Disaggregated Asian American, Native Hawaiian, and Pacific Islander Patients...

Cancer is the leading cause of death among Asian American, Native Hawaiian, and Pacific Islander (AA&NHPI) populations, who are among the most diverse and rapidly growing racial/ethnic groups in the United States. Despite this population's diverse socioeconomic, cultural, and immigration backgrounds, little is known about the within-group disparities in breast cancer stages at diagnosis. This study aims to identify AA&NHPI subgroups at heightened risk for advanced breast cancer by analyzing detailed incidence rates and diagnostic stages across these diverse subgroups.

Patient data spanning from 2004 to 2020 were extracted from the National Cancer Database, focusing on individuals newly diagnosed with breast cancer. Individuals were disaggregated into specific AA&NHPI subgroups by self-reported country of origin. Ordinal logistic regression, adjusting for clinical and sociodemographic factors, was used to calculate adjusted odds ratios (AORs). Higher adjusted odds ratios signify more advanced stage diagnoses.

Of 3,001,173 patients with breast cancer, 99,128 (3.30%) identified as AA&NHPI. Compared with NHW patients, AA&NHPI patients were younger (median age, NHW: 62 years versus AA&NHPI: 57 years, p < 0.001) and more likely to be uninsured (NHW: 1.50% vs. AA&NHPI: 2.60%, p < 0.001). The largest AA&NHPI subgroups were Filipino (n = 21,666, 21.9% of AA&NHPI), Chinese (n = 21,303, 21.5%), Indian/Pakistani (n = 20,295, 20.5%), Vietnamese (n = 6680, 6.74%), and Korean (n = 7776, 7.84%). In aggregate, AA&NHPI patients were less likely to present with advanced stage at diagnosis relative to NHW patients (AOR 0.89, 95% confidence interval [CI] 0.88-0.90, p < 0.001). However, AA&NHPI disaggregation demonstrated that Hawaiian (AOR 1.15, 95% CI 1.09-1.22, p < 0.001), Hmong (AOR 1.70, 95% CI 1.28-2.27, p < 0.001), Laotian (AOR 1.37, 95% CI 1.17-1.61, p < 0.001), and Pacific Islander patients (AOR 1.24, 95% CI 1.17-1.32, p < 0.001) were more likely to present at a more advanced stage relative to NHW patients. Relative to Chinese Americans (the reference AA&NHPI group), all AA&NHPI ethnic groups had higher odds of advanced-stage diagnosis with the highest odds in Hmong (AOR 2.41, 95% CI 1.81-3.20, p < 0.001), Laotian (AOR 1.89, 95% CI 1.61-2.20, p < 0.001), Pacific Islander (AOR 1.71, 95% CI 1.60-1.82, p < 0.001), and Hawaiian (AOR 1.57, 95% CI 1.48-1.67, p < 0.001) patients.

Our study characterizes disparities in the stage of breast cancer at presentation across disaggregated AA&NHPI groups, with notably advanced diagnoses in patients of Hmong, Laotian, Pacific Islander, Hawaiian, and Kampuchean descent. These findings underscore the need for disaggregated research exploring both risk factors and barriers to early diagnosis, as well as culturally tailored interventions that involve community leaders and leverage cultural norms to improve cancer screening and diagnosis.