Cancer-Specific and Other-Cause Mortality of Asian Pacific Islanders vs. Caucasians Across Eleven Primary Cancers

Several studies reported more favorable cancer-specific mortality (CSM) in Asian Pacific Islanders (APIs) vs. Caucasians. We tested these findings across 11 primary cancers of all stages: cutaneous melanoma, bladder, breast, colorectal, gastric, kidney, liver, lung, nasopharyngeal, prostate, and uterine cancer.

Within the Surveillance, Epidemiology, and End Results database (SEER 2000-2021), we identified APIs and Caucasians with one of the 11 primaries. Multivariable competing risks regression (CRR) models tested the effect of API race/ethnicity on cancer-specific mortality (CSM) and other-cause mortality (OCM).

Overall, 339,576 APIs (8.5%) vs. 3,643,873 (91.5%) Caucasians were identified. The API to Caucasian ratio varied by cancer type, ratio ranged from 1:1.2 for nasopharyngeal cancer (4,007 APIs vs. 4,723 Caucasians) to 1:80.7 for cutaneous melanoma (4,924 vs. 397,549). In general, APIs were younger (median age 64 vs. 67 years) and harbored less frequently localized stage (in ten of 11 primaries), more frequently regional (in nine of 11 primaries) or metastatic (in seven of 11 primaries) stage. In multivariable CRR models, API race/ethnicity predicted lower CSM in eight of 11 primaries (hazard ratios [HRs] ranged 0.80-0.95), except for cutaneous melanoma, kidney, and uterine cancer. Additionally, API race/ethnicity independently predicted lower OCM in ten of 11 primaries (HRs ranged 0.80-0.95), except for cutaneous melanoma. Exploratory analyses separating Asian Americans and Pacific Islanders demonstrated that the observed survival advantage was largely driven by Asian Americans, whereas Pacific Islanders showed distinct demographic, stage distribution, and mortality patterns.

By jointly evaluating cancer-specific mortality (CSM) and explicitly reporting other-cause mortality (OCM) across multiple primary cancers using a uniform competing risks framework, this study provides novel and comprehensive evidence that API race/ethnicity, largely driven by Asian Americans, is associated with more favorable survival outcomes in most malignancies, with some exceptions.