May 20, 2022

Cancer’s the Number One Killer of Asian Americans—Here’s How the System Fails Them

This piece originally appeared on

This Asian American and Pacific Islander Heritage Month, we’re exploring the unique challenges this community faces when it comes to cancer care, and what the medical community can do about it.

Asian Americans are the fastest-growing ethnic group in the U.S. and are on track to become the nation’s largest immigrant group by 2055 — in fact, the term AAPI (which stands for Asian Americans and Pacific Islanders) encompasses more than 20 countries with more than 200 dialects. But within the healthcare system, many practitioners don’t take cultural differences into account, and sometimes lump all AAPI patients into one group. When it comes to cancer, the number one killer of Asian Americans, many doctors may not be aware of specific cancer risks this group faces, and the cultural differences that may impact how these patients view healthcare and treatment.

This AAPI Heritage Month, we’re taking a closer look at cancer detection and outcomes to understand what’s driving these cancer disparities and how to reverse the trend.

Why is this happening?

“Model minority” myths hide inequities

There’s a persistent myth that Asian Americans are a“model minority” — that they’re uniformly well-educated and wealthy. This stereotype conceals the very real barriers to health care and cancer risks that many Asian Americans and Pacific Islanders face: In reality, the gap between rich and poor is wider among Asian Americans than any other major racial and ethnic group in the U.S.

That discrepancy plays a major role in health outcomes. “Your level of education, income, and zip code can strongly impact your likelihood of developing cancer and your chance of having cancer diagnosed early and treated effectively,” says Dr. Durado Brooks,  Deputy Chief Medical Officer of Screening for Exact Sciences.

“We saw how economics and environment played such a huge role in the risk of who was going to develop and die from COVID,” Brooks says. “That picture is very similar to what we’ve seen in cancer for many, many years.”

Low cancer screening rates

It’s been more than a decade since President Obama signed an executive order to tackle health disparities among the AAPI community, yet no ethnic group within the community has reached national cancer screening targets.

Asian Americans have lower screening rates for cervical cancer, breast cancer, and colorectal cancer compared with White Americans. Research also shows they receive significantly less smoking-cessation counseling, and that language barriers for some prevent screening and proper care.

Brooks says people with lower levels of income and education are less likely to be up to date with cancer screenings, along with recent immigrants who have been in the country less than 10 years. Medical information can be difficult to understand for patients who speak English as a second language, which is why Brooks says it’s crucial to offer info about the importance of screenings in multiple languages and formats.

“We have to make people understand what screening is. Screening is not, ‘Oh, I see blood in my stool, and now I need to go get it checked out,’” Brooks says. “Screening is something you do when you feel well — you don’t wait until you develop symptoms.”

Stigma can play a role

According to researchers, the way some Asian Americans think about cancer can be linked to cultural beliefs that may keep people from seeking screening or care. The word “cancer” itself carries stigma in some Asian cultures, and is tied to poor fortune. A study of how some doctors in Asian countries talk about cancer with their patients found they often use the words “lump” or “growth” instead.

Breast cancer survivor Yvonne Liu kept her illness hidden because of cultural stigma. “I was ashamed to be sick,” she wrote in an essay for She thought Asian Americans would ghost her if they thought her illness might bring them bad luck. Some might even believe cancer was contagious. 

Many health care providers aren’t educated about these cultural perceptions of cancer, according to a 2021 article published by a group of cancer doctors focused on the challenges Asian Americans face in cancer care. That lack of knowledge can affect a patient and their family’s approach to health care decisions and treatment following a cancer diagnosis.

What can be done?

Doctors and researchers see the string of recent violence against Asian Americans as a call to action to address the problem.  “Bigotry against Asian Americans, pervasive since the 19th century, but especially during the COVID-19 pandemic, is only exacerbating the cancer disparities that are costing Asian Americans their lives,” says Moon Chen, associate director for community outreach and engagement with the UC Davis Comprehensive Cancer Center. Experts are now calling out the lack of funding for cancer research specific to Asian Americans — and the small share of patients from those communities involved in clinical trials.

Chen was the lead author for a recent commentary in the Journal of the National Cancer Institute, which lays out steps for addressing race-based disparities, including:

  • Separating health data for Asian American subgroups and native Hawaiians and Pacific Islanders rather than lumping together the more than 24 million Asians who live in the U.S.
  • Emphasizing culturally competent care by assessing the impact of lived experiences and historical trauma, improving access to care, and addressing language and cultural barriers.
  • Partnering with patients and community advocates to better understand the experience of distinct Asian American and Pacific Islander communities.

Advancing research on the rich diversity among the AAPI community in the U.S. is a critical step toward addressing some of these disparities. By building more awareness among doctors about the health barriers people in the AAPI community face, we can hopefully increase screening rates and drive better cancer outcomes.