To advance study of cancer among the Asian Americans, the National Cancer Institute this spring set aside $12.45 million for researchers at the University of California at San Francisco. The researchers’ aim will be to gather data and uncover potential causes of cancer in the Asian American population for whom the disease is the leading cause of death.
“This study represents a significant advancement by recognizing these distinctions and offering relevant data specific to diverse Asian populations,” said Dr. Tim Rebbeck, professor of cancer prevention at the Dana-Farber Cancer Institute, in a statement. “It’s well known that various Asian populations have distinct cancer risk factors and risks.”
Researchers will specifically study breast cancer among young Asian American women, nasopharyngeal cancer of Chinese Americans, liver cancer in Southeast Asian Americans, gastric cancer in Korean and Japanese Americans, and thyroid cancer in Filipino Americans.
The study holds promise for benefiting Asian Americans by potentially revealing differences in health metrics compared to the general population, said Dr. Yuheng Ruan, a internal medicine doctor at South Cove Community Health Center.
“For instance, we already understand that Asians tend to develop diabetes and metabolic syndrome at lower body mass indices than the general population. It would be valuable to ascertain whether Asian Americans exhibit distinct risk profiles for cancer, particularly across various ethnic backgrounds. Such insights could enable healthcare providers, including myself, to personalize patient care more effectively based on specific cultural backgrounds,” said Ruan in a statement.
To find out more about cancer and the Asian American population, Sampan spoke with Dr. Andreas Klein, the interim chief at the division of hematology and oncology at Tufts Medical Center, who is not affiliated with the grant.

SAMPAN: Based on your background as an oncologist at Tufts, what shortcomings have you seen in cancer research and currently available data for minority groups, such as Asian Americans?
KLEIN: What first strikes me when you say Asian Americans is just how large a population that actually represents. … The world’s population is 7.9 billion and of that 4.6 billion are within Asia. It’s a gross generalization to consider everybody within the entire Asian continent as a single entity – to reduce that whole group to a single identity. For us, in terms of cancer research, I think we don’t understand enough about the potential different etiologies of cancer. Lung cancer may have a different basis in parts of the world where there is heavy pollution vs. parts of the world where there is heavy smoking vs. parts of the world where there are other underlying features about us as people that make us different and may lead to different outcomes to cancer treatment. Historically, we have had trouble reaching minority populations across the entire spectrum in the United States. We have had trouble recruiting them to clinical trials, we have had trouble reaching them in their own communities, making it harder to bring new developments in cancer research to them. For many first-generation Asian immigrants, language presents a barrier to understanding and developing relationships with patients that foster trust in the safety of clinical trials. It can be difficult to communicate the reasons for the clinical trial as well as the associated risks and potential benefits.

SAMPAN: What steps do you think researchers and physicians can take to bridge the gap with first-generation Asian immigrant populations?
KLEIN: I think one of the most important things is meeting patients where they are. The expectation needs to be on us that we need to be able to communicate with them rather than the other way around. We have to have interpreter services available to translate in real-time the recommendations for their clinical care and participation in clinical trials. We need to make it easier to participate in clinical trials. In cancer care, many of our clinical trials are run out of large clinical centers. Many may not be close by, so transportation becomes an issue. Navigating their way to the hospital and within the healthcare system can be very challenging to those who cannot speak English.

SAMPAN: As a population, Asian Americans tend to be grouped together. Many studies tend to discuss Asian Americans as a whole, despite there being a lot of diversity within that group. What factors within the Asian American population do you think are often overlooked?
KLEIN: There are a number of cultural differences that influence a patient’s relationship with Western medicine, taking medications, laboratory evaluations, and things like that. I think education is the key to understanding those differences and being able to identify when those differences may stand in the way of care or when they influence the way we care for patients. In addition, we do recognize that there are certain variations in genes that affect the speed at which we metabolize medications. There are some of those differences – as in we see those genes more – in certain Asian American populations. Having this genetic variation would influence how well a drug works and how much toxicity or side effects may be associated with the drug. I think we don’t appreciate within the broad population to whom that applies. Therefore, we run the risk of oversimplification if we apply a general label such as “Asian” or “Asian-American” that might influence the way we use a drug. Education and appreciation for how broadly both culturally and geographically patient backgrounds are within that label are important.

SAMPAN: Based on research that is currently available, do you think there is information missing regarding how the social determinants of health impact Asian American populations and recent immigrants?
KLEIN: I think absolutely. I think the language barrier and economic barriers only amplify the impact of social determinants of health. Those are prime drivers of disparities that we see. We need to take that into account… The social determinants of health have an enormous impact on the outcomes of those receiving care, whether that is for cancer or any medical illness. Different perceptions of healthcare and taking medications are going to have an impact. If you look at just one feature of this, such as whether someone is insured or uninsured, it misses a lot of the richness of what differentiates people within that population. A lot of that impacts the people who have access to care.