Asian ethnic minorities: underserved in cancer care

6/01/2021, Lancet Oncology

Hate crimes against Asian Americans in the USA, fuelled by anti-Asian rhetoric in light of the COVID-19 pandemic, have shocked the world. A recent report unveiled the ugly truth—anti-Asian hate crime increased 164% in 16 of the largest US cities in the first quarter of 2021 compared with the first quarter of 2020.

Shortly after the tragic shootings in Atlanta, GA, USA, on March 16, 2021, workers at Memorial Sloan Kettering Cancer Center and New York-Presbyterian Hospital (New York, NY, USA) held a moment of silence to show solidarity against anti-Asian hate. This display of unity reinforces the need for all stakeholders in oncology to be vocal about the changes needed to ensure that every minority ethnic group is considered equally in health care, including in cancer research and cancer care systems. In the case of Asian Americans, ironically, despite representing just 6% of the US population, they comprise 18% of all doctors. Thus, it might be assumed that health-care systems have a good understanding of the needs of this minority group. However, this notion is wrong: a recent review has exposed fatal flaws in such an assumption. The review found that Asian Americans are the only group for whom cancer is the leading cause of death in the USA. The review also showed that the US census bureau definition of Asian Americans comprises people from more than 20 countries, the majority from China (23%), India (19%), and the Philippines (18%). Although Asian minorities are perceived to be more highly educated and financially solvent than some other minority groups, this generalised grouping of all Asians into one category overlooks the vast diversity of ethnicities and backgrounds, which contribute different drivers of disease and health outcomes. Disparities also exist in terms of cancer types in Asians and there is a wide array of biological, cultural, and environmental factors that remain largely under-researched and poorly implemented into clinical decision-making.

The pandemic has exposed the unpreparedness of health-care systems, and shined a rare light on Asian minorities globally. Asian minorities face unique and diverse challenges in cancer care; only by recognising and understanding these differences can we improve cancer outcomes for all.