AAPI Women and Breast Cancer: What to Know About Rising Rates and Hidden Disparities

Breast cancer is rising among AAPI women, but outcomes vary significantly among different ethnicities. Here’s what’s driving the disparities

Advances in early detection and treatment have helped breast cancer mortality rates drop significantly over the last 30 years. But for Asian American and Pacific Islander (AAPI) women, the picture is more complicated. While their survival outcomes tend to be better overall, recent data show that breast cancer cases are rising faster in this community than in any other racial or ethnic group.

Yet, AAPI women are not a monolithic group, and examining data across different subpopulations reveals significant disparities in risk, diagnosis, and outcomes. Some groups experience disproportionately higher rates of late-stage diagnosis, while others face lower survival rates despite medical advancements. It’s a complex reality that’s impacted by genetics, access to care, differences in breast cancer subtypes, and cultural norms around screening.

Here, we look at both the progress and the ongoing challenges in breast cancer outcomes for AAPI women, as well as the factors driving these disparities.

How breast cancer impacts AAPI women overall

Breast cancer is the most common cancer in AAPI women. While historically considered a lower-risk group, AAPI women are now experiencing the fastest-rising incidence rates of the disease.

Data compiled by the American Cancer Society (ACS) show that while the overall breast cancer incidence rate rose one percent annually from 2012 to 2021, it increased 2.5 to 2.7 percent for AAPI women every year during the same period. Among AAPI women under 50, cases have surged by 50 percent since 2000, placing their incidence rate on par with white women for the highest rate of any racial or ethnic group. Breast cancer makes up the highest proportion of new cancer diagnoses among most Asian Americans, Native Hawaiians, and Pacific Islanders, per the CDC.

AAPI women experience a few key differences in screening, diagnosis, and subtype. AAPI women are less likely to be up to date on their annual breast screening compared to other racial groups. They’re also more likely to be diagnosed at a younger age: The median age at the time of diagnosis is 58 for AAPI women, which is younger than that of Black, American Indian/Alaska Native, and white women, but a year older than Hispanic women.

Among all racial and ethnic groups, AAPI women experience higher rates of HER2-positive breast cancer, which can be more aggressive. And overall, Asian Americans, Native Hawaiians, and Pacific Islanders are more likely to be diagnosed with cancer at a later stage compared to white individuals.

Overall breast cancer outcomes tend to be better among AAPI women than those of most other ethnic groups. According to the CDC, breast cancer death rates among AAPI women dropped from 12.7 percent in 1999 to 11.4 percent in 2020. As of 2024, AAPI women had the lowest breast cancer mortality rate of all racial and ethnic groups studied, ranging from 12 to 14 per 100,000 women, according to ACS.

Nuances among AAPI ethnic groups

While AAPI women as a whole tend to have better breast cancer outcomes than some other racial and ethnic groups, it’s important to remember that the label AAPI doesn’t represent a single, uniform community. It’s an umbrella term that includes people from dozens of ethnic backgrounds, each with their own genetic risks, cultural beliefs, and access to healthcare.

These differences can play a big role in the overall risk of breast cancer and certain subtypes, diagnosis, and outcomes. What holds true for women of one ethnic background may not apply to another, even if they’re both characterized as members of the AAPI community. Looking at AAPI women as a single group can conceal important disparities in breast cancer risk and care.

The prevalence of breast cancer among AAPI women varies significantly by ethnicity. According to ACS data, it accounts for 17 percent of all cancer cases in Hmong women, while in Fijian women, it makes up 44 percent of all cancer diagnoses—more than twice as much.

What’s more, certain breast cancer subtypes affect some AAPI women at higher rates than those of other racial and ethnic groups. A 2015 analysis of the California Cancer Registry found that Korean, Filipina, Vietnamese, and Chinese women had a significantly higher risk of a HER2-positive breast cancer diagnosis than non-Hispanic white women.

A previous study evaluated data on 346 Asian breast cancer patients at two New York City institutions. It reported that Chinese and Japanese women had a higher proportion of hormone receptor–positive breast cancers (66.7 percent and 80 percent, respectively), which have the best prognosis, than Filipinos and Koreans. It also found that the more-difficult-to-treat triple-negative breast cancer (TNBC) affected Koreans at a higher rate than other ethnic groups.

Differences in when breast cancer is diagnosed also vary among AAPI subpopulations, with some groups more likely to receive an earlier-stage diagnosis than others. Localized-stage breast cancer accounts for 73 percent of breast cancer cases in Japanese women, compared to just 47 percent in Samoan women.

This could play a role in survival rates among different AAPI subpopulations. A 2022 study published in JCO Oncology Practice found that while the 10-year survival rate of AAPI women with stage 0 through 2 breast cancer was 91 percent overall, it was just 83 percent for Native Hawaiian and other Pacific Islanders. According to ACS data, the five-year relative survival rate for breast cancer varies significantly among AAPI subpopulations, ranging from 94 percent in Japanese women to between 72 percent and 74 percent in Tongan, Chamorro/Guamanian, and Samoan women.

More nuanced research on each of the subpopulations within the AAPI community could help identify specific risk factors, improve screening rates, and promote better outcomes.

What accounts for breast cancer disparities in AAPI women?

No single factor is responsible for the disparate impact of breast cancer among AAPI women. Instead, these differences may be shaped by a combination of systemic challenges, along with genetic and cultural issues that vary widely across ethnic subgroups.

The stigma surrounding breast cancer in AAPI communities may contribute to delayed diagnoses and poorer outcomes, says Dr. Scarlett Gomez, a BCRF investigator. Cultural beliefs and fear of social repercussions may discourage some women from getting regular screenings or following up on symptoms, potentially increasing the chances of a late-stage diagnosis in certain AAPI populations. This issue is further complicated by socio-economic challenges, such as finances, language barriers, and access to healthcare.

Dense breast tissue, which is prevalent among Asian women, presents another challenge in detecting early-stage breast cancer. Women with dense breasts have a higher risk of developing breast cancer, which may be due, in fact, to the fact that dense breast tissue can make it more difficult for mammograms to detect suspicious areas and tumors. This means that AAPI women may require additional imaging, such as breast ultrasounds or breast magnetic resonance imaging (MRI), for more accurate screening—yet some patients may not be aware of this need or have access to these screening services, which could contribute to higher rates of later-stage diagnosis in some subpopulations.

Certain genetic predispositions may contribute to disparities in breast cancer subtypes and outcomes among AAPI women. This may explain the higher rates of TNBC among Koreans and HER2-positive breast cancer among Korean, Filipina, Vietnamese, and Chinese women.

The lack of research focused on AAPI women and breast cancer has significant consequences for prevention, diagnosis, and treatment. While Asian Americans comprise about seven percent of the U.S. population, a 2019 study reported that less than one percent of funding from the National Institutes of Health was spent on research on this community between 1992 and 2018, and very little research has been dedicated to investigating the causes of cancer in this group. This lack of attention can lead to missed opportunities for early detection, less effective screening guidelines, and a failure to develop targeted interventions that address the unique risks faced by AAPI women. It also perpetuates the misconception that breast cancer isn’t a burden among AAPI women.

Research on AAPI women and breast cancer

More research is needed to understand the driving factors behind the rising incidence rate of breast cancer in AAPI women, as well as the gaps in early-stage diagnosis, care, and outcomes in subpopulations.

BCRF makes significant investments in research to reduce breast cancer disparities and improve outcomes for racial groups—like AAPI women—who are disproportionately impacted by the disease in unique ways.

We’re currently supporting Dr. Gomez’s work to understand how structural and social determinants of health impact breast cancer risk among AAPI women specifically. Across a multitude of projects, BCRF investigators are working to better understand and treat HER2-positive and triple-negative breast cancers, improve screening for women with dense breasts, and understand why incidence rates are rising among younger women. Such research stands to benefit AAPI women at this critical juncture—when their incidence rates are on the rise.