Asian & Pacific Islander Cancer Screening & Care

Asian American, Native Hawaiian and Pacific Islander communities in the United States come from dozens of countries. They speak hundreds of languages. Their histories of migration, work, insurance and health risk differ just as widely. This page covers the obstacles that come up most often in cancer care for these communities. It also covers what tends to help.

Cancer statistics often group everyone under a single "Asian and Pacific Islander" heading. The Asian American population is much larger, so that averaging can hide what is happening in smaller groups.

A National Cancer Institute study separated the data. It found cancer death rates were far higher among Native Hawaiian and Pacific Islander men and women than among Asian Americans. The combined figure had hidden that difference for years. The researchers also said the data needs to be broken down further by ethnicity, because real differences exist within each of those groups as well.

This is not an abstract complaint. Risk patterns get averaged into a much larger group. Screening outreach and research money can then end up aimed somewhere other than where the need is. It also means a national figure may say very little about you. Has someone handed you a statistic and told you what it means for you? Read what a five-year survival rate actually means before you let it settle.

Chronic hepatitis B is one of the clearest and most actionable cancer risks in many Asian and Pacific Islander families. People often catch it at birth or in early childhood. It causes no symptoms for decades. And it is often found late.

The CDC recommends that all adults aged 18 and older be screened for hepatitis B at least once in their lifetime, using a three-part blood test. CDC also names two groups for testing in particular. One is people born in regions where hepatitis B prevalence is 2% or higher. The other is US-born people who were not vaccinated as infants and whose parents were born in regions where prevalence is 8% or higher.

Chronic hepatitis B can be monitored and, when needed, treated. Ongoing medical care lowers the risk of serious liver disease. That is the whole reason to test while you feel well. A positive result is information you can act on, not a verdict. If someone in your family tests positive, other household and family members are usually advised to be tested too.

If English is not the language you think in, ask for a professional interpreter and expect the facility to arrange one. Federal civil rights law requires health programmes and facilities that receive federal funding to take reasonable steps to provide meaningful access to people with limited English, including qualified language assistance where it is needed, at no charge to you. How that is delivered varies — in person, by phone, by video — but the cost is not yours to carry, and you should not have to bring your own interpreter.

Asking your adult child or a bilingual neighbor to interpret feels easier, and it is very common. But cancer conversations involve words most people do not have in either language. And someone who loves you may soften what they heard. Use family for company and note-taking. Use a professional for the medical conversation.

Patient navigators and community health workers exist for this. Many cancer centers, community health centers and local groups employ them. Their job is to make the system work for you rather than the other way around. Ask whether one is available. It is rarely offered unprompted.

Practical steps that tend to make a difference:

• Ask your primary care clinician directly for hepatitis B testing, and ask for the result in writing.
• Tell every new clinician where you were born, and where you have lived. Some infections that raise cancer risk, hepatitis B among them, are much commoner in some countries than others, and that history can shape which tests are worth doing. It is one piece of the picture rather than a rule about your ethnicity, and clinicians often will not think to ask.
• Request a professional interpreter when the appointment is booked, not when you arrive.
• Ask whether the hospital has a patient navigator, financial counselor or social worker, and ask what each one does.
• Bring a written list of questions and ask permission to record or take notes. Questions to ask before treatment begins is a place to start.
• Say it out loud in the appointment if a family member smokes or drinks. Say it too if your family has a history of stomach, liver, nasopharyngeal or cervical cancer.

It also helps to know what screening can and cannot do. Read that before you decide which tests are worth your time.

None of this fixes the underlying problem. Data gets collected the way it gets collected, and one clinic visit will not change that. What it does do is shift some control to you. Your care then leans less on whether the system was built with your community in mind. If you need help finding someone to talk to, our support page lists places to start.

• National Cancer Institute (DCEG) — Disparities in Mortality Rates Revealed by Disaggregating Data on Asian American and Native Hawaiian and Pacific Islander Individuals
• Centers for Disease Control and Prevention — Clinical Testing and Diagnosis for Hepatitis B
• U.S. Department of Health and Human Services, Office for Civil Rights — Limited English Proficiency and Language Access
• National Cancer Institute — Cancer Disparities