Why Are Asian American Women Suddenly Tied for HIGHEST Breast Cancer Rates? How to prevent and self-check

Chien-Chi Huang was 40 when she decided to get her first mammogram at the hospital, shortly after her aunt passed away from breast cancer. Unfortunately, the radiologist didn’t find anything alarming at the time — her dense breast tissue had made it difficult to detect any tumors.

Soon after that mammogram, Huang felt a lump under her armpit and began experiencing flu-like symptoms. Four months later, she was diagnosed with triple-negative breast cancer, one of the most aggressive forms of the disease.

“As Asian Americans, we often don’t prioritize prevention. We only go to the hospital when we’re already sick,” said Huang, now 59, who has become an advocate for early screenings among Asian American women.

Since 2000, breast cancer cases among Asian American and Pacific Islander women under 50 have increased by 50%, rising more than 2% each year since 2012, according to a new report from the American Cancer Society. In 2000, Asian American and Pacific Islander women had the second-lowest rate of breast cancer among all racial groups in this age group. Now, they share the highest rate with white women, at about 86 per 100,000.

“While breast cancer is still more common as we age, it’s concerning to see so many younger women being diagnosed,” said Dr. Helen Chew, director of the clinical breast cancer program at UC Davis Health.

Experts suggest that the sharp rise in breast cancer among younger Asian American women over the past 25 years may be linked to acculturation and greater awareness around screenings, but more research is needed to determine specific causes for different ethnic groups.

Asian women, like Huang, are more likely to have dense breast tissue — meaning they have more glands and tissue compared to fat — than women of other races, likely due to genetic factors and lower body mass indexes. Women with dense breasts are also four times more likely to develop breast cancer compared to those with fattier breasts. Experts agree that more awareness is needed around the unique risks posed by dense breast tissue.

One possible reason for the rise in breast cancer incidence among Asian American and Pacific Islander women is increased westernization, or the adoption of lifestyle choices not typical in Asia, according to Scarlett Lin Gomez, an epidemiologist at the University of California, San Francisco, who is leading the first long-term study of cancer among Asian Americans.

“Established risk factors for breast cancer have typically been more common in westernized and industrialized countries,” Gomez said. She noted that the increase in breast cancer among women in Asia has been linked to economic development and lifestyle changes, such as delayed childbearing, eating a Western diet high in refined grains and trans fats, growing alcohol consumption, and the use of hormone therapy.

Late pregnancies may increase the risk of breast cancer because breast cells have more time to accumulate genetic damage as a woman ages, and hormonal changes during pregnancy can stimulate the growth of damaged cells.

Asian women who immigrate to the U.S. are more than twice as likely to develop breast cancer than U.S.-born Asian women, a trend that Gomez suggested could be linked to the higher socioeconomic status and education level of recent immigrants.

Women from higher socioeconomic backgrounds, Gomez noted, tend to have “more risk factors for breast cancer, especially as they are coming from Asia, where we have been seeing very rapidly increasing rates of breast cancer.”

Since Asian Americans are such a diverse group, Chew said, breast cancer incidence and mortality rates vary widely across different ethnicities. Korean, Chinese, Filipina, and South Asian American women face the highest risk of breast cancer. Most Asian American women, including Chinese and Japanese Americans, are less likely to die from breast cancer compared to white women, but the mortality rates for Filipina and Pacific Islander women are 30% higher.

Socioeconomic status and education level, which differ greatly between groups like Asian Indians, Pacific Islanders, and Southeast Asians, could help explain these disparities in breast cancer rates, Chew explained.

“Breast cancer is the only cancer with such vast disparities among AAPIs,” Chew said, adding that researchers would need to conduct long-term studies on each subgroup to find definitive answers. “You wonder if it has to do with education and class. Is it biology? Is it cultural? It’s hard to know.”

For younger Asian American women, Gomez said, rising obesity rates, increased access to screenings, and exposure to environmental chemicals like PFAS could be “early indicators of the onset of cancer.” Additionally, younger generations may be more vulnerable to cancer, as Gen Xers and millennials are now more likely to be diagnosed with 17 types of cancer, half of which had been declining in older adults. Obesity, sedentary lifestyles, and chemical exposure have been pointed to as common contributing factors.

Gomez also noted that the increase in breast cancer among younger Asian American women is evident across all stages of the disease, suggesting that this trend is not solely attributable to increased screenings. She and her colleagues at UCSF are currently studying unique and emerging risk factors among Asian American women that may predispose them to breast cancer. “We’re hypothesizing something related to stress, maybe due to living conditions, work, or discrimination,” Gomez said.

The mortality rate for Asian American women under 50 has not declined over the past two decades, even though the death rate among all women has dropped by 30%. Research has shown that Asian American women may be more susceptible to an aggressive type of breast cancer caused by the HER2/neu protein, more so than women from other racial groups.

Asian American and Pacific Islander women collectively have some of the lowest screening rates, which experts say may contribute to the stabilizing mortality rate instead of a declining one. At the same time, stigma surrounding cancer remains widespread within these communities, as does the culturally ingrained belief that visiting a doctor is only necessary when pain becomes unbearable.

Disaggregating data is crucial to understanding what is driving the rapid rise in breast cancer among Asian women, Chew emphasized.

“There needs to be a better effort at categorizing patients instead of lumping everyone under the ‘Asian American’ umbrella,” she said. “Recent immigrants from Southeast Asian countries are different from Japanese Americans who have been here for generations.”

Are breast cancer precursors painful?

When there is swelling and tingling in the chest, is it a warning sign of breast cancer? In fact, most breast cancers are not painful, and furthermore, more than 85% of breast pain is not related to breast cancer. In outpatient observations, nearly 60% of patients with breast pain are related to hormonal imbalances in the menstrual cycle. However, it is important to note that although breast pain is not a common symptom of breast cancer, it does not mean that as long as it is painful, it is not breast cancer, which means that breast cancer with a rare chance may be

painful.Just keep in mind that breast pain or not is definitely not the main basis for diagnosing breast cancer.

What are the early symptoms of breast cancer?

The early symptoms of breast cancer mainly include:

Breast lump

Nipple discharge with blood or abnormal secretions

Nipple retraction

Changes in breast size or shape

Skin changes on the breast

Enlarged lymph nodes in the armpit

Of course, stage 0 breast cancer may have no clinical symptoms and no pain, but it may manifest as tiny calcifications, which are usually detected early through mammography. Most patients do not discover they have breast cancer until they feel a lump, but by that time, the lump is often already larger than 2 cm.

Is nipple discharge a warning sign of breast cancer?

In fact, even if you notice nipple discharge, there is no need to worry too much initially, as most nipple discharges are clear and benign. However, if the discharge appears bloody, it could be a higher risk for breast cancer, and it is necessary to seek medical evaluation promptly.

Is a lump always a warning sign of breast cancer?

Not necessarily. Many women may worry when they inadvertently feel a hard lump in the breast and wonder whether it is breast cancer or a fibroadenoma. Actually, there is a 90% chance that a breast lump is benign, such as a fibroadenoma or a fibrocystic change, and only 10% are malignant tumors. There are two key ways to differentiate them:

A malignant lump tends to feel harder.

If the lump enlarges before menstruation and shrinks afterward, it is more likely to be a fibrocystic change.

The type of breast lump can also vary with age:

Teenagers with breast lumps: About 90% are fibroadenomas.

Breast lumps before the age of 30: Mostly benign fibroadenomas or fibrocystic changes.

Breast lumps between the ages of 30 and 50: Typically fibrocystic changes, or possibly breast cancer.

Postmenopausal women: If a new lump is detected, the likelihood of malignancy is higher.

These classifications are general principles, and breast lumps can occur at any age. Generally speaking, the older a woman is, the higher the likelihood of breast cancer when a lump is present. However, the final diagnosis must be made after further examination by a breast specialist.

Women who discover a breast lump are advised to stay calm and consider the following three points:

Does the lump feel like a small grain or is it rough in texture?

Does it cause any pain?

Has this condition been present before?

It is important to be vigilant: if a lump appears recently and does not disappear after the menstrual cycle, it is crucial to see a doctor promptly for further examination.

How to self-check for breast cancer?

In clinical practice, more than 90% of breast cancers are discovered by the patients themselves. Therefore, women are advised to perform a “breast self-exam” at least once a month, preferably within one week after their menstrual period. For those with irregular periods or postmenopausal women, self-exams can be done on the same day each month.

To check yourself for signs of breast cancer, try the following three methods:

Sitting upright in front of a mirror: Let your arms hang naturally or raise them above your head and observe the following:

Are there any differences in size or shape between the breasts?

Are there any wrinkles or indentations in the skin of the breasts?

Has the appearance of the nipples changed?

Is there any fluid discharge when lightly pressing the nipple?

Lying down after bathing: Place a towel or small pillow under your shoulder, then begin the exam. Check one side before switching to the other. Use the pads of your index, middle, and ring fingers to carefully feel the following areas:

Both sides of the breast, with the right hand for the left breast and the left hand for the right breast.

The area above the collarbone, below the sternum, and extending to the armpit and its surrounding area.

Sitting upright: Place one hand behind your head and repeat the steps mentioned above, checking one side before switching to the other to make sure there are no abnormalities.

If any abnormalities are found in the breast, it is recommended to seek medical attention at the “General Surgery” or “Breast Surgery” department of a healthcare facility. A breast specialist will conduct a detailed examination. The initial assessment usually involves “visual inspection” and “palpation,” and based on factors such as the patient’s age, risk factors for breast cancer, breast density, or the presence of a palpable lump, further in-depth examinations may be scheduled.

What are the breast cancer screening methods?

There are three common types of breast exams: ultrasound, mammography, and breast MRI. Each is suitable for different groups, and it’s recommended to choose the appropriate exam based on factors such as age, family history, and pregnancy status:

Breast Ultrasound: A non-invasive examination with no side effects, but it is not very effective at detecting early-stage breast cancer. It is best suited for women under the age of 40 without a family history of breast cancer, as it yields better results in this group.

Mammography (X-ray): A non-invasive examination that involves radiation. It is suitable for women with a family history of breast cancer and can detect early calcifications that are indicative of cancer. However, it is not recommended for pregnant women.

Breast MRI: Also known as magnetic resonance imaging, this exam involves no radiation and has high accuracy. It can detect tumors and monitor their location and size, identifying over 90% of breast cancers, but it is less sensitive to detecting calcifications. It is suitable for women with a family history of breast cancer or those who have had previous breast surgery.

How often is breast cancer screening recommended?

Recommended Breast Cancer Screening Guidelines

Women aged 20–40:

Perform breast self-examination within one week after the end of each menstrual period.

Undergo ultrasound examination or mammography every two years.

Women aged 40–49:

Perform monthly breast self-examination.

Get a professional breast examination once a year.

Women aged 50 and above:

Conduct monthly breast self-examinations.

Schedule both ultrasound examination and mammography once a year.

Regular screening supports early detection and timely intervention for breast cancer, increasing the chances of effective treatment.