Cancer and Culture: The impact of data aggregation on the Asian American community

The phrase “model minority” has been used countless times to describe the Asian American community. Although many may identify with and use this label with pride, it may have unintended consequences.

This overgeneralization does more than skim over the various issues that the population faces — it also aggregates healthcare data from the fastest growing minority population in the United States. In the context of healthcare, aggregated data is information collected from a variety of sources that is combined and reported as one group.

Within the Asian American community, data aggregation flattens a three-dimensional snapshot of a diverse group from over 30 countries into one category: Asian. The effects of this grouping become apparent in the analysis of cancer incidence rates for Asian American women because it shifts attention away from barriers within the healthcare system that contribute to preventable cancer cases.

At first glance, cancer trends within the Asian American community seem promising — as a group, Asian American women have some of the lowest rates of breast, lung, and colorectal cancers compared to other races, according to 1998 data in the California Cancer Journal for Clinicians.

As many studies demonstrate, however, the disaggregation, or breaking down of health data from the Asian American community reveals contradictory information. For instance, within breast cancer trends alone, although both Laotian and Japanese women would be grouped as “Asian,” annual breast cancer diagnosis rates between the two groups vary nearly threefold, with 126 diagnoses per 100,000 Japanese women and only 44 diagnoses per 100,000 Laotian women, according to 2010 data in the American Journal of Public Health.

Moreover, Filipinas have breast cancer diagnosis and mortality rates comparable to the high rates found among African American women, while the low-risk trends found among Japanese women mirror those of non-Latina white women, according to the American Journal of Public Health.

Data disaggregation is a helpful tool in analyzing cultural factors beyond the scope of typical cancer analyses. Acculturation, or the extent to which a person has adopted the norms of the dominant culture, correlates with trends of cancer screening and accounts for stark differences in screening trends amongst Asian American ethnicities.

Women who are more acculturated to American culture are more likely to take control of their health care and receive cancer screenings, indicating high self-efficacy. For instance, breast cancer incidence trends among United States-born and immigrant Japanese women are remarkably similar, in part because Japanese women who emigrate to the United States are likely to do so earlier in life, allowing them to transition more easily into American culture, according to 2010 data in the American Journal of Public Health.

Conversely, Vietnamese Americans tend to be less acculturated than other Asian Americans, largely due to immigration later in life to the United States and increased likelihood of living in ethnic enclaves, according to 2014 data in the American Psychological Association.

All of these factors contribute to strong beliefs in collectivist values, such as putting family before one’s personal health, in part causing lower preventative screening rates and comparatively high cancer-related mortality rates, according to 2014 data in the APA.

In fact, the risk of cancer mortality for foreign-born Vietnamese American women is four times as high than the risk for US-born Vietnamese women, 2010 data in the American Journal of Public Health found.

Ultimately, Asian cultures that generally promote values such as modesty and collectivism can form a barrier to preventative healthcare by encouraging less-acculturated women to avoid cancer screenings and put the needs of the family before their own health, according to 2014 data by the APA.

Despite its benefits, assimilation to United States culture can lead to immigrants risking losing a part of their cultural identity when they subscribe to the practices and beliefs of the dominant culture. Even so, it is unfortunately one of the only processes that encourages Asian American women to adopt preventative healthcare practices.

Recent trends, however, show a gradual shift toward Westernized medical norms, perhaps fueled by more education about preventative practices. Increased screening practices within the Asian American community have dramatically decreased cervical and colorectal cancer incidence, although disaggregation reveals that only specific ethnicities have seen a decline in incidence rates — many Asian American groups are still less likely to participate in screening.

For instance, although cervical cancer screening rates decreased among Filipina and Chinese women, rates of screening increased among Vietnamese, Kampuchean, and Laotian women, which led to a dramatic decline in cervical cancer incidence, according to 2013 data by the National Cancer Institute.

Declining rates demonstrate the life-saving potential of promoting Western medicine, and low rates of screening for each ethnicity should inform the development of culturally appropriate efforts in education and public health policies.

Disaggregation offers policymakers and public health officials a clearer picture of which ethnicities are most in need of education and assistance.

Overall, the grouping of health data masks significant disparities in cancer incidence among Asian ethnicities. It contributes to the inaccurate perception that overall low Asian cancer rates eliminate the necessity for any additional efforts to fight cancer within specific subgroups of the “model minority.” Low screening rates contribute to preventable deaths, and although all Asian American ethnicities face this threat, disaggregation offers policymakers and public health officials a clearer picture of which ethnicities are most in need of education and assistance.

Despite relatively low existing cancer incidence rates for Asian American women, observing cultural factors outside the scope of typical cancer analyses holds the potential for more drastic reductions in these trends.

Preventative screenings can prevent lives lost to cancer. Implementing educational and reformative policies that normalize preventative practices and make healthcare more accessible to Asian Americans can ensure that cancer screening rates continue to rise.