Current Breast Cancer Reports (2024) 16:351–358

https://doi.org/10.1007/s12609-024-00531-8

REVIEW

Breast Cancer in Women of Asian Heritage: Disparity Trends

in the Asian American Breast Cancer Population Literature
Claire M. Eden1 · Laura Jao1 · Georgia Syrnioti2 · Josh Johnson2 · Manmeet Malik1 · Lisa A. Newman2 · Tammy Ju1

Accepted: 24 January 2024 / Published online: 31 January 2024

© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2024

Abstract
Purpose of Review The Asian American (AsAm) population is one of the most rapidly growing ethnic groups in the coun-
try, and the incidence of breast cancer among AsAm women has been steadily increasing. The purpose of this review is to
describe the breast cancer disease burden and characteristics among this burgeoning minority group and the challenges/
disparities they face.
Recent Findings AsAm women are reported to have low rates of up-to-date mammography screening and the highest annual
percent increase in breast cancer incidence compared to other ethnicities. Persons within the AsAm aggregate are dispro-
portionately affected by these inequities, a trend revealed once this population is disaggregated.
Summary The AsAm population is uniquely impacted by breast cancer with regard to risk, screening, and treatment and
faces unique challenges in our healthcare system. Inequities are further elucidated once these data are disaggregated showing
the heterogeneity in this diverse patient population, an issue that is crucial to address in future research.

Keywords Breast cancer in Asian American women · Disaggregated ethnic data Asian Americans · Breast cancer
screening in Asian Americans

Introduction

According to recent reports, the Asian American (AsAm)

minority is the fastest-growing single ethnic group in the
United States (US), with the current population of approxi-
* Claire M. Eden
[email protected] mately 20 million estimated to surpass 35 million by the year
2040 [1]. This group is composed of individuals from over
Laura Jao
[email protected] twenty vastly diverse countries with distinct languages, cul-
tures, and genetic ancestry [2]. AsAm women have tradition-
Georgia Syrnioti
[email protected] ally been considered a relatively low-risk population with
respect to breast cancer. A 2022 review found AsAm women
Josh Johnson
[email protected] to have the second lowest overall incidence of breast cancer
between 2015 and 2019 of all racial/ethnic groups examined
Manmeet Malik
[email protected] (White, Black, American Indian/Alaska Native and His-
panic). This study also found that AsAm women have the
Lisa A. Newman
[email protected] lowest mortality rate of all mentioned groups [3•]. Similarly,
the 2022 American Cancer Society’s report on cancer dis-
Tammy Ju
[email protected] parities reported identical findings with regard to incidence
and mortality from breast cancer among AsAm women [4].
1
Department of Surgery, New York Presbyterian Queens At an initial glance, these data are reassuring with regard to
Weill Cornell Medicine, 56‑45 Main Street, Flushing, this seemingly low-risk population, which perhaps accounts
NY 11355, USA
for the relative dearth of breast cancer research for this group
2
Department of Surgery, New York Presbyterian Weill Cornell of patients. However, recent investigations focused on the
Medicine, New York City, NY, USA

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352 Current Breast Cancer Reports (2024) 16:351–358

disaggregation of the AsAm population provide insight into breast cancer in AsAm women include the globalization of
how the focus on broader trends may be misleading and con- Asia resulting in increased screening, delayed parity, and
firm the need for a tailored approach to this minority group. increased sedentary lifestyle that may increase breast cancer
risk. This is specifically reflected in the increased breast can-
cer rates seen in Southeast and East Asia [13, 14]. The nativ-
Increasing Rates of Breast Cancer ity status of Chinese immigrant women has been studied
in the Asian American Population in California and showed that foreign-born Chinese women
who immigrate to the US have a higher risk of breast cancer
Previous studies show breast cancer incidence among AsAm than US-born Chinese women, suggesting there are even
women is relatively low when examined as a single group. more environmental factors that largely affect this risk [15].
However, these data reveal distinct inequity when examined Breast cancer risk is multifactorial, with evidence that
in a temporal fashion. The same study that found the overall certain ethnic subgroups are affected differently within the
incidence of breast cancer is among the lowest for AsAm AsAm population. Inherent breast density, tumor biology,
women, also reported that when diagnoses were viewed nativity, or even environmental exposures all seem to play
as average annual percent change, AsAm women had the a role in the risk profile for AsAm women. This ultimately
highest rate of increase between 2015 and 2019 of 2.1% leads to many challenges in terms of breast cancer risk strati-
compared to all other ethnic/racial groups [3•]. These find- fication for this population. One of the most common tools
ings were mirrored in another study analyzing data between currently utilized is “The Breast Cancer Risk Assessment
2000 and 2018 which similarly found the highest rates of Tool” (BCRAT), also known as the Gail model (GM) which
annual percent increase in breast cancer among AsAm was originally developed for use in white females to esti-
women [5]. A 2020 study published by Tuan et al. exam- mate breast cancer risk but has been subsequently applied to
ined incidence rates among the disaggregated AsAm popula- women of other ethnicities. A systematic review published
tion and reported findings for non-Hispanic white (NHW), in 2020 found that this model does not accurately predict
Japanese, Chinese, Filipina, Korean, South Asian, and Viet- risk among Asian patients [16]. Our practice approach, com-
namese persons as separate ethnic groups. They found that ing from an ethnically rich and largely immigrant patient
between 1990 and 2014, overall breast cancer incidence population in Queens, NY, is acknowledging the different
increased significantly among all populations except for risk profiles (or lack thereof) for our patients when they
NHW (− 0.2%/year, 95% CI =  − 0.73 to 0.33%) and Japa- present. Specifically, additional screening for breast density
nese women (0.22%/year, 95% CI =  − 1.26 to 1.72%). Nota- using MRI or ultrasound is incorporated, and we encourage
bly, there was significant heterogeneity observed between screening for women of Asian heritage starting at age 40 due
the Asian ethnic subgroups, with Korean women having the to peak incidence rates in the 4th decade of life [8].
greatest annual increase in breast cancer (2.55%/year, 95%
CI = 0.13 to 5.02%) and Chinese women having the small-
est annual increase (0.65%/year, 95% CI = 0.03 to 1.27%) Disparities in the Asian American Breast
[6•]. Other studies using earlier data mirror these findings, Cancer Population
with breast cancer incidence consistently increasing among
Korean women while staying stable among Japanese women Screening and Time to Treatment
[7]. Further, breast cancer rates are also noted to have a peak
incidence in the 4th decade of life for Asian women com- Similar to the rising incidence of breast cancer among
pared to the 6th decade of life for US women [8, 9]. AsAm women, there is a disturbing trend showing low rates
There have been several theories as to why the rates of preventative screening for this population. The Ameri-
of breast cancer are rising in the AsAm population, with can Cancer Society’s most recent report found only 60%
one such theory being due to the increased breast density of AsAm women had up-to-date mammography screening,
among this population, which has been shown to increase which was the second lowest of any racial/ethnic group [17].
the risk of breast cancer [10, 11]. A 2022 study by Par- This finding has been reproduced in multiple other recent
anjpe et al. reported follow-up patterns in this group of studies [18, 19]. There has been some speculation that the
women compared to NHW patients. They found that while historically low incidence of breast cancer among AsAm
NHW women were less likely to be told they had dense women may in part be due to these low rates of screening
breast tissue compared to AsAm women (25.38% versus that may not reflect accurate rates of disease. A 2022 study
17.74%, respectively, P = 0.001), NHW women were also by Paranjpe et al. explored this theory and used the 2015
significantly more likely to be referred for follow-up MRIs National Health Interview Survey to examine rates of mam-
than AsAm women (14.18% versus 6.08%, respectively, mography screening among the aggregated and disaggre-
P = 0.048) [12•]. Other factors that may affect the risk of gated AsAm population. They found that when controlling
Current Breast Cancer Reports (2024) 16:351–358 353

for sociodemographic factors including education, insurance mammogram and Japanese women the shortest. When this
status and whether patients had been born in the US, the same study considered the AsAm patients in aggregate, they
aggregated AsAm group was less likely to have undergone observed a significantly smaller number of AsAm women
screening mammography within the past 2 years compared receiving any follow-up within 30 days compared to white
to their NHW counterparts (OR = 0.68; 95% CI: 0.46–0.99) women [25]. On the other hand, a more recent study found
with a P value of 0.047 [12•]. While this study did not that Asian Indian, Pakistani, and Chinese patients had
find significant differences in the rates of screening mam- greater odds of undergoing surgical treatment within 30 days
mogram between most of the disaggregated AsAm groups of diagnosis compared to white women, while Other Asians
when controlling for socioeconomic factors, they did note experienced a significantly longer wait time than those
that the “Other Asians,” which included Korean, Japanese, of other races and ethnicities [26]. It is known that delay
and Vietnamese patients were less likely to have undergone from time at breast cancer diagnosis to surgical treatment
mammography when compared to NHW women [12•]. adversely affects survival [27]. As such, it is imperative to
Explanations for the lower rates of screening mammog- further investigate why certain subgroups may be delaying
raphy among AsAm women have been investigated. A 2019 treatment compared to others.
review by Miller et al. examined barriers to preventative Our group practice often uses medical interpreters or
screening among minority women and found AsAm women practitioners who speak the same native language as our
most frequently reported psychological/knowledge-related patients due to the largely AsAm population and specifi-
barriers including lack of information and misinformation cally mandarin-Chinese speaking patient population we
along with fear of pain/discomfort as reasons for omitting serve. As we work to establish a rapport with patients, we
screening. Cultural barriers, including primary language often directly address patient perceived barriers in person
spoken, lack of mammography screening in their native by questioning what they may feel be challenging for them
country, and cultural modesty were reported among AsAm in completing their breast cancer workup and treatment.
women more frequently than any other minority group Anecdotally, we find that identifying barriers in the upfront
[20]. Another study published in 2019 by Shon et al. found setting and in their native language if possible, are often
that the odds of never having a mammogram significantly ways we obtain an improved understanding of the patient’s
decreased with an increasing number of physician visits perspective and also help mitigate breast cancer treatment
among Chinese patients only and did not observe this effect delays for the AsAm population.
among Vietnamese or Korean women in their analysis [21].
Data are somewhat conflicting, with other studies focused Tumor Biology
on Korean American women, finding predictors of mammo-
gram adherence to include having regularly scheduled pri- Breast cancer tumor biology among the AsAm popula-
mary care checkups, health insurance status, being proficient tion differs from that of other American ethnic subgroups.
in English, and hearing about mammography from friends or Between 2010 and 2016, Acheapong et al. found that the
family [22, 23•]. These findings emphasize the mixed data rates of luminal A breast cancer increased by 2.5% (95%
within the AsAm population’s breast cancer screening habits CI, 0.6–4.5%) for Asian American Pacific Islander (AAPI)
and views of healthcare when investigating Asian ethnic sub- women between the ages of 40 and 54 years, while NHW
groups. Further, from these varied data, we acknowledge the and black/AA women experienced annual increases in lumi-
importance of appropriately tailored outreach initiatives and nal A breast cancer rates until 2014 and 2012, respectively,
education platforms to increase screening mammography followed by stable or declining rates for this subtype [28].
among AsAm women overall and identify subgroups at the Utilizing the Surveillance, Epidemiology, and End Results
highest risk for lack of preventative care. (SEER) database from 1990 to 2016, it was found that
In addition to the low rates of up-to-date screening mam- AsAm women had higher rates of human epidermal growth
mography among AsAm women, there is growing evidence factor receptor 2 (HER2)-positive disease compared with
of substantial delay in time to treatment from breast cancer NHW women (18.7% vs 13.8%), and further disaggrega-
diagnosis among this population. A recent study by Lawson tion showed that among younger women (< 50 years), Fili-
et al. examined multilevel factors associated with time to pino women had the highest rates of HER2-positive disease
biopsy after abnormal mammography results by race and (27.1%), and among older women (> 50 years), Vietnam-
ethnicity and found AsAm women had an increased risk ese women had the highest rates (21.5%; both P < 0.001).
of no biopsy at 30 and 60 days from imaging compared to Regardless of age, Japanese women had the lowest rates of
white women [24]. These findings vary meaningfully when HER2-positive disease compared to all Asian groups and
the AsAm population is disaggregated, with a 2017 study NHW women [29]. Furthermore, although triple-negative
by Nguyen et al. finding Vietnamese and Filipina women breast cancer (TNBC) rates have been shown to be relatively
experiencing the longest follow-up time from abnormal low among AsAm as a combined group, Asian Indian and
354 Current Breast Cancer Reports (2024) 16:351–358

Pakistani women are also more likely to have TNBC com- vs 34.4%; P < 0.001). When the AsAm population was fur-
pared to NHW women [30]. ther disaggregated, there was further variation in surgical
Tumor genomics is becoming integral as part of the clini- treatment decisions with Japanese women having the low-
cian’s evaluation and treatment in hormone-positive breast est mastectomy rate (31.6%) and Vietnamese women hav-
cancer, notably using the Oncotype DX score® (ODX-RS), a ing the highest rate (49.2%), a finding that may reflect the
21 gene recurrence score evaluating the risk of distant recur- potential impact of immigration patterns on values placed
rence and guiding the recommendation for chemotherapy for on breast conservation with less American acculturated
breast cancer patients [31, 32]. A 2022 study showed that Asian groups more often opting for mastectomy [29].
NHW patients were more likely to receive an ODX-RS® Other factors that may play a role in the disparity between
test compared to other ethnic groups including Black, His- mastectomy and BCT include differences in breast size,
panic, and Asian American patients (36.7%, 32.8%, 31.6%, cultural preferences, hospital/treatment proximity, omis-
and 35.5%, respectively; P < 0.001) [33]. When stratified by sion of radiation after mastectomy, education level, and
race, Black women were associated with an increased risk physician–patient relationships [39]. However, there is a
of ODX-RS® greater than 25 when compared with NHW lack of studies that investigate these factors in relation to
women (17.7% vs 13.7%; P < 0.001); AsAm were only at disaggregation by race/ethnicity.
increased risk compared to NHW by 7% on univariate analy- Although AsAm women are more likely to undergo mas-
sis; however, when adjusted for age, year of diagnosis, tumor tectomy than BCT, they are also less likely to undergo breast
size, nodal status, receptor status, and tumor grade, the dif- reconstruction after mastectomy despite evidence indicat-
ference was no longer statistically significant [34]. Interest- ing improved psychosocial and physical well-being with
ingly, different ethnic groups may have different thresholds breast reconstruction [40–42]. When looking for determi-
for chemotherapy utility as studied by Shaw et al. In their nants of receiving immediate breast reconstruction within
study, a forest survival model to the SEER-oncotype data a single tertiary care center in the USA between 2003 and
demonstrated that there is a racial difference in chemother- 2015, Siotos et al. found that older age (OR = 0.18, 95%
apy benefit, namely that AsAm women may benefit from CI: 0.08–0.40), Asian race (OR = 0.29, 95% CI: 0.19–0.45),
chemotherapy at a lower ODX-RS® of 18.0 compared to bilateral mastectomy (OR = 0.71, 95% CI: 0.56–0.90), and
NHW women who showed benefit at a score of 19.9 [35]. higher stage of disease (OR = 0.44, 95% CI: 0.26–0.74) were
independent risk factors for not receiving immediate breast
Treatment reconstruction [41]. Hu et al. investigated trends in breast
reconstruction following bilateral prophylactic mastectomy
After the diagnosis of breast cancer is made, disparities in patients with genetic predispositions to developing BC
persist for AsAm women with regard to treatment. The and found that the AsAm group was the most likely to defer
landmark NSABP B-06 trial published in 2002 demon- reconstruction and undergo mastectomy only (MO) com-
strated equivalent survival outcomes between mastec- pared to all other ethnic groups (32% AsAm MO vs. 19%
tomy and BCT; however, a more recent study published NHW, 26% Black/AA; P < 0.05) [42]. Fu et al. conducted a
by Wrubel in 2021 demonstrated that 5-year overall sur- qualitative study to investigate cultural factors, values, and
vival was superior for patients who underwent BCT with perceptions held by AsAm women that might influence their
radiation compared with mastectomy (92.9% vs. 89.7%, lower breast reconstruction rates. Barriers to reconstruction
P = 0.001), and this survival advantage persisted for stage within the AsAm population included fear of multiple opera-
I and stage II disease [36, 37]. Notably, trends continue tions, quality and quantity of information provided by clini-
to show that AsAm women are more likely to undergo the cians, community and family influence on decision-making,
latter, mastectomy. In a study published in 2023, Patel and cultural perceptions of plastic surgery and the function
et al. analyzed 239,801 women diagnosed with cT1- of breasts during the role of motherhood [43].
2N0M0 breast cancer between 2004 and 2017 using the Similar to existing data, our practice notes increased
National Cancer Database (NCDB) and found that after utilization of simple mastectomy without reconstruction in
adjusting for clinical and sociodemographic factors, AsAm our AsAm population compared to our non-Asian patient
women had greater odds of receiving mastectomy over population. Using targeted language-concordant education
BCT compared with NHW women (odds ratio [OR] 1.35, materials and language-concordant providers including
95% confidence interval [CI] 1.30–1.39, P < 0.001) [38]. plastic surgeons, we often are able to educate patients on
Similarly, utilizing the SEER database, Yu et al. looked at more detailed reconstruction information or breast conser-
disease characteristics of 910,415 women aged 18 years or vation therapy options. We further suggest targeted trans-
older who were diagnosed with breast cancer from 1990 to lated education materials in a patient’s native language that
2016 and found that AsAm women underwent mastectomy may help dispel preconceived notions regarding surgery and
instead of BCT more frequently than NHW women (42.2% reconstruction.
Current Breast Cancer Reports (2024) 16:351–358 355

Survival and Locoregional Recurrence Rates Hispanic (3%) and non-Hispanic white women (2%). In
adjusted analyses, LRR was independently associated with
Within the US breast cancer population, racial disparities increased breast cancer mortality (hazard ratio, 5.71 [95%
exist with regards to overall survival (OS) with AsAms CI, 3.50–9.31]). LRR thus serves as an additional factor that
having the highest 5-year relative survival rate, followed by may help explain disparities in breast cancer mortality, par-
the NHW population, Hispanic, American Indian/Alaska ticularly instances in which there is failure to rescue after
Native, and finally the African American (AA) population LRR [48••]. Strikingly, these Asian patients were part of a
[44]. Overall trends show that mortality from breast cancer clinical trial with relatively high treatment adherence, high-
has been declining in recent years (2016–2020) from 1.0 lighting the unaccounted factors such as social determinants
to 1.4% in the AA, Hispanic, and NHW populations while of health, systemic racism, or other unknown tumor subtype
decreasing only by 0.6% in the AAPI population [3•]. Breast details that may contribute to these disparities.
cancer mortality within the AsAm population has been tra-
ditionally reported as low; however, when the population
is further disaggregated, differences emerge showing that Lack of Asian American Representation
subgroups have varying survival outcomes, demonstrating in Clinical Trials
that the notion of uniformly low breast cancer mortality risk
among Asian women is misleading [45–47]. Gao and Heller It is impossible to adequately address disparate treatment
demonstrated that between 2003 and 2017, breast cancer- and outcomes in the AsAm population without also discuss-
related deaths increased significantly among AsAm women ing the lack of representation in clinical trials and research
(annual percent change [APC], 3.07; P = 0.071), while it initiatives. A 2019 study by Doan et al. evaluated trends in
declined among NHW women (APC, − 2.1; P < 0.001), and AsAm, Native Hawaiian and Pacific Islander participation in
the most pronounced increase in mortality rates occurred research funded by the National Institutes of Health (NIH)
in the Filipina, Korean, and Chinese subgroups [45]. When from 1992 to 2018. They found that just 0.17% of the total
the Native Hawaiian and Pacific Islander (NHPI) popula- NIH budget during this 26-year time period was allocated
tion is disaggregated from the rest of the AsAm population, to clinical research focused on these minority groups [49•].
additional disparities become apparent. Taparra et al. looked Indeed, there have been several recent publications that
at women diagnosed with stage 0-II BC between 2004 and report the underrepresentation of AsAm patients in clini-
2017 who underwent up-front mastectomy or breast-con- cal trials [50, 51]. These findings are important, as without
serving surgery, followed by external beam radiation therapy adequate representation in medical research, it becomes
with or without chemotherapy within 1 year of diagnosis necessary to extrapolate data and assume its relevance to
and found that NHPI had inferior OS compared with NHW a distinct group of breast cancer patients that present with
women (aHR 5 1.38; 95% CI, 1.09 to 1.77), while AsAm unique biologic and genetic manifestations of disease.
had superior OS for all subpopulations: East Asian (aHR 5
0.57; 95% CI, 0.48 to 0.69), South Asian (aHR 5 0.66; 95%
CI, 0.51 to 0.84), and Southeast Asian (aHR 5 0.78; 95% Unique Social Determinants of Health
CI, 0.65 to 0.94) [46]. A retrospective study using the SEER
database showed that while AsAm women had the highest AsAm patients often face unique barriers when navigating
10-year unadjusted OS and cancer-specific survival (CSS) the healthcare system in the US due to differences in cul-
among all racial/ethnic groups, Southeast Asian women had tural beliefs, language discordance, mistrust, and even overt
the worst unadjusted CSS (78%; 95% confidence interval, discrimination [52–54]. These challenges have been specu-
74.1–81.3%; P < 0.001) and had OS rates comparable to that lated to be the cause for poor breast cancer care including
of NHW women [29]. These variations in OS and CSS data the lower rates of up-to-date screening mammography, dif-
emphasize to avoid generalization of the AsAm population ferences in treatment, and survivorship outcomes including
so that unaccounted factors affecting breast cancer survival quality of life measures, or the lack thereof [20, 53, 54]. A
can be further elucidated including social determinants of qualitative study done in the San Francisco Bay Area has
health, cultural preferences, acculturation, and possible shown that Asian breast cancer patients were exposed to
underreporting. multiple medical discriminations including lack of access
Recent studies have shown how racial disparity affects and readily available translation services [52]. The results of
breast cancer local regional recurrence (LRR) rates in their study reveal an unresolved aspect of cancer care, spe-
Asian patients who are part of a clinical trial. Kantor et al. cifically how discrimination can affect breast cancer patients
found in a post-hoc analysis from the TAILOR X study that and survivorship.
8-year rates of breast cancer LRR were the highest among The COVID-19 pandemic has led to a surge in anti-Asian
Asian and non-Hispanic Black women (4%) compared with hate and discrimination and thus has shed light on the health
356 Current Breast Cancer Reports (2024) 16:351–358

inequities that AsAm people may experience. Dee and col- 1. Budiman A, Ruiz NG. Asian Americans are the fastest-grow-
leagues’ commentary to promote investigating this patient ing racial or ethnic group in the U.S. Pew Research Center.
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population from a nuanced perspective including understand- ameri​cans-​are-​the-​faste​st-​growi​ng-​racial-​or-​ethnic-​group-​in-​
ing systematic barriers and racism, disaggregating the AsAm the-u-​s/. Accessed 6 Oct 2022.
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as an individual is essential to further understanding and diverse and growing population. Pew Research Center. n.d.
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Conclusions tistics, 2022. CA Cancer J Clin. 2022;72(6):524–41. https://​
doi.​org/​10.​3322/​caac.​21754. This report on recent breast
cancer statistics showed increasing rates of breast cancer
The rise in breast cancer rates among women of Asian herit- over time among AsAm women in the USA.
age, and particularly the younger AsAm breast cancer popu- 4. Islami F, Guerra CE, Minihan A, et al. American Cancer Soci-
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This study examined the incidence of breast cancer among
minorities such as AsAms have historically been underrep- the disaggregated AsAm population and found an increase
resented in medical research and clinical trials [50, 51]. We among all groups (Chinese, Filipina, Korean, and Vietnam-
also acknowledge that Asian racial and cultural identity, along ese) except Japanese and non-Hispanic white women.
with factors such as language and health literacy, are a contin- 7. Gomez SL, Von Behren J, McKinley M, et al. Breast can-
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9. Fane L, Biswas T, Jindal C, Choi YM, Efird JT. Breast can-
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Author Contribution C.M.E., L.J. and T.J. wrote the main manuscript research. Int J Environ Res Public Health. 2022;19(16):9790.
text. C.M.E., L.J., G.S., J.J., L.A.N., M.M. and T.J. made substantial https://​doi.​org/​10.​3390/​ijerp​h1916​9790.
contributions to the conception and outline of the paper and provided 10. Park B, Cho HM, Lee EH, et al. Does breast density meas-
critical revisions. All authors reviewed the manuscript and approved ured through population-based screening independently
its final version. increase breast cancer risk in Asian females? Clin Epidemiol.
2017;10:61–70. https://​doi.​org/​10.​2147/​CLEP.​S1449​18.
Declarations 11. Kim S, Park B. Association between changes in mammo-
graphic density category and the risk of breast cancer: a
Competing interests The authors declare no competing interests. nationwide cohort study in East-Asian women. Int J Cancer.
2021;148(11):2674–84. https://​doi.​org/​10.​1002/​ijc.​33455.
Human and Animal Rights and Informed Consent This article does not 12.• Paranjpe A, Zheng C, Chagpar AB. Disparities in breast cancer
contain any studies with human or animal subjects performed by any screening between Caucasian and Asian American women. J
of the authors. Surg Res. 2022;277:110–5. https://​doi.​org/​10.​1016/j.​jss.​2022.​
03.​0 32. This study investigated disparities in screening
between non-Hispanic white and the disaggregated AsAm
population and found that when controlling for sociodemo-
graphic factors such as education and insurance status, the
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Current Breast Cancer Reports (2024) 16:351–358 357

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trial found AsAm and Black women had the highest rates of jurisdictional claims in published maps and institutional affiliations.
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49.• Ðoàn LN, Takata Y, Sakuma KLK, Irvin VL. Trends in clini- author(s) or other rightsholder(s); author self-archiving of the accepted
cal research including Asian American, Native Hawaiian, and manuscript version of this article is solely governed by the terms of
Pacific Islander participants funded by the US National Institutes such publishing agreement and applicable law.
of Health, 1992 to 2018. JAMA Netw Open. 2019;2(7):e197432.