CANCER-RELATED RESEARCH in Asian Americans suggests this large group of people has a lower risk of developing and dying from cancer than other ethnic groups. But Asian subgroups living in the U.S. likely have different chances of developing cancer depending on multiple factors, including their country of origin. Asian Americans can trace their origins to more than 20 countries, but research often lumps this heterogeneous group into one broad category that includes people from different regions of Asia, as well as Pacific Islanders and Native Hawaiians.
Scarlett Lin Gomez, an epidemiologist and the co-leader of the Cancer Control Program at the UCSF Helen Diller Family Comprehensive Cancer Center in San Francisco, has published numerous studies that glean information from registries and paint a clearer picture of cancer patterns among Asian Americans and other ethnic groups. During the opening session of the AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved, held in Los Angeles in September 2024, Gomez highlighted the diversity of Asian American groups, including differences in educational levels and socioeconomic status—as well as the rising rates of certain cancers, including breast cancer, among young Asian American women. (The AACR also publishes Cancer Today.)
As one of three principal investigators for a new study called ASPIRE, Gomez says she hopes to better understand cancer risk in people of various Asian ethnic backgrounds and the impact factors such as stress, environment and neighborhood have on their chances of developing and surviving cancer. ASPIRE, which stands for Asian American Prospective Research, initially aims to recruit 20,000 Asian Americans between ages 40 and 75 who do not have cancer so researchers can observe factors that play a role in cancer development.
Gomez spoke with Cancer Today about the importance of cohort trials like ASPIRE.
CT: What is a cohort study?
GOMEZ: A cohort study follows a large group of people with a common characteristic—such as ethnicity, geographic location, occupation, environmental exposures—and tracks how many develop a certain outcome of interest, such as cancer. There are also cancer survivorship cohort studies, which follow large groups of cancer survivors to learn more about outcomes, such as recurrence and quality of life. There’s great value in using cohorts to dive in deeply and focus on understudied, underserved racial and ethnic groups.
CT: Why is this study important?
GOMEZ: Cancer research on Asian Americans has been underfunded, so we actually know very little about the risk of different groups that make up Asian Americans. What we do know is based on research that has aggregated this vast heterogeneous group together. The data that suggest a lower risk of cancer among Asian Americans use the largest ethnic groups that make up this group, so that includes Japanese, Chinese and Filipinos.
But we also know that certain Asian American subgroups have higher risks of certain cancers, such as cancers of infectious origins, including gastric, liver and cervical cancers. Our work has shown a higher risk of cancer among Asian American females who’ve never smoked. An emerging trend is the increasing rates of breast cancer among Asian American women, especially before age 50. So, we need to find out what factors are contributing to these patterns.
CT: How will you ensure representation from all Asian American subgroups?
GOMEZ: This is a national study, but we have six recruitment sites on the East and West Coasts, in areas where more than one-third of the population is Asian American. These investigators have decades of experience working with community-based organizations and health centers in their regions. Our team has bilingual field staff who are out there talking to patients and participants every day. You can’t rely on phone calls and social media. We plan to meet people where they are—whether they’re comfortable filling out surveys online, with pen and paper, or through an interview. I think of people like my parents, whom you could only reach if you went to their senior center and spoke to them in Taiwanese.
CT: What are you interested in learning?
GOMEZ: Initially, we want to look at screening rates. We’re interested in health behaviors associated with increased cancer risk—and the structural and social factors that drive them. Stress is a pathway we’re really interested in understanding better, and in the longer term, we hope to look at potential biomarkers of stress and aging. Our group also has expertise in geospatial data, which captures the social structures and neighborhoods where people live and work, as well as their environmental exposures.
CT: What is the value of studies that look at these factors?
GOMEZ: There is so much value in studying dynamic populations going through rapid changes within a generation or two. The sentiment from community leaders and the residents is, “Finally, a study that’s just for us.” Cohort studies are a legacy you leave for new generations of researchers who can utilize the data to conduct research of their own. And it’s a legacy we can leave for Asian American communities, too, so they have data they can take to policymakers to effect change. Anyone who takes part in a cohort study contributes to knowledge with great benefit for future generations.
This interview has been edited and condensed for clarity.
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