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Breast cancer rises among Asian American and Pacific Islander women, and experts aren’t sure why
Christina Kashiwada was traveling for work during the summer of 2018 when she noticed a small, itchy lump in her left breast.
She thought little of it at first. She did routine self-checks and kept up with medical appointments. But a relative urged her to get a mammogram. She took the advice and learned she had stage 3 breast cancer, a revelation that stunned her.
“I’m 36 years old, right?” said Kashiwada, a civil engineer in Sacramento, California. “No one’s thinking about cancer.”
About 11,000 Asian American and Pacific Islander women were diagnosed with breast cancer in 2021 and about 1,500 died. The latest federal data shows the rate of new breast cancer diagnoses in Asian American and Pacific Islander women — a group that once had relatively low rates of diagnosis — is rising much faster than that of many other racial and ethnic groups. The trend is especially sharp among young women such as Kashiwada.
About 55 of every 100,000 Asian American and Pacific Islander women under 50 were diagnosed with breast cancer in 2021, surpassing the rate for Black and Hispanic women and on par with the rate for white women, according to age-adjusted data from the National Institutes of Health. (Hispanic people can be of any race or combination of races but are grouped separately in this data.)
The rate of new breast cancer cases among Asian American and Pacific Islander women under 50 grew by about 52% from 2000 through 2021. Rates for AAPI women 50 to 64 grew 33% and rates for AAPI women 65 and older grew by 43% during that period. By comparison, the rate for women of all ages, races, and ethnicities grew by 3%.
Researchers have picked up on this trend and are racing to find out why it is occuring within this ethnically diverse group. They suspect the answer is complex, ranging from cultural shifts to pressure-filled lifestyles — yet they concede it remains a mystery and difficult for patients and their families to discuss because of cultural differences.
Helen Chew, director of the Clinical Breast Cancer Program at UC Davis Health, said the Asian American diaspora is so broad and diverse that simple explanations for the increase in breast cancer aren’t obvious.
“It’s a real trend,” Chew said, adding that “it is just difficult to tease out exactly why it is. Is it because we’re seeing an influx of people who have less access to care? Is it because of many things culturally where they may not want to come in if they see something on their breast?”
There’s urgency to solve this mystery because it’s costing lives. While women in most ethnic and racial groups are experiencing sharp declines in breast cancer death rates, about 12 of every 100,000 Asian American and Pacific Islander women of any age died from breast cancer in 2023, essentially the same death rate as in 2000, according to age-adjusted, provisional data from the Centers for Disease Control and Prevention. The breast cancer death rate among all women during that period dropped 30%.
The CDC does not break out breast cancer death rates for many different groups of Asian American women, such as those of Chinese or Korean descent. It has, though, begun distinguishing between Asian American women and Pacific Islander women.
Nearly 9,000 Asian American women died from breast cancer from 2018 through 2023, compared with about 500 Native Hawaiian and Pacific Islander women. However, breast cancer death rates were 116% higher among Native Hawaiian and Pacific Islander women than among Asian American women during that period.
Rates of pancreatic, thyroid, colon, and endometrial cancer, along with non-Hodgkin lymphoma rates, have also recently risen significantly among Asian American and Pacific Islander women under 50, NIH data show. Yet breast cancer is much more common among young AAPI women than any of those other types of cancer — especially concerning because young women are more likely to face more aggressive forms of the disease, with high mortality rates.
“We’re seeing somewhere almost around a 4% per-year increase,” said Scarlett Gomez, a professor and epidemiologist at the University of California-San Francisco’s Helen Diller Family Comprehensive Cancer Center. “We’re seeing even more than the 4% per-year increase in Asian/Pacific Islander women less than age 50.”
Gomez is a lead investigator on a large study exploring the causes of cancer in Asian Americans. She said there is not yet enough research to know what is causing the recent spike in breast cancer. The answer may involve multiple risk factors over a long period of time.
“One of the hypotheses that we’re exploring there is the role of stress,” she said. “We’re asking all sorts of questions about different sources of stress, different coping styles throughout the lifetime.”
It’s likely not just that there’s more screening. “We looked at trends by stage at diagnosis and we are seeing similar rates of increase across all stages of disease,” Gomez said.
Veronica Setiawan, a professor and epidemiologist at the Keck School of Medicine of the University of Southern California, said the trend may be related to Asian immigrants adopting some lifestyles that put them at higher risk. Setiawan is a breast cancer survivor who was diagnosed a few years ago at the age of 49.
“Asian women, American women, they become more westernized so they have their puberty younger now — having earlier age at [the first menstrual cycle] is associated with increased risk,” said Setiawan, who is working with Gomez on the cancer study. “Maybe giving birth later, we delay childbearing, we don’t breastfeed — those are all associated with breast cancer risks.”
Moon Chen, a professor at the University of California-Davis and an expert on cancer health disparities, added that only a tiny fraction of NIH funding is devoted to researching cancer among Asian Americans.
Whatever its cause, the trend has created years of anguish for many patients.
Kashiwada underwent a mastectomy following her breast cancer diagnosis. During surgery, doctors at UC Davis Health discovered the cancer had spread to lymph nodes in her underarm. She underwent eight rounds of chemotherapy and 20 sessions of radiation treatment.
Throughout her treatments, Kashiwada kept her ordeal a secret from her grandmother, who had helped raise her. Her grandmother never knew about the diagnosis. “I didn’t want her to worry about me or add stress to her,” Kashiwada said. “She just would probably never sleep if she knew that was happening. It was very important to me to protect her.”
Kashiwada moved in with her parents. Her mom took a leave from work to help take care of her.
Kashiwada’s two young children, who were 3 and 6 at the time, stayed with their dad so she could focus on her recovery.
“The kids would come over after school,” she said. “My dad would pick them up and bring them over to see me almost every day while their dad was at work.”
Kashiwada spent months regaining strength after the radiation treatments. She returned to work but with a doctor’s instruction to avoid lifting heavy objects.
Kashiwada had her final reconstructive surgery a few weeks before COVID lockdowns began in 2020. But her treatment was not finished.
Her doctors had told her that estrogen fed her cancer, so they gave her medicine to put her through early menopause. The treatment was not as effective as they had hoped. Her doctor performed surgery in 2021 to remove her ovaries.
More recently, she was diagnosed with osteopenia and will start injections to stop bone loss.
Kashiwada said she has moved past many of the negative emotions she felt about her illness and wants other young women, including Asian American women like her, to be aware of their elevated risk.
“No matter how healthy you think you are, or you’re exercising, or whatever you’re doing, eating well, which is all the things I was doing — I would say it does not make you invincible or immune,” she said. “Not to say that you should be afraid of everything, but just be very in tune with your body and what your body’s telling you.”
Phillip Reese is a data reporting specialist and an associate professor of journalism at California State University, Sacramento.
This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. KFF Health News is the publisher of California Healthline, an editorially independent service of the California Health Care Foundation.
Lewes, England — In an urban nature reserve in a small town about two hours south of London, you’ll find the Lewes Railway Land urban nature reserve teaming with life — including a lot of humans and their companions.
“We get lots of people come onto the reserve — which we want — lots of dog walkers,” Dylan Walker, with the Railway Land Wildlife Trust that manages the green oasis, told CBS News. “Inevitably, that has an impact on the habitat.”
After years of heavy use, the reserve has suffered a little for its popularity, losing some native plant species. But Walker is hoping to bring that biodiversity back.
“We were kind of going, what could we do here?” Walker said. They found the answer in a backpack, designed specifically for dogs.
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“We’ve got our seed and sand mix here, of our native wildflowers and grasses, and we’re going to put them inside the pack,” Walker explained, noting the importance of ensuring that any seeds spread deliberately in a natural area must be native to the region.
Small holes allow the seeds inside to drop out as dogs move around.
Ruthie Martin tested it out on her daughter’s golden doodle when she came to the reserve for a walk.
“They don’t mind the packs on their backs,” Martin said of the canine seed sowers.
More than 300 years ago, wolves roamed the U.K., often covering up to 100 miles in a single night. Walker said they’d pick up seeds in their fur and drop them in new places.
“It’s really great to have this kind of project where we could use our beloved pets to imitate the behavior of these wild animals,” said Martin.
It’s an idea that initially came from two sisters in Chile, whose backpack-wearing dogs have been helping to regrow forests destroyed by wildfires.
Organizers in the U.K. say it could take a couple years to see the full impact of the pilot project on the reserve.
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Will 988 call the police? Data suggests 1% of mental health crisis calls get “involuntary” rescues
Many people in mental health crisis fear that if they dial 988, law enforcement might show up or they might be forced to go to the hospital.
But getting sent that kind of “involuntary emergency rescue” happens to around 1% of callers, suggests new data from Vibrant Emotional Health, the administrator of the 988 Lifeline for suicide and mental health crises.
“Involuntary intervention is the last resort. We want to make sure we’re collaborating and engaging with people in crisis and empowering them, so we don’t need to go in that direction,” said Christopher Drapeau, Vibrant’s director of research and evaluation.
A Pew Charitable Trusts survey last year cited by Vibrant’s white paper found that around 1 in 5 adults worry that law enforcement would be sent after them for using 988 or that they might be forced to go to the hospital.
According to 988’s policies, counselors are urged to use “the least invasive intervention” possible to respond to suicide attempts. But if other attempts to deescalate fail, then counselors can summon other emergency response services like an involuntary rescue.
Counselors for 988 do not have the ability to track the exact location of callers. But the Substance Abuse and Mental Health Services Administration or SAMHSA, which oversees Vibrant and the hotline, says in “rare situations” that counselors are able to ask a 911 dispatcher to use “geolocation services” to try and find where a call is coming from.
It is not clear from the data what percentage of the “involuntary” rescues relied on police responding to calls, as opposed to paramedics or another kind of emergency response.
“We haven’t been this transparent in the past. So we want to acknowledge that, and show people that this is what we have,” Drapeau told CBS News of the white paper he authored.
Drapeau said the white paper is his team’s first evaluating the performance of 988 and is the most comprehensive look at the topic to date. The idea for the report came from talks with SAMHSA officials.
Law enforcement have often been the go-to for 911 dispatchers responding to suicide attempts. Advocacy groups have called for more jurisdictions to fund “mobile crisis teams” that can respond to suicide attempts with medics and behavioral health professionals, instead of police.
“If somebody attempted suicide during the call and had a medical injury as a result, you need to respond to that. So I don’t know if we could completely abolish all involuntary interventions,” Drapeau said.
“These numbers may not be perfect”
Vibrant’s white paper focuses on two snapshots of data that come largely from when the line was a 1-800 number, before the nationwide launch of the easier-to-remember 988 shortcut to reach a counselor during a mental health crisis.
The largest snapshot in the paper still only spans around 2 million calls made from 2019 through 2023, tallied from a fraction of the now more than 200 locally run crisis centers that underpin the network.
For context, more than 400,000 calls were routed by the 988 network in July alone.
“We acknowledge the limitations of these data. These numbers may not be perfect. They may differ if we had every single center reporting data, if we had a more precise definition, maybe it changes. But it appears today that the vast majority of 988 calls do not involve emergency services intervention,” said Drapeau.
Of those nearly 2 million calls, the white paper tallies around 2% resulting in emergency services – both “voluntary” and “involuntary” – being sent in response to calls.
Callers categorized by counselors as being at “imminent risk” of suicide, a much narrower group, had emergency services sent to them at a higher rate.
Among those, a quarter got “voluntary dispatches” — with the consent of the callers — while another quarter got “involuntary” rescues.
Better data is in the works. While current figures rely on a mix of requirements and voluntary reporting, a Vibrant spokesperson said it is working with SAMHSA to develop a national standard for what metrics all centers will be required to report in the future.
A plan drawn up by SAMHSA in April calls for states to submit data to the agency on the number of contacts that result in law enforcement being sent.
Another evaluation planned by Vibrant will try to refine the definition of when to deem a caller at “imminent risk” and how to handle those cases. Completing that evaluation will likely take a couple of years, Drapeau said, and will help them figure out how to move from involuntary to more collaborative interventions.
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Over 30 killed in Mexico cartel stronghold as violence rages after Sinaloa leaders detained in U.S.
Eleven more people have been killed in a wave of violence in a Mexican cartel heartland shaken by gang infighting, authorities said Sunday.
The latest fatalities included five men whose bodies were found on a highway south of the city of Culiacan, the Sinaloa state prosecutor’s office said in a daily update.
More than 30 people have been reported dead in a week of bloodshed in Sinaloa, although authorities did not specify how many were believed to be linked to the cartel infighting.
The clashes follow the dramatic arrest on U.S. soil on July 25 of Sinaloa Cartel co-founder Ismael “El Mayo” Zambada, who claimed he had been kidnapped in Mexico and delivered into US custody against his will. Zambada pleaded not guilty last week in New York in a drug trafficking case that accuses him of engaging in murder plots and ordering torture.
Zambada, 76, was detained along with Joaquin Guzman Lopez, a son of El Chapo, who is serving a life sentence in the United States.
The violence is believed to pit gang members loyal to El Chapo and his sons against others aligned with Zambada, who pleaded not guilty to a raft of charges in a New York court Friday.
Schools were closed Thursday and Friday due to the violence and the governor said Sunday’s Independence Day festivities had been canceled.
The United States on Thursday issued a security alert because of “reports of car thefts, gunfire, security forces operations, roadblocks, burning vehicles and closed roadways” in the vicinity of Culiacan.
IVAN MEDINA/AFP via Getty Images
In an unexpected twist, last month Mexican prosecutors said they were bringing charges against Guzmán for apparently kidnapping Zambada — but it also cited another charge under an article of Mexico’s criminal code that defines what he did as treason.
Nowhere in the statement does it mention that the younger Guzmán was a member of the Chapitos — “little Chapos” — faction of the Sinaloa cartel, made up of Chapo’s sons, that smuggles millions of doses of the deadly opioid fentanyl into the United States, causing about 70,000 overdose deaths each year. According to a 2023 indictment by the U.S. Justice Department, the Chapitos and their cartel associates used corkscrews, electrocution and hot chiles to torture their rivals while some of their victims were “fed dead or alive to tigers.”
El Chapo, the Sinaloa cartel’s founder, is serving a life sentence in a maximum security prison in Colorado after being convicted in 2019 on charges including drug trafficking, money laundering and weapons-related offenses.
Last year, El Chapo sent an “SOS” message to Mexico’s president, alleging that he has been subjected to “psychological torment” in prison.
