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Despite being diagnosed later with more advanced disease, Asian Americans typically live longer than other U.S. populations.
New statistical analysis by MedStar Health Research Institute scientists has revealed details about Asian Americans and lung cancer that offers the tantalizing potential to one day reshape cancer care for everyone in the U.S.
The category “Asian American” includes very diverse sub-populations of people and their ancestors from many different countries and regions, each with distinct ethnicities. When broadly considered, Asian American or Pacific Islander is the only population in the U.S. for whom cancer is the leading cause of death.
The purpose of the study was to examine lung cancer stage at diagnosis and survival between Asian Americans and those of Hispanic, African, and White non-Hispanic descent. Our researchers found that:
- Fewer Asian Americans are diagnosed with Stage IIB lung cancer—an early stage that is easier to treat.
- More Asian Americans are diagnosed with Stage IV lung cancer—advanced lung cancer that has spread.
- Despite these differences, Asian Americans typically survive longer despite presenting with advanced lung cancer.
Now the questions become why these patients aren’t being diagnosed sooner and how they survive longer with more severe lung cancer. Understanding the answers will help improve care for Asian American patients—and could lead to better care for all patients with lung cancer.
Peeling back layers in the National Cancer Database.
Our quest for answers began in the National Cancer Database, which contains data on every patient treated at a cancer institute in the U.S. We analyzed data from more than 800,000 patients with lung cancer from 2004 to 2016.
This critical research led by first-year medical student and Principal Investigator Yunna Gu is part of her capstone project under my mentorship. We collaborated with statistician Dr. Les Becker at MedStar Simulation Training and Education Lab (SiTEL) to analyze the data, and Georgetown Medical School provided initial funding.
We first separated the data into patient population groups to perform a statistical analysis on this data. This is the first time the different populations of Asian Americans have been compared in this way to our knowledge. The groups included:
- East Asian: Chinese, Japanese, Korean
- Southeast Asian: Filipino, Vietnamese, Laotian, Hmong, Thai
- South Asian: Asian Indian, Pakistani, and Asian Indian/Pakistani
Data from these groups were compared to other U.S. ethnicities: White Non-Hispanic, Black, and Hispanic. By classifying Asian American patients into subpopulations, we revealed significant findings:
- Fewer Asian Americans are diagnosed with Stage IIB lung cancer. In this relatively early stage, a tumor is five centimeters or smaller and has spread to the nearest lymph nodes on the same side of the chest.
- More Asian Americans are diagnosed with Stage IV lung cancer. At this advanced stage, the cancer has spread to other areas of the lung, the fluid around the heart, or other body parts through the bloodstream.
- All groups of Asian Americans tend to survive lung cancer significantly longer than people of other ethnicities despite being diagnosed with later-stage disease and being less likely to have lung cancer surgery due to a variety of cultural factors, including language barriers, stigma, guilt, and not wanting to be a burden on family members.
While data sources like the National Cancer Database are essential, they’re not designed to answer questions like, “Why do some people live longer with cancer than others?” What the data can do, however, is help us identify trends that can then become the focus of further research.
Next steps: Learning why.
We have submitted our initial findings for publication, and our work continues to try to understand why Asian Americans survive lung cancer longer than other people in the U.S. despite later-stage diagnosis. We’re continuing to analyze the data to consider whether socioeconomic, geographic, genetic, or other factors might explain these outcomes.
This research relates directly to improving patient care. Lung cancer detected at an early stage is much more likely to be treated successfully. Any time we can improve our understanding of who is at risk for developing cancer, doctors and patients will be better equipped with the knowledge to save lives.
If we can understand why Asian Americans tend to have better success surviving lung cancer, we may be able to apply that knowledge to help even more patients.
