Younger Indian and Pakistani Women Diagnosed with Aggressive Breast Cancer

Women of Indian and Pakistani descent are more often diagnosed – at a younger age -- with more aggressive forms of breast cancer, and they could benefit from more culturally targeted screening and prevention strategies, experts have said.

Finding ways to reach these women successfully is critical, according to investigators from Rutgers University because the South Asian population is the fastest-growing group in the United States – and breast cancer rates among these women are increasing. To date, research has provided little data about the disease and this unique population.

To offer more clarity, Rutgers researchers looked at the characteristics of breast cancers in women of Indian and Pakistani descent and compared those findings to results from non-Hispanic white women in the United States. They published their findings Oct. 25 in the International Journal of Cancer.

“Our results provide an insight into breast cancer in Indian and Pakistani women, suggesting several hypotheses to guide future scientific studies to better understand the risk factors influencing disease etiology and prognosis,” said Jaya M. Satagopan, Ph.D., professor of biostatistics and epidemiology and director of the Center for South Asian Quantitative Health and Education at Rutger’s School of Public Health.

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To draw these comparisons, Satagopan’s team examined data from the National Cancer Institute’s Surveillance, Epidemiology and End Results Program. They analyzed incidence data from women of Indian and Pakistani descent gathered from 1990 to 2014, as well as disease characteristics, treatment, and survival data captured between 2000 and 2016 for 4,900 women in these groups. In additional, they examined the same data from 482,250 non-Hispanic white women who had breast cancer.

Based on their analysis, they determined that, while breast cancer occurrence was lower in women of Indian and Pakistani descent, the number of diagnosed cancers increased throughout the years studied. Additionally, women in these groups were more likely to be diagnosed with a more advanced-stage disease at a younger age.

As a result, the team said, women of Indian and Pakistani descent received more subcutaneous or total mastectomies than non-Hispanic white women. And, even though they had lower breast cancer mortality than their white counterparts, their health outcomes were tracked for less time.

Historically, Satagopan said, fewer women of Indian and Pakistani descent have participated in scientific research, and many delay seeking necessary health services due to sociocultural factors. Specifically, diminished family support, transportation difficulties, modesty, fear, and beliefs about cancer being a divine punishment for past misdeeds have all factored into poor mammogram screening rates in this group. This is particularly true for women who have lived in the United States less than a decade, have low English proficiency, and do not have confidence in the U.S. healthcare system, she said.

Consequently, the team determined, the industry must devise strategies than can specifically engage women of Indian and Pakistani descent into breast cancer studies, potentially improving their experiences and interactions with healthcare providers. Identifying the sociocultural factors that come into play with their screening and healthcare use decisions is paramount, they said.

“As the South Asian population in the United States grows, it is imperative that we work to promote health equity in cancer prevention, screening, early diagnosis, and treatment through community engagement and a team science approach, said Anita Kinney, Ph.D., RN, director of the Center for Cancer Health Equity at Rutgers School of Public Health and Rutgers Cancer Institute of New Jersey.

Ultimately, the team said, their study findings point to the existence of important differences within this population that support further study. Future research should focus on findings ways to better understand the biological, sociocultural, and system-level factors that impact breast cancer screening patterns and diagnosis, as well as risk and survival rates in women of Indian and Pakistani descent.

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