Young Native Hawaiians and Pacific Islanders face highest cancer death rates

May 3, 2023

The National Cancer Institute (NCI) has revealed for the first time ever that young Native Hawaiians and Pacific Islanders (NHPI) experience the highest rates of cancer death among people their age in any other race group in the United States.

A manuscript published in the Journal of the National Cancer Institute (JNCI) reports that between 2018 and 2020, NHPI between the ages of 20 and 49 had the highest death rate from any cancer, compared to 20 to 49 year-olds from other racial and ethnic groups (American Indian/Alaska Native, Asian, Black, Latino, or White). The new research highlights the importance of disaggregating Asians and Native Hawaiians/Pacific Islanders cancer data.

University of Hawaiʻi Cancer Center researcher and Hawaiʻi Tumor Registry (HTR) Principal Investigator, Brenda Hernandez, PhD, MPH, says that these disparities clearly demonstrate the importance of disaggregation of Asians and NHPIs from one another.

Until recently, race reporting at the federal level in the U.S. lumped Americans of Asian, Native Hawaiian, and Pacific Islander ancestry all in a single category. In 1997, the “Asian/Pacific Islander” category was split into “Asian” and “Native Hawaiian or other Pacific Islander.” It took another 10 years to transition fully to using the updated race list on individual states’ death certificates, so statistics like cancer death rates for this new set of races have only been reportable since 2018. Because of Hawaiʻi’s unique multiethnic composition, the HTR, responsible for cancer surveillance in the state of Hawaiʻi, has long collected and reported these more granular statistics.

“In Hawaiʻi, Asian, Native Hawaiian, and Pacific Islander ethnic communities have experienced dramatically different cancer burdens,” Hernandez said. Last year, the HTR’s Hawaiʻi Cancer at a Glance revealed that Native Hawaiian women have higher death rates from breast and lung cancers than do women of Chinese, Filipino, Japanese, other Asian, and white races in Hawaiʻi.

Addressing disparities from multiple angles

Under the leadership of new director Naoto Ueno, MD, PhD, the UH Cancer Center is taking a “multifactorial approach” to addressing these disparities. This includes construction on the highly-anticipated Early Phase Clinical Research Center, which would allow Cancer Center researchers to conduct innovative trials in Kaka‘ako. It also involves intense efforts led by the Cancer Center in collaboration with the State, legislators, local healthcare systems, advisory boards, patient advocacy groups, and others.

“We are trying to establish more robust clinical research so that we can provide more clinical trials that would allow people to stay in state,” Ueno said. “We need to make a collective impact with the various stakeholders, and the Cancer Center could be the driving force to make these changes.”

Ueno said that the JNCI report is timely as May is Asian American, Native Hawaiian, and Pacific Islander Heritage Month. However, it does not change the UH Cancer Center’s philosophy or general direction, since the Cancer Center is already focused on serving the needs of the residents of Hawaiʻi and USAPI, which includes large Asian, Native Hawaiian, and Pacific Islander populations; however, it does raise awareness at the national level. This then provides more opportunities for funding of more focused research related to unique diverse ethnic backgrounds.

“Even for clinical trials, if we can determine the genomic and molecular connection between the kind of aggressive disease you have, we can potentially personalize treatment based on racial or ethnic background,” he said. “There are many different opportunities with UH Cancer Center, National Institutes of Health (NIH), NCI, and pharmaceutical companies to bring better treatment and diagnostic tools, etc.”

Native Hawaiian oncologist: ‘That’s what I saw’

By the time he graduated from Kamehameha Schools Kapālama in 2008, Kekoa Taparra, one of the authors of the JNCI article, a number of close family members had been diagnosed with cancer. Every one of them died of cancer by the time he earned his bachelor’s degree. The ones in the 20- to 49-year age range had died the quickest. “When they sent me (a draft of) this manuscript, it resonated with me,” Taparra said. “Growing up, I thought that, as a Hawaiian, if you get cancer, you die from cancer, ‘cause that’s what I saw.”

Now, as a resident physician specializing in radiation oncology at Stanford, Kekoa Taparra, MD, PhD, treats scheduled patients in his department, and he treats patients when he is on call in the Emergency Department (ED). A great proportion of his patients who are Native Hawaiian or Pacific Islander are the ones who end up meeting him through the ED, who may be in an emergent situation because their symptoms have been ignored by other physicians or because they lack access to health care.

Taparra’s mission is to return to Hawaiʻi to practice medicine, and he, like Ueno, feels that this new data being published is an important step in educating people who, unlike him, did not grow up learning about Hawaiʻi and the Pacific.

“My mission has always been to come home, to take care of the lāhui back home that raised me,” he said. “The data doesn’t change that, but what it does is inform people that there are Pacific populations that are different from Asian Americans… I don’t blame people on the continent for not knowing that, but I want people to hear it and know it.”