Cervical cancer disparities in stage at presentation for disaggregated Asian Americans, Native Hawaiians, and Pacific Islanders.
Authors: Thaploo Advait , Ho Frances Dominique , Wang Katarina , Narayan Aditya , Alberto Isabelle , Ong Erika , Kohli Khushi , Kohli Mahi , Jain Bhav , Dee Edward Christopher Christopher , Gomez Scarlett L. , Janopaul-Naylor James Robert , Chino Fumiko 
Published: June 2024

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Background: Over 20 million Americans identify as Asian American, Native Hawaiian, or Pacific Islander (AANHPI). Despite the diversity of indigenous and immigration histories, lived experiences, and health needs within the AANHPI community, prior research has considered this group as an aggregate. Given known disparities in access to cancer screening, this study assessed on cervical cancer stage at presentation, focusing on disaggregated AANHPI groups. Methods: Data from the National Cancer Database (NCDB) from 2004 to 2020 identified patients with newly diagnosed cervical cancer. Patients were disaggregated into AANHPI groups by indigenous history or historical country of origin. We performed ordinal logistic regression, adjusting for clinical and sociodemographic factors, with higher adjusted odds ratios (aORs) indicating diagnoses at later stages on a local, regional, and metastatic scale. Results: Out of 82,193 patients with cervical cancer, 3,943 (4.80%) identified as AANHPI. Compared to non-Hispanic White (NHW) patients, pooled AANHPI patients were slightly older (median age, NHW: 55 years, AANHPI: 56 years, χ2 P<0.001) and more likely to be uninsured or on Medicaid (NHW: 25.6%, AANHPI: 34.0%, χ2 P<0.001). In aggregate, AANHPI patients presented at lower stages of cancer (NWH: 58.7% diagnosed local/regional, AANHPI: 85.6% at local/regional, χ2 P<0.001). The largest AANHPI subgroups included Chinese (n=802, 20.3% of AANHPI), Filipinos (n=777, 19.7%), Asian Indian/Pakistani (n=554, 14.0%), Vietnamese (n=480, 12.2%), and Korean (n=452, 11.5%) Americans respectively. AANHPI disaggregation revealed that Pacific Islander patients had higher odds of later stage at diagnosis (aOR 1.59, 95% CI 1.24–2.03, p < 0.001) relative to NHW patients. Conversely, Chinese (aOR 0.64, 95% CI 0.56–0.73, p < 0.001) and Vietnamese (aOR 0.77, 95% CI 0.65–0.91, p = 0.003) American patients were less likely to represent at later stage. Compared to the largest AANHPI group (Chinese American), all other subgroups were more likely to present at a higher stage. The largest differences were observed in Thai (aOR 2.84, 95% CI 1.56–5.14, p = 0.001), Pacific Islander (aOR 2.71, 95% CI 2.03–3.63, p < 0.001), Hmong (aOR 2.03, 95% CI 1.30–3.18, p = 0.002), Laotian (aOR 1.96, 95% CI 1.27–3.02, p = 0.002), and Korean (aOR 1.87, 95% CI 1.49–2.34, p < 0.001) American patients. Conclusions: Aggregated evaluation of the AANHPI monolith masks disparities in outcomes for distinct populations at risk for equity gaps. This disaggregation study shows that marginalized groups within the larger AANHPI population – including Hmong and Pacific Islander patients – may face different exposures and larger structural barriers to cancer screening and early-stage diagnosis. A future focus on community based disaggregated research and tailored interventions is necessary to close these gaps.