Stephanie Tran’s life flipped when she was diagnosed with Paget’s disease, a rare form of cancer in her left breast, at 35 years old.
“Of course I was sad, I have two young kids, including a daughter. And now I have to think about her getting screened early, to know the signs and symptoms,” said Tran, now 38. “My mom passed away (from lung cancer) when I was 23, and I’m thinking, with any cancer, there’s so much unknown … you don’t know what stage you’re at or what’s next. So I was very emotional. It was like, what’s going to happen to my family? Who will take care of my kids?”
The Garden Grove resident said that with her condition – and no history of breast cancer in her immediate family line – she decided a double mastectomy was her best option, and elected to have the surgery in September 2021 at Providence St. Joseph Hospital in Orange.
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“I’m very thankful God gave me another chance,” Tran said. “As long as I’m cancer-free, other issues are all little things. My biggest goal is to raise my kids, but the fear is always there … for me, it’s not just about getting the surgery and having the cancer gone – it’s living. I don’t think you’re ever completely back to normal.”
A new Centers for Disease Control and Prevention and National Institutes of Health study, released in the fall, reveals an alarming rise in breast cancer rates among Asian American and Pacific Islander (AAPI) women – a group that once had relatively low rates of diagnosis. About 11,000 AAPI women, Tran included, were diagnosed with breast cancer in 2021, with about 1,500 deaths reported, research showed.
And breast cancer is affecting a larger number of younger AAPI women – a health trend previously unheard of, researchers say.
About 55 of every 100,000 AAPI women under age 50 were diagnosed with breast cancer in 2021, surpassing the rate for Black and Hispanic women, and on par with the rate of breast cancer in White women, data showed. Also, the rate of new breast cancer cases among AAPIs under 50 grew by about 52% from 2000 through 2021, the time frame of the study.
Meanwhile, breast cancer diagnoses for AAPI women between 50 to 64 grew 33% during the same time, and rates for AAPI women 65 and older grew by 43%. By comparison, the rate of diagnoses for women of all ages, races and ethnicities grew by 3%.
Though rates aren’t broken out for different ethnic groups, such as Chinese, Filipino or Korean women, the CDC distinguishes between Asian American women and Pacific Islander women. Research found that nearly 9,000 Asian American women died from breast cancer from 2018 through 2023 – compared with around 500 Native Hawaiian and Pacific Islander (NHPI) women, who had a 116% higher chance of dying from the cancer.
A similar report from the American Cancer Society, published in October, revealed declining numbers in breast cancer mortality overall, but a sharp increase among AAPI women.
Since 2000, breast cancer rates among AAPI women under age 50 have increased by about 50%, which the report said is more than 2% every year since 2012 (about 2.5 to 2.7% per year). By comparison, AAPI women under 50 years old had the second-lowest rate of breast cancer among all racial groups over 20 years ago.
AAPI women in this cohort now have the highest rate, alongside White women – about 86 per 100,000 cases.
Dr. Hang Dang, Tran’s oncologist at the Center for Cancer Prevention and Treatment at St. Joseph’s Hospital, said that the rise in younger breast cancer diagnoses shows that family history is not always a factor; cancer can be “sporadic.”
Adapting to a more “Westernized lifestyle” – one with fattier diets, higher obesity rates, later births, less exercise, alcohol consumption, “culturally normalized” stress, or lower socioeconomic status – can all contribute to any risk.
Some Asian women don’t think twice about the possibility of cancer because they could have smaller breast sizes, Dang noted. However, growing research shows that Asian women could have a higher prevalence of dense breast tissues, meaning they have more glands and tissue than fat – and thus could be more likely to develop it than women of other racial groups.
“Education, research and early detection are so important. I do think that some in the Asian community, especially the older ones, when there’s no problem, they don’t want to see a physician,” Dang said. “They wait until there’s an actual issue. Sometimes it’s when it’s almost too late and there’s a large mass growing in the breast, then they’re like, ‘OK, fine, I want to see somebody now.’”
But as an AAPI woman in the field herself, Dang’s goal is to “make sure that my patients see themselves in five to 10 years,” and no matter their age or any cultural stigmas, that women learn to advocate for themselves if they know something is wrong – just like her patient Stephanie Tran did.
As a survivor, Tran feels like she has to advocate for more women to get annual breast exams and know the signs – which she conceded that she herself could have easily missed.
Tran, who works as a physician’s assistant in home health, hopes that by sharing her experiences, she can better connect with her patients at work and with other women in the AAPI community, encouraging them to get themselves checked routinely.
“We have to adapt and have a positive mindset. Of course, I’m always afraid of a recurrence or another type of cancer,” Tran shared. “But once you’ve gone through it, you’re always thankful to live another day, and not take that for granted.”
Importance of early testing
Dr. Shilpa Jindani, director of equity and community health at CalOptima Health, said that some factors for rising breast cancer rates can include genetic predispositions and overall lifestyle changes.
CalOptima Health data demonstrated that across four cancer types – including breast, cervical, colorectal and lung cancers – members of the AAPI community were “overrepresented in the late-stage diagnoses.”
The organization has invested in cancer research and resources, working directly with Southern California AAPI organizations – including Korean Community Services, the Orange County Asian Pacific Islander Community Alliance, the Cambodian Family and the Vietnamese American Cancer Foundation – to promote early detection and frequent screenings.
“The direct benefit of cancer screening is more joy and time with loved ones. Because when cancer is caught early, the chances of beating it go way up,” Jindani said. “We want to flip the script and change any negative associations with cancer screening to strongly positive ones – a long and happy life.”
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Survivor Jovanne Anguluan, from Torrance, understands this benefit well. She was only 30 years old, about to start a nursing program in Long Beach, when she noticed a lump in her right breast.
”I went to have it checked, got an ultrasound and mammogram – they immediately told me that something was off,” Anguluan, now 44, said. She thought getting routine testing was only after a certain age. “At first I was in denial. I never thought I would get breast cancer; no one else had it in my family. The memory is still vivid until now — I had early stage 3 and the tumor was already growing big.”
After more than a decade of spreading out treatments to fully get rid of the cancer — including a mastectomy surgery in 2010, chemotherapy, radiation and hormone pills — she had a biopsy earlier this month “just to make sure it hasn’t come back.” During the time, Anguluan also lost an aunt to stage 4 breast cancer in the Philippines.
“Having gone through the cancer journey, I look at life very differently now; it’s so fragile and valuable. Anything can change in an instant,” she said. “I’m so blessed I was given a chance to continue life – not many (like my aunt) are given that same chance.”
Two years after her initial diagnosis, Anguluan was able to go back to nursing school, later becoming a hospice nurse serving the South Bay area, where she works with other cancer patients. She also does her part in raising awareness among peers, posting videos about doing at-home breast checks, and being involved in October Breast Cancer Awareness Month drives.
Seeing more Asian American women like herself being diagnosed, Anguluan said, “says something.” Breast cancer is “not just the disease of the elderly, or the disease of White women. It’s very important for people to know that cancer is not discriminatory; it doesn’t matter what race or age … early detection can save lives. It saved mine.”
Dr. Sarina Pai, Anguluan’s radiologist and co-director at the Polak Breast Diagnostic Center at Torrance Memorial Medical Center, said that AAPI women are among the groups who get screened regularly the least.
Pai said that getting earlier mammograms – recommended annually at age 40, or before depending on race or background – has helped cut cancer deaths by 40%. Women should be aware of symptoms, which can include a palpable lump, rash or skin changes, nipple discharge and skin indentation.
Also, Pai said, providing “culturally sensitive” cancer research – with the knowledge of long-standing attitudes, including any stigmas in the AAPI community, toward health – can optimize care.
Dr. Preeti Chaudhary, an oncologist at Pomona Valley Hospital Medical Center, also emphasized more diversity in clinical studies and community program outreach, which helps underserved women get access to high-quality screenings and treatments.
“There is definitely an urgency to solve this mystery because it is costing lives,” Chaudhary said. “Spreading more awareness among Asian Americans and NHPI women is critical. This has caused a lot of anguish, but research is ongoing to understand this better.”
One of Chaudhary’s patients, Katey Vuong, is still battling cancer in one breast. Vuong was diagnosed in November 2023 and had multiple surgeries to remove the cancerous tissues on her right breast. Then, earlier this year, she was diagnosed on her left, went in for a partial mastectomy, and is restarting radiation treatments soon.
Having the support of loved ones – and staying joyful throughout it all – is what keeps Vuong going, the Claremont resident and home health nurse said, despite multiple surgeries and weekly radiation treatments.
“If I could do anything differently, it would be getting my checkups sooner, so I don’t want to worry more. Why worry all those extra days?” Vuong, 45, said. “I kept pushing it off – and that’s when they found something. Don’t assume. As Asians, the way we were raised is (to not) talk about it. Now, I do the complete opposite. … If testing could save your life, just go do it.”
KFF Health News contributed to this report.