Cancer is a complex disease that affects different ethnic groups in various ways, and studying these disparities can help develop effective prevention, early detection and treatment strategies to promote healthy lifestyles and health equity.
In Hawaii, cancer incidence and mortality rates have declined over the past decade, but cancer disparities remain a concerning issue. Native Hawaiians continue to have the highest cancer incidence and mortality rates among men and women and have higher incidences of breast and ovarian cancers. Similarly, Filipino Americans have high incidence rates for lung, colorectal and thyroid cancer and rapidly increasing rates of breast and prostate cancers.
National data typically aggregate health information for Asian Americans, Native Hawaiians and Pacific Islanders, ignoring the cultural and lifestyle diversity of these groups and masking their marked differences in cancer incidence and outcomes. Studies primarily conducted in Hawaii, using disaggregated data, have shown that known risk factors, such as tobacco use and obesity, do not fully account for cancer disparities alone.
Additional factors, such as social determinants of health — including income and social stress — and environmental and occupational exposures, may contribute to differences in cancer occurrence and survival rates. However, due to gaps in the available data, additional risk and protective factors that may drive cancer disparities remain unknown. Likewise, little is known regarding the biological mechanisms that explain these disparities.
To address these critical gaps, a new multiethnic study in Hawaii that includes representation from affected communities is urgently needed. The University of Hawaii Cancer Center is one of 71 National Cancer Institute-designated cancer centers in the country and is uniquely positioned to conduct research on cancer disparities among Native Hawaiians, Pacific Islanders and Filipinos that cannot be easily conducted anywhere else in the world.
The Hawaii Legislature can support and help fund such a study, via House Bill 1301, which would help fill gaps in the available data and provide a more comprehensive understanding of cancer risk and outcomes among different ethnic groups in the Islands. The multiethnic cohort study would focus on social determinants of health, lifestyles, novel risk factors and environmental and occupational exposures, as well as resilience factors among Native Hawaiians, other Pacific Islanders and Filipinos.
If funded, this preliminary study would bolster chances of securing a National Institutes of Health grant and foster new valuable partnerships with communities to identify shared research priorities and support recruitment efforts.
Findings from this multiethnic cohort study could lead to the development of culturally appropriate prevention and treatment strategies to reduce the risk of cancer-related health behaviors and the occurrence of cancers. These strategies may be more effective as they are tailored to meet the specific needs of these communities, ultimately promoting health equity in Hawaii.
As researchers and advocates with the American Cancer Society Cancer Action Network (ACS CAN), we know that investing in the study of cancer disparities could ultimately reduce the burden of cancer in populations that have been underserved and underrepresented by bringing new insights into the social, environmental and biological factors that lead to these disparities. Thus, this study will ultimately provide Hawaii public health practitioners and the community with the necessary data to advance health equity for Filipinos, Native Hawaiians and Pacific Islanders.
We urge Hawaii legislators to support and fund the feasibility study for a new multiethnic cohort study by the UH Cancer Center, a critical step in building a future where all communities in Hawaii have an equal opportunity to prevent, detect and survive cancer.
Dr. Alika Maunakea is a professor of epigenetics and health disparities at John A. Burns School of Medicine, and director of the Consortium of Research Advancement Facilities and Training; Dr. Loïc Le Marchand is a researcher focusing on the role of biological and environmental factors of cancer; Dr. Lani Park’s research focuses on genetic, health behavioral and environmental factors that contribute to the racial/ethnic differences in cancer risk.
