In an interview with The American Journal of Managed Care^®, Alice W. Lee, PhD, MPH, associate professor at California State University, Fullerton, discusses the inspiration behind her recent study, “Disparities in Ovarian Cancer Survival Among Ethnic Asian American Populations, 2006-2020.”

She highlights how analyzing ovarian cancer survival across disaggregated Asian American subgroups revealed significant survival disparities, underscoring the importance of a subgroup-specific approach in cancer research.

This transcript has been lightly edited for clarity.

Transcript

What are the consequences of analyzing Asian Americans as a single group vs as individual subgroups?

When I think about Asian Americans, I find that they are a very heterogeneous and very diverse racial group. They encompass many different countries, many different cultures, many different languages, and all of that really translates to all of these different ethnic groups being different in terms of their sociodemographics, in terms of their behaviors, and in terms of their lifestyles. When we think about all of this, that really does impact cancer risk. It also impacts cancer outcomes.

So, when we start analyzing Asian Americans as a single group, these ethnic-specific differences just get overlooked. In turn, any differences across ethnicities that we’re seeing when it comes to cancer risk and cancer survival also end up becoming completely masked. What ends up happening is that what we see in what we call the aggregate ends up being associated with every single Asian ethnic subgroup.

That observation may not necessarily be true. Some subgroups may be at higher cancer risk than others, but when we look at the aggregate, we don’t see that, that ends up becoming missed. When we think about this, these are those subgroups that we really want to focus on when we’re thinking about research, when we’re thinking about public health interventions, as well as other efforts.

What was the main objective of your study?

I’ve been talking a lot about disaggregation. So, it makes a lot of sense that my study is focused on disaggregation, particularly looking at disaggregating Asian American populations when looking at ovarian cancer survival. So, I said that a lot of my research is in cancer epidemiology as well as in women’s health, so I was really interested in looking at survival when it comes to ovarian cancer because it is the most fatal malignancy in the female reproductive system.

I think part of the reason why I was also interested in looking at Asian Americans in subgroups is that when we think about Asian Americans when it comes to ovarian cancer, or when it comes to cancer for that matter, they’re often considered this low-risk, high-survival population, especially when we’re comparing Asian Americans with other major racial groups. We felt that it was really important to look at whether or not this higher survival actually translates to all of the different ethnic subgroups, and we focused on 7 subgroups in our analysis.

Part of the motivation for this as well is because there’s actually been quite a lot of research looking at cancer risk and cancer outcomes in disaggregated Asian subgroups, a lot of this literature is showing that there are these differences. We’re seeing differences in breast cancer, we’re seeing it in cervical cancer and liver cancer, I mean, a whole bunch of cancers.

I will say, prior to this work, I looked at ovarian cancer incidence in disaggregated Asian subgroups, and so it really felt like this next step for me to take that data and look at it in terms of ovarian cancer survival.

What were your key findings? Which findings surprised you the most?

It was really interesting. What we hypothesized was that there would be some differences, and that is what we observed. I think our overall finding is that this overarching conclusion that Asian American ovarian cancer patients have the highest survival across major racial groups doesn’t necessarily apply to all Asian ethnic subgroups.

In fact, what we found most interesting was that even after we had considered important survival-related characteristics, like some socioeconomic factors, thinking about treatment, or thinking about tumor characteristics, Hawaiian and Pacific Islander patients were the only Asian subgroup to be more likely to die from ovarian cancer. Asian Indian/Pakistanis were the least likely to die from ovarian cancer, and this is when we compare them to non-Hispanic Whites as our reference group, which is what is commonly done.

When we look at these findings overall, I think it really just goes to show how important it is to take a disaggregated approach. These kinds of nuances would be missed, and they have been missed in the ovarian cancer literature.