Cancer Among Asian Indian/Pakistanis Living In The United States

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Cancer Causes Control (2009) 20:635–643
DOI 10.1007/s10552-008-9275-x


Cancer among Asian Indians/Pakistanis living in the United
States: low incidence and generally above average survival
William B. Goggins Æ Grace Wong

Received: 1 August 2007 / Accepted: 19 November 2008 / Published online: 6 December 2008
Ó Springer Science+Business Media B.V. 2008

Background South Asian immigrants living in the United
Kingdom and Canada have been found to have lower rates of cancers of all types compared with the native born population and most other immigrant groups. Cancer among Asian Indian/Pakistani people in the United States has been studied very little.
Methods Incidence rates for all cancers combined and site-specific rates for major cancers were estimated for
Asian Indians/Pakistani population using incidence data from the U.S. National Cancer Institutes SEER database and population data from the U.S. Census Bureau. Sitespecific survival was compared for major cancer sites between Asian Indians/Pakistanis and Caucasians using
Cox proportional hazards models.
Results Cancer rates for Asian Indian/Pakistani males and females were considerably lower than for White Americans with standardized incidence ratios (SIRs) of 0.46 (95%
CI = 0.44, 0.48), and 0.55 (95% CI = 0.53, 0.58) respectively. Site-specific rates were lower for both genders for most sites with particularly low rates observed for lung, colorectal, female breast, and prostate cancer. Among common cancers sites, survival was generally better among
Asian Indians/Pakistanis than Caucasians with the notable exception of breast cancer for which Caucasians had slightly better survival.

W. B. Goggins (&) Á G. Wong
School of Public Health, Chinese University of Hong Kong, Room 501, Shatin, Hong Kong e-mail:
W. B. Goggins
Nethersole School of Nursing, Chinese University of Hong Kong, Shatin, Hong Kong

Conclusions The finding that Asian Indians/Pakistanis in the United States have relatively low incidence rates for most major cancers is consistent with studies from other countries. Whether the low incidence of cancer and above average cancer survival for this group is related to their well-above average socioeconomic status or cultural and behavioral factors is a topic for further research.

SEER Á Ethnic Á Race Á South Asian Á

Considerable ethnic variation in the incidence and survival rates for many types of cancers have been reported from the United States and other countries. One group whose cancer experience has been little studied in the United
States are Asian Indians, a mostly affluent, and well-educated group whose numbers have been rapidly increasing in recent years.
Previous studies have shown that cancer rates for South
Asians are generally lower than those of the non-South
Asian population of that country but higher than those of the
Indian subcontinent. A study using data from the California cancer registry found that South Asians, of whom about 90% were Asian Indians, had lower cancer incidence than nonHispanic whites for most sites, but higher incidence than
Whites for liver cancer for both genders, and stomach, esophageal, and cervical cancer for females [1]. A registrybased study from the United Kingdom [2] found that South
Asians had substantially lower incidence rates for most major cancers than non-South Asians. A Canadian study [3] found that cancer mortality rates among South Asians were lower than those of both White and Chinese Canadians. Data



from Singapore indicate that Indians there recently have lower cancer incidence than either Chinese or Malays [4], whereas incidence rates for Indians in Malaysia are lower than those for Chinese but higher than those for
Malays [5].
A study of female breast cancer survival using U.S. cancer registry data found that Asian Indian/Pakistani women had non-significantly worse overall survival than non-Hispanic Whites after