Breast Cancer Risk Assessment in Hawaiʻi and the USAPI
About the study
This investigation is supported by U54 Grant #5U54CA143727 through the University of Guam / University of Hawaiʻi Cancer Center Partnership, directed by Dr. Neal Palafox. Since 2003, the University of Hawaiʻi Cancer Center ↗ and the University of Guam ↗ have collaborated to examine cancer health disparities among Pacific Islanders across Hawaiʻi, Guam, and neighboring U.S. Associated Pacific Islands (USAPI).
The partnership is one of 14 Partnerships to Advance Cancer Health Equity (PACHE) — an NCI program supporting cancer-research capacity building at minority-serving institutions. It is the only PACHE serving Pacific Islanders, with emphasis on Micronesians.
Background
Despite advances in early detection and treatment, breast cancer remains the second leading cause of cancer-related mortality among women in Hawaiʻi and the USAPI. Implementation of the Breast and Cervical Cancer Early Detection Program (BCCEDP) has not substantially reduced advanced-stage cancer rates due to limited mammography access or low screening participation.
Current risk models present significant limitations:
- Some exclude race/ethnicity considerations (Tyrer-Cuzick v8)
- Others lack breast-density data (NCI Breast Cancer Risk Assessment Tool)
- Many fail to differentiate Native Hawaiian / Pacific Islander and Asian subgroups
Recent unpublished Breast Cancer Surveillance Consortium data indicated that only 11 % or fewer Filipina, Chinese, and Japanese women with invasive cancer were classified as high-risk — compared to 46 % of White women — demonstrating inadequate model calibration for Pacific populations.
Goals and aims
The long-term objective is developing validated breast-cancer risk biomarkers to reduce advanced-stage diagnoses and mortality — through improved screening identification and risk-reduction strategies including dietary, exercise, and pharmaceutical interventions.
The Hawaii Pacific Islands Mammography Registry (HIPIMR), currently operating in Oʻahu, serves as a resource for identifying and validating novel imaging and clinical biomarkers across diverse Pacific ethnic groups: Native Hawaiians, Chamorro, Japanese, Filipino, Chinese, and others. This proposal extends HIPIMR to Guam and the broader USAPI.
Specific aims
Aim 1. Explore mechanisms for curating clinical risk factors (age, BMI, family history, biopsy status, parity, first-live-birth age, hormone-therapy use, menarche/menopause age) and breast density across Hawaiʻi and Guam screening populations. Sub-hypothesis: risk-factor distribution varies by region, race, and ethnicity.
Aim 2. Identify unique breast density and imaging characteristics in screening-mammography patients across Hawaiʻi and Guam. Sub-hypothesis: breast-density associations with clinical risk factors differ significantly for USAPI women compared to non-Hispanic White populations.
Aim 3. Assess prevalence trends of high breast-cancer risk in Asian American, Native Hawaiian, and Pacific Islander (AANHPI) groups using established models versus White women. Sub-hypothesis: current risk-model accuracy is substantially reduced for AANHPI groups.
Exploratory. Identify opportunities and challenges in extending HIPIMR to the USAPI.
Investigators
- John Shepherd, PhD — Co-Lead, UH Cancer Center
- JaeYong Choi — ESI Co-Investigator, University of Guam
- Brenda Hernandez — Co-Investigator, Hawaiʻi Tumor Registry
- Grazyna Badowski — Co-Lead, University of Guam
- Lee Buenconsejo-Lum — Co-Investigator, CDC-PRCCR
Funding
National Cancer Institute ↗ — UH Cancer Center / University of Guam U54 Competitive Renewal Grant, U54CA143727 ↗.