Hidden Disparities in Thyroid Cancer Stage at Presentation Among Disaggregated AANHPI Subgroups: US Evidence to Inform Global Cancer Control
Angela Kim, Milit Patel, Yingzhi Wu, Stephanie Wang, Bhav Jain, Charlie Wong, Sophia Chen, Miranda Lam, Michael Wu, Eric Sherman, Nancy Lee, Lara DunnPURPOSE
Thyroid cancer is a growing global health concern, particularly among Asian and Pacific Islander populations in low- and middle-income countries (LMICs) who account for a majority of global thyroid cancer cases and deaths. Countries such as the Philippines, Laos, Cambodia, Thailand, and Pacific Island nations face compounding challenges: limited cancer screening infrastructure, iodine deficiency in rural populations, scarce pathology and imaging resources, and the absence of population-based cancer registries that capture ethnicity-level data.
METHODS
This study leverages the National Cancer Database (NCDB), capturing approximately 70% of newly diagnosed US cancers, to analyze 337,595 thyroid cancer patients diagnosed between 2004 and 2021 for all histologies and papillary thyroid carcinoma specifically. To account for the change in AJCC staging criteria that happened in 2018, analyses were conducted separately for two time periods: 2004 to 2017 and 2018 to 2021.
RESULTS
By disaggregating AANHPI populations into specific ethnic subgroups, this analysis exposes profound disparities hidden within aggregated data. Hmong patients faced nearly three times the odds of advanced-stage presentation compared to White patients, followed by Laotian and Filipino patients. In the most recent papillary thyroid carcinoma cohort, Thai patients had the highest odds, followed by Japanese and Filipino patients. These disparities persisted after adjusting for insurance status, income, education, and comorbidity burden, meaning socioeconomic disadvantage alone does not explain the inequities. Filipino and Japanese Americans, despite relatively high income and English proficiency, still faced substantially elevated odds of advanced-stage disease, pointing toward deeper structural, cultural, and biological contributors.
CONCLUSION
These findings carry direct implications for LMICs. Hmong and Laotian Americans originate from Laos and Southeast Asia, where iodine deficiency may be associated with a higher proportion of non-papillary histologies and a later-stage presentation. Filipino and Japanese American population trends can reflect cancer control gaps relevant to the Philippines and Japan. These findings carry implications for LMICs where these populations originate. Since many of these countries lack disaggregated cancer surveillance capacity, U.S.-based ethnic subgroup data can inform LMIC policymakers in prioritizing ethnicity-specific early detection programs, strengthening cancer registries, and designing culturally concordant community outreach, translating local discovery into global cancer control impact.