Breast Cancer Incidence in Asian American, Native Hawaiian, and Pacific Islander Populations, 2000-2022.

Importance: Breast cancer incidence among Asian American, Native Hawaiian, and Pacific Islander females as an aggregated group have been increasing rapidly. The extent to which these trends apply across Asian American, Native Hawaiian, and Pacific Islander ethnic groups is unclear. Objective: To examine incidence trends of invasive breast cancer in 7 Asian American (Asian Indian or Pakistani, Chinese, Filipino, Japanese, Korean, Laotian or Kampuchean, and Vietnamese) and 2 Native Hawaiian or Pacific Islander (Guamanian, Chamorro, and Samoan and Native Hawaiian) ethnic groups overall and by age, stage, and subtype. Design, Setting, and Participants: This population-based, descriptive, cross-sectional study used National Cancer Institute Surveillance, Epidemiology, and End Results Program data contributed by 14 US states (3 in the Northeast, 2 in the Midwest, 4 in the South, and 5 in the West). Asian American, Native Hawaiian, and Pacific Islander females of any age diagnosed with invasive breast cancer between January 1, 2000, and December 31, 2022, were included. Data were analyzed between September 2025 and March 2026. Main Outcomes and Measures: Annual (or triannual) percentage change (APC) and 95% CIs of incidence rates were estimated using joinpoint regression, by age (<50 years, ≥50 years), stage (localized, regional, distant), and subtype (hormone receptor [HR] and ERBB2 [formerly HER2/neu] negativity and positivity). Results: A total of 148 608 Asian American, Native Hawaiian, and Pacific Islander females with breast cancer (44 234 aged <50 years [29.8%] and 104 374 aged ≥50 years [70.2%] at diagnosis; 138 808 of Asian American [93.4%] and 9800 of Native Hawaiian or Pacific Islander [6.6%] race and ethnicity) were included, among whom 63.9% were diagnosed at a localized stage and 66.6% with the HR-positive and ERBB2-negative subtype. Increased incidence rates of invasive breast cancer were observed among Asian American females (APC, 2.34%; 95% CI, 1.83%-3.68%) from 2012 to 2022, surpassing the trend in other racial and ethnic groups. A smaller steady increase was observed among Native Hawaiian or Pacific Islander females (APC, 0.84%; 95% CI, 0.48%-1.29%) from 2000 to 2022. Significant increases in overall and early-onset (ie, age <50 years) breast cancer were evident in all Asian American, Native Hawaiian, and Pacific Islander ethnic groups, with Chinese and Vietnamese females experiencing increased APCs of 4.57% (95% CI, 2.03%-8.36%) and 4.30% (95% CI, 1.98%-8.93%) since 2015 and 2016, respectively. Incidence increases were most pronounced for distant stage disease, with APCs of 4.02% (95% CI, 2.74%-5.72%) for Asian Indian and Pakistani females and 4.52% (95% CI, 2.55%-7.09%) for Chinese females. All Asian American groups, except Laotian and Kampuchean females, experienced increasing trends of HR-positive and ERBB2-negative cancer, with APCs ranging from 2.10% (95% CI, 0.74%-3.45%) for Japanese females to 6.00% (95% CI, 3.62%-8.78%) for Korean females since 2010, whereas Native Hawaiian and Pacific Islander groups saw stable trends. Nearly all Asian American groups experienced increases in triple-negative breast cancer, with an APC as high as 6.17% (95% CI, 3.30%-11.73%) among Chinese females for 2017 to 2022. Conclusions and Relevance: This cross-sectional study found that breast cancer incidence rates increased rapidly across Asian American, Native Hawaiian, and Pacific Islander ethnic groups over a 20-year period. Research tailored to these distinct ethnic groups is needed to discern potentially novel risk factors for breast cancer. Culturally sensitive efforts are needed to promote awareness and increase breast cancer screening in distinct ethnic groups. The rapid recent increases in breast cancer incidence in Asian American, Native Hawaiian, and Pacific Islander women, especially early-onset disease, warrant urgent attention.