Native Hawaiian women have the highest breast cancer incidence rate of any group in the United States, a finding that emerged only when researchers separated cancer statistics that federal and clinical reporting normally combine into one category.
The number is not small. Native Hawaiian women's breast cancer incidence runs 27 percent above the rate for White women and 57 percent above the rate reported when Asian American and Pacific Islander women are counted together. For years, that combined figure has looked reassuring, which is exactly the problem.
The practical consequence reaches individual exam rooms. A clinician assessing risk, or a health system deciding where to place mobile mammography, works from population data. When the data say a group has favorable rates, outreach goes elsewhere. That is how a population with the highest national burden ends up treated as low priority.
Behind a Single Category, Eleven Different Risk Profiles
The findings come from Cancer Statistics for Asian American, Native Hawaiian, and Pacific Islander People, 2026, published in the journal CANCER and summarized by the American Cancer Society. Researchers examined population-based registry data from the National Cancer Institute's Surveillance, Epidemiology, and End Results program covering 2000 through 2022.
Across the 11 ethnic groups examined, overall cancer incidence varied by more than twofold. Cambodian people had the lowest rate at 218.3 per 100,000. Native Hawaiian people had the highest rate at 474.5 per 100,000, roughly 1.5 times the rate observed when all these populations are combined, at 307.3 per 100,000.
Breast cancer is not the only place the pattern shows up. Nikita Wagle, the American Cancer Society principal scientist who led the analysis, said the aggregated data conceal "some of the highest cancer incidence rates in the country." The report found Korean people have the highest stomach cancer incidence of any racial or ethnic group nationally, Vietnamese people the highest liver cancer incidence, and Samoan women the highest uterine corpus cancer incidence. Prostate cancer incidence among Native Hawaiian men runs six times the rate among Laotian men, who have the lowest.
Rising Incidence Across Nearly Every Group
Breast cancer incidence is climbing in almost all of the ethnic groups studied, though at sharply different speeds. The increase is about 1 percent per year among Native Hawaiian and Filipino women, and 3 to 5 percent per year among Guamanian or Chamorro, Chinese, Vietnamese, and Korean women.
Separate research published in JAMA Network Open this year, analyzing 148,608 women with invasive breast cancer across 14 states, found that Asian American women's incidence rose 2.34 percent annually from 2012 to 2022, with especially rapid increases in early-onset disease among women under 50. That analysis found a smaller steady increase among Native Hawaiian and Pacific Islander women, 0.84 percent annually across the full period, a reminder that the two datasets measure different things over different windows. The study was summarized by The ASCO Post, and its authors reported no conflicts of interest.
Colorectal cancer incidence among Native Hawaiian people is 37 percent higher than the combined figure and 11 percent higher than among White people. Rebecca Siegel, the senior author and the society's senior scientific director for surveillance research, said favorable rates for the population as a whole mask the highest national burden for many cancers, including breast and endometrial cancers, and argued that interventions must be tailored rather than uniform.
The Screening Consequence for Families
For readers in Honolulu, Los Angeles, San Francisco, Seattle, Las Vegas or Sacramento, the useful question is not the statistics but what to ask a clinician. Metropolitan areas with sizable Native Hawaiian and Pacific Islander communities outside Hawaii include Las Vegas, Los Angeles, Salt Lake City, and the San Francisco Bay Area, and clinicians in those markets may be working from the aggregated picture.
Nothing in this report changes national screening guidance. Mammography recommendations for average-risk women still begin at age 40, and no organization has issued group-specific screening ages based on these findings. What the data support is a more specific conversation about family history, ancestry, and personal risk, particularly for women approaching or past 40 who have not started screening.
Cost should not be the obstacle it often is. Most insurance plans cover screening mammography without cost sharing, Medicaid covers it in every state, and the CDC's National Breast and Cervical Cancer Early Detection Program funds free or low-cost screening for uninsured and underinsured women who meet income and age criteria. Eligibility is set at the state level rather than nationally, so a household turned away in one state may qualify in another. Community health centers and federally qualified health centers offer sliding-scale access. A companion reference report from the society collects the underlying statistics in one place.
Limits of the Analysis
This is a descriptive study of cancer registry data. It documents differences in incidence and survival but does not explain them or establish what causes the gaps. Diet, obesity prevalence, reproductive patterns, screening participation, insurance coverage, immigration history, and access to specialty care all plausibly contribute, and the analysis cannot separate them.
Registry data also carry a known weakness in exactly the area this report addresses. Race and ethnicity are often recorded from medical records rather than self-report, and misclassification between Asian and Pacific Islander categories has been a documented problem in vital statistics. If anything, that would understate the differences rather than exaggerate them.
The report's authors and the American Cancer Society Cancer Action Network have called on lawmakers to fund routine collection and publication of disaggregated demographic data. Whether that happens is a policy question with no scheduled decision point. Until it does, the numbers most clinicians see will continue to average together populations with very different risks.
The takeaway for households is modest and actionable. If you or a family member belong to one of these communities, the aggregate reassurance does not necessarily apply to you, and it is reasonable to ask a clinician about screening timing rather than assume the general picture fits.
Key Questions Answered
What did the report find? Native Hawaiian women have the highest breast cancer incidence in the United States, 27 percent above White women, a difference invisible when Asian American and Pacific Islander data are combined.
What does disaggregated data mean? Reporting each ethnic group separately rather than merging them into a single broad category that averages out differences.
Which other cancers showed large gaps? Korean people had the highest stomach cancer incidence nationally, Vietnamese people the highest liver cancer incidence, and Samoan women the highest uterine corpus cancer incidence.
Does this change screening guidelines? No. Mammography guidance for average-risk women still begins at 40, and no group-specific screening ages have been issued.
Does the study explain why the differences exist? No. It documents incidence and survival patterns but does not identify causes.
What should someone in these communities do? Discuss family history and personal risk with a clinician, and ask directly about the appropriate timing for screening rather than relying on aggregate reassurance.
Where can uninsured women get screened? The CDC's National Breast and Cervical Cancer Early Detection Program funds free or low-cost screening through state programs for those who meet income and age criteria.
