What is the clinical evidence from this study?

Study design: Cohort. Population: Breast cancer (n=3971). Intervention: Born outside the US vs. Born in the US. Primary outcome: All-cause mortality (ACM) and breast cancer-specific mortality (BCSM) (HR 0.72, 95% CI 0.61-0.85, p=<0.001).

What question did this study set out to answer?

The study aims to understand how immigration and acculturation affect all-cause and breast cancer-specific mortality in Asian American women.

April 5, 2026

Abstract 895: Impact of immigration and acculturation on mortality in Asian American women with breast cancer.

Q: What are the key findings of this study?

Being born outside the US was associated with lower all-cause mortality in Asian American women with breast cancer at 10 years (HR 0.72; 95% CI 0.61-0.85; p<0.001) compared to those born in the US.

Q: What question did this study set out to answer?

The study aims to understand how immigration and acculturation affect all-cause and breast cancer-specific mortality in Asian American women.

Key Result

Being born outside the US was associated with lower all-cause mortality in Asian American women with breast cancer at 10 years (HR 0.72; 95% CI 0.61-0.85; p<0.001) compared to those born in the US.

Key Points

The study aims to understand how immigration and acculturation affect all-cause and breast cancer-specific mortality in Asian American women.
Included 3971 Asian American women with breast cancer from the ARC Study.
Used nativity, years lived in the US, age at immigration, and preferred language as key measures of immigration/acculturation.
Employed Cox proportional hazards for all-cause mortality and Fine and Gray models for breast cancer-specific mortality, adjusting for various factors.
Stratified analyses by follow-up duration: ≤10 years and >10 years.
Women born outside the US had lower all-cause mortality compared to US-born women at 10 years and beyond.
Higher breast cancer-specific mortality was suggested for those born outside the US after 15 years of follow-up.
Longer residence in the US correlated with higher all-cause mortality for those who immigrated later in life, particularly past 40 years.
Earlier immigration age associated with lower mortality overall, while late adulthood immigration was linked to higher all-cause mortality.

Study Design

Type

Cohort (n=3,971)

Structured PICO

Do immigration and acculturation factors affect all-cause and breast cancer-specific mortality in Asian American women with breast cancer?

Population

3971 Asian American women with breast cancer from the Asian American Resiliency and Cancer Disparities (ARC) Study

Intervention

Immigration/acculturation factors (nativity, years in US, % life in US, age at immigration, Asian country of birth, preferred language)

Comparator

US-born women (for nativity) or different categories of acculturation factors

Outcome

All-cause mortality (ACM) and breast cancer-specific mortality (BCSM)hard clinical

Being born outside the US is associated with lower all-cause mortality among Asian American women with breast cancer, though age at immigration and length of stay modify this risk.

Main Result

Effect estimate: HR 0.72 (95% CI 0.61-0.85)

p-value: p=<0.001

Abstract

Abstract Purpose: Immigration/acculturation may affect breast cancer outcomes among minoritized racial and ethnic populations. Limited data exist on how these factors influence survival in Asian American women with breast cancer. We investigated associations of immigration/acculturation with all-cause (ACM) and breast cancer-specific mortality (BCSM) in this population. Methods: 3971 Asian American women with breast cancer were included from the Asian American Resiliency and Cancer Disparities (ARC) Study. Measures of immigration/acculturation included nativity (born in the US vs. outside the US), number of years (y) and percent (%) of life lived in the US, age at immigration, Asian country of birth, and preferred language at interview. Primary outcomes were ACM and BCSM. Cox proportional hazards were used to estimate hazard ratios (HRs) for ACM and Fine and Gray competing risk models for BSCM, adjusted for clinical, demographic, socioeconomic, reproductive, and lifestyle factors. Analyses were stratified by follow-up duration (≤10 y and 10 y). Results: Women born outside the US had lower ACM compared with women born in the US at 10 y (HR 0.72, 95% CI 0.61-0.85, p0.001) and beyond 10 y (HR 0.72, 95% CI 0.63-0.82, p0.001) follow-up. No statistically significant differences by nativity in BCSM were observed overall; however, higher BCSM in women born outside the US after 15 y of follow-up was suggested. Among women born outside the US, living longer in the US was associated with higher ACM, particularly beyond 40 and 50 y (HR 1.49, 95% CI 1.05-2.10, p=0.02; HR 1.94, 95% CI 1.34-2.81, p0.001, respectively), which became non-significant after adjustment. Earlier age at immigration was associated with lower ACM and BCSM, and immigration in late adulthood (≥55 y) with higher ACM (10-y HR 2.04, 95% CI 1.09-3.80, p=0.02; 10-y HR 2.05, 95% CI 1.23-3.41, p=0.006). However, after adjustment, associations with ACM remained significant only for immigration in adolescence (13-17 y) (10-y HR 0.56, 95% CI: 0.36-0.88, p=0.01) and early adulthood (25-34 y) (10-y HR 0.75, 95% CI: 0.59-0.96, p=0.02). For BCSM, associations were seen for immigration in adolescence (10-y HR 0.56, 95% CI: 0.34-0.92, p=0.02), adult transition (18-24 y) (10-y HR 0.71, 95% CI: 0.52-0.97, p=0.03) and middle adulthood (35-54 y) (10-y HR 0.62, 95% CI: 0.39-0.97, p=0.04; 10-y HR 0.60, 95% CI: 0.40-0.88, p=0.01). No significant associations were observed between % of life in the US, Asian country of birth, or preferred language at interview, and ACM or BCSM. Conclusions: Immigration factors may influence long-term mortality in Asian American women with breast cancer. Women born outside the US demonstrated lower ACM, but the length of stay in the US and age at immigration may have influenced this association. This highlights the need for culturally tailored survivorship and public health interventions that promote native cultural behaviors in this population. Citation Format: Alfredo V. Chua, Rabsa Sikder, Luna Gao, Julie Von Behren, Janise M. Roh, Esperanza Castillo, Isaac J. Ergas, Iona Cheng, Marilyn L. Kwan, Salma Shariff-Marco, Mi-Ok Kim, Katherine Lin, Brittany N. Morey, Anna H. Wu, Esther M. John, Lenora W. M. Loo, Allison W. Kurian, Christine B. Ambrosone, Lawrence H. Kushi, Scarlett L. Gomez, Song Yao. Impact of immigration and acculturation on mortality in Asian American women with breast cancer abstract. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 1 (Regular Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(7 Suppl):Abstract nr 895.

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