PROJECT SUMMARY / ABSTRACT
Despite recent advances in early detection and treatment, breast cancer remains a major cause of morbidity
and mortality. Native Hawaiian women have the highest breast cancer incidence in Hawaii despite their
favorably reproductive patterns. Japanese American women now experience the same breast cancer risk as
non-Hispanic White women Further, advanced breast cancer rates are considerably higher in Asian American
Women in Hawaii and the Pacific compared to the US mainland, 15% versus 9%. The absolute risk of invasive
cancer and advanced cancer in these groups of the US population is not known. Our long-term goal is to
develop accurate and validated breast cancer risk biomarkers that can contribute to screening strategies for
Asian groups with diverse breast cancer risk profiles who to date have not been well represented in breast
cancer cohorts and clinical trials. The Hawaii Pacific Islands Mammography Registry (HIPIMR) will be a
resource to identify and validate novel image biomarkers for the diverse ethnic groups of this region with
varying risk factor profiles including Native Hawaiians, Japanese, Filipino, Chinese, and other ethnic groups.
Combining San Francisco Mammography Registry and HIPIMR cohorts will give us the statistical power to
describe risk of invasive and advanced cancer in Asian groups. Our central hypothesis is that standard breast
cancer risk factors and image factors and their prevalence are different in the diverse populations found in high
concentrations in the Pacific (Hawaii, Guam, American Samoa) and Asian ethnic groups in the mainland US
compared to non-Hispanic White, non-Hispanic Black and Hispanic women. We plan to test the hypothesis that
using risk factor profiles and next generation breast composition and texture features across Asian groups, the
fastest growing segment of the US population,9 and NHPI ethnic groups will improve cancer risk prediction.
Our specific aims are as compared to non-Hispanic White women: 1. Examine clinical risk factors and their
association with invasive and advanced breast cancer in women undergoing breast cancer screening by Asian
(Japanese, Filipino, Chinese) and Native Hawaiian Pacific Islander (AANHPI) ancestry, 2. Identify next-
generation breast imaging characteristics from 2D and 3D mammography, including volumetric breast density,
calcifications, masses, texture features and their association with invasive and advanced breast cancer for
AANHPI women, using advanced artificial intelligence and machine learning approaches, 3. Identify the
combination of clinical risk factors and image factors associated with invasive and advanced breast cancer risk
among AANHPI women. This study addresses the need for accurate identification of defined clinical and
radiomic risk factors among AANHPI populations and their relation to breast cancer risk to improve outcomes
for these women.