Gastric Cancer among Asian Americans – 2022 Gastric Cancer Summit

[00:00] Thank you, Juha and Rob and Lee and all the members of the care team here and Dr. Ko for the introduction. This is amazing to be here and I'm so excited that Juha

[00:20] and the team has been able to bring all of us together for a such an important topic that really is what I've been working on for the this is my dedication for the past 10 years but these are my disclosures I'm just going to talk today about gaseous cancer in Asian-Americans.

[00:40] Americans, but I think almost all of the topics and presentations this morning actually covered it. So I will try to make this interesting for you. I hope everyone knows that November is Stomach Cancer Awareness Month, so just to shout out for that.

[01:00] And when I think about gaseous cancer and the innovations and all the science that is coming for cancer, I think about Albert Einstein and what Malala has said. So only those who can see the invisible can do the impossible. And sometimes

[01:20] when I listen to everybody talking about gaseous cancer and eliminate gaseous cancer, it seems like something is invisible and we just have to believe that we will find an answer to this question. And so we need to dream about our tomorrow and I dream that there will be no more gaseous cancer or gaseous cancer disparities and that the work that is

[01:40] being done here will get us there within the next 5 to 10 years, and so we can imagine a world without cancer. So why do I care? Well, I'm an Asian and I put Korean there because I think we need to desegregate data so that we know the subpopulations of Asians that really are being

[02:00] being affected by gastric cancer and how we are being affected by gastric cancer. I'm a robotic gastric cancer surgeon. I became a surgeon because I wanted to cure gastric cancer. I immigrated to the United States when I was seven years of age. So I'm a 1.5 generation. I speak Korean with an English accent.

[02:20] and I speak English with a New Jersey accent, although since I moved to California, I don't know what accent I have. Most of my training is on the East Coast, and at the time everyone talks about the East Coast, I really miss it. I miss New Jersey, so Dr. Im was talking about it.

[02:40] about New Jersey Rutgers, I missed that. We were talking about New York, I missed New York. And I did my fellowship, so I have a unique perspective. I spent a year in Korea learning robotics and gaseous cancer and what I learned was that robotic surgery is an amazing tool to cure gaseous

[03:00] cancer for early gastric cancer. In patients, we have BMI of 21, which was, I saw more than about 200 gastric cancer cases. I participated in a bunch of those, and I came back to the states, realized that our patient population is a little bit different. So you know.

[03:20] It was a tough learning curve for me when I got back, but I am in California right now. We talk about Asian Americans with gastric cancer. So I want to put a face to the Asian Americans with gastric cancer. We heard this morning about

[03:40] a grandfather that's Asian American with gastric cancer. But I want to let you know that a lot of my patients are not that old. They are younger than the average age. A lot of the Asian Americans and Hispanic Americans actually are closer to like 40 years old or 45 years old.

[04:00] five years old. And those on the left lateral, right lateral, they're still alive and cured and my patients in the middle have passed away and they were barely 40. Okay, so this is real. I see these patients every day in clinic. And this is what

[04:20] What do I do? I want to cure cancer. So I learned how to do the right operation and robotically. So we can cure this cancer if they're found at early stages. But what happens if you are a 38-year-old Korean American male and you thought that, you know, a Stanford grad thought that you're going to live

[04:40] an awesome life and you end up with stage 4 gastric cancer symptoms that went on for a long time like we heard before but nobody imagined that someone could someone so young or could have gastric cancer. So it's not such a simple question to answer about screening and early detection in this patient population.

[05:00] So most gastric cancer patients in the United States are not curable. For most of you who study gastric cancer, treat gastric cancer, and care for gastric cancer patients, you probably know this data inside and out. For those of you who bring expertise from other cancers to gastric cancer, it's just a dismal disease when it's not

[05:20] diagnosed early. So we did we did make some improvements. We went from 25% five year survival to 30% five year survival and the most recent NCDB data shows that we have about 41% five year survival and that survival is not because of early development.

[05:40] detection, increasing early detection. But I think we made improvements in surgery and chemo, maybe. But not for the late stages. It's still very poor. So what is clear is that when I joined our Cacicancer Disparities Initiative,

[06:00] I learned something very important from Rob and Juha in that it's gastric cancer. The reason I was having such difficulty finding funding for my research, because I researched gastric cancer and there is no funding for gastric cancer at the NIH. And this is.

[06:20] This is a disparity and this is disheartening because funding is equivalent to improved survival in cancer. So we have such poor funding, it's equivalent to poor survival rates, and it's 0.1

[06:40] six percent of the total budget. So lease funded is what Rob and Lee and and Jua has taught me. This is and it's going down over the years. Percentage wise even though the budget for the NIH is is growing, the percentage of gashiguru is growing.

[07:00] cancer funding is poor. So I think we, you know, we are learning a lot about how gaseous cancer is adversely affecting ethnic minorities and Asian Americans, and the funding needs to be increased to battle that. So we've already

[07:20] heard why we think that some of the ethnic minorities that are living in the United States have increased risk of gastric cancer. They immigrate from endemic areas with gastric cancer like China, Japan, and Korea, Vietnam, and the more desegregated data

[07:40] or dissociated data that we have, the better we're going to be able to find out what the real risks are and desperate outcomes are. But without this kind of data, we won't know, because if you lump all Asian Americans together, we just become like color brown instead of the distinct color.

[08:00] that we are. So we know that globally it's a major issue and it's become the third leading cause of cancer death worldwide and these risks of death are carried over to the United States. Howard asked me yesterday

[08:20] Dr. Koh asked me yesterday what is the life year loss to gastrocancy and this is a slide that I had. So the average, there is an average of 15.48 years of life loss due to gastrocancy in the United States and the life expectancy is about 80 or 80 so those who die from

[08:40] gaseous cancer younger, there's significant life loss. So women are at higher, they lose more life years. Clinical CH4 patients obviously, you know, die sooner. And non-whites lose more life years to gaseous cancer. This is a

[09:00] ethnic disparities in gastric cancer. And it is clear that gastric cancer is not a rare cancer among ethnic minorities and can range between 12.5 to 35 and 35 being in Korean Americans. Not only that, we know that young adults under the age of 40 are most likely to

[09:20] to die from gastrocancy, Hispanic Americans present with very advanced disease with more likely of having peritoneal chosmetosis, and this is definitely an urgent unmed cancer care need. It's also demographically heterogeneous. This is a map of the United States.

[09:40] United States, and you can see that the areas on the east coast and west coast where a lot of Asian Americans live have a higher incidence of gaseous cancer. And if you look at America like from far away and you just look at what the top cancers are, these are the top cancers.

[10:00] cancers, and we talk about these cancers, we study these cancers, and we fund these cancers all the time. But this is not the same for Asian Americans. So you'll notice that stomach cancer actually falls into the top cancers that Asian Americans get. Incidents in Men is

[10:20] is much higher than non-Hispanic whites, and incidence in women is also double compared to non-Hispanic whites, and the death rates are higher, almost double, in both men and women. And if you look at Asian Americans in general, you can see that there's a lot of women

[10:40] see that, but there's also been data that's talking about Chinese Americans and Filipinos, Japanese, Korean, and Vietnamese separately, and you can see that within these tables that their cancers differ also. And studies have been done to show that Korean Americans are at

[11:00] 13-fold increase. So if you look at the subpopulations, Juha, you are at the highest risk of getting gastric cancer in the United States. So I hope you have your endosch- yes! And all the Korean American men sitting in the audience, I hope you had your endosch-

[11:20] What is clear is that there is plenty of data to show that there's disparities. We know that they exist and in populations they're more gaseous cancer per capita than colon cancer like in Koreans and especially by the time you're age 69.

[11:40] It may make sense to have a colonoscopy or endoscopy at the time of your colonoscopy. And the late stage presentations in the US are life's loss. But if you compare that to early stage presentations in Korea, you can see that there is significant

[12:00] and differences in the presentations. It has, you know, the increase in early stage presentations or detection in gaseous cancer in Korea, as we heard before, is due to screening endoscopies. And in the absence in the United States, there's been no movement. So in

[12:20] We looked at our data at City of Hope for the last decade and there were about 244 surgically resected cancer patients and 45.5% are Asian Americans. These are the patients that we treated at City of Hope. City of Hope is only like less than 10% Asian American.

[12:40] American overall, but in gastric cancer. We do really well with treating Asian Americans. But we also learned that 25.8% of these patients are stage 1 gastric cancer or stage 0. So either they came in through a genetics counseling service.

[13:00] or got referred for hereditary diffuse gastric cancer for prophylactic treatment. Or they were either Korean or Taiwanese Americans who underwent screening of brandoscopy in the LA community like you heard earlier. Or they have gone to get their executive.

[13:20] health screening. No patients who presented with symptoms were diagnosed with early stage cancer. So none of the patients that were early stage actually went with a symptomatic look for a noscopy. And if you look at the recurrence-free survival after they have received

[13:40] purative resection or surgery for their gastric cancer. It's very clear that only early-stage cancers live a long time patients. So we know that we should recognize that there are delays in gastric cancer despite the symptoms. So even if we have symptoms in the US, people are not picking it up.

[14:00] PCPs are not referring to GIs, and we see this all the time. There's months delay before they get treated, and also I think because of COVID, we're going to be seeing more of these late stage presentation patients, especially in the absence of any recommendations for screening. There's some

[14:20] Now, there's an analysis that we did with looking at the California Cancer Registry, which has really good data about Asian Americans. And we learned that Hmong Americans have the highest risk of death due to gastric cancer. Did anyone know that? I have not ever treated a Hmong patient, and I don't know where.

[14:40] they get treated, but they have the highest risk of dying due to gastric cancer. And Hispanic Americans also have a high risk of death due to gastric cancer. And their presentations are also very different as well. So there is data that we can use to get more information on Asian Americans and

[15:00] disparities in gas-free cancer. Why is this so important? Well, it's important because Asian Americans, we are the fastest growing population between 2010 and 2019, and it's the fastest growing and the majority of the Asian Americans are

[15:20] made up of six of the major groups, the Japanese, the Chinese, Indians, Filipino, Vietnamese, and Korean Americans. And around six in 10 Asian Americans, 50%, including 71% of Asian American adults, were born in another country. That means they immigrated like our parents immigrated here.

[15:40] There's a lot of information about the subtypes of Asian Americans and we are not all the same. And so understanding that we may speak different languages, that we immigrated at different times and

[16:00] that we're talking about mixed races. So US-born Asians are significantly younger than our foreign-born counterparts. And we know that socioeconomic disparities exist in gastric cancer.

[16:20] the lower the income, the higher risk you are. And if you look at the Asian American populations, the populations, they are across the board in terms of economics. So I bring us back to here and I am very grateful to be part of this initiative because I think for sure

[16:40] there is gastrocancer disparities in Asian Americans and that if we're going to find gastrocancer care equity for all Americans that we're going to have to work together to eliminate gastrocancer disparities. Perhaps it's by implementing programs for early detection of gastrocancer and high risk population.

[17:00] patients, we can urge the USPSTF to consider primary and secondary screening for gastric cancer and high-risk Americans. How will we define high-risk Americans? What data is needed? How can we collect this data? What policies will need to be created? These are all questions I think that we can answer together.

[17:20] And top barriers that we had set to eliminating US disparities in gastric cancer, there is, for sure, low levels of public and government awareness. There's lack of NIH funding for gastric cancer research and generalization of cancer care for all Americans without regard to the spirit and incidence.

[17:40] and outcomes is harming our cancer health. So in the era of precision oncology and personalized cancer treatment, disregard for ethnic disparities in gastric cancer risk and treatment responses are not acceptable, and I think that's why we're all here. So I think we also need policy support that.

[18:00] that we are going to engender. And it's important for us to look at our existing data and to find out that the census data won't be coming out that soon. I'm a little bit disheartened because we are waiting for that data as well. To look for

[18:20] food deserts, access to comprehensive gastric cancer care, local isolation scores, immigration and census status that are all associated with poor outcomes in gastric cancer. You know, and how do we design gastric cancer specific and population-based studies? Are we going to use nomograms? Are we going to use risk?

[18:40] predicting modeling, new biomarkers, new screening tools, CT DNAs, there's so much information coming out. Non-germline acquired mutations that lead to gastric cancer. Is it going to be a two-tier study or prospective randomized design? Is that even possible? So I invite all of us to join together.

[19:00] together for this gaseous cancer disparities initiative and our glowing partnership. And so we can find better cures and more cures for our gaseous cancer patients. And thank you for your attention.