Ethnic Enclave Residence and Breast, Cervical, and Colorectal Cancer Incidence among Asian American Adults, 2006 to 2017

BACKGROUND: Ethnic enclaves are culturally or ethnically distinct neighborhoods with high concentrations of individuals with shared ethnic origins, immigrants, and/or ethnic-specific businesses. We examined whether residence in Asian American enclaves was associated with the incidence of three screening-amenable cancers, using a composite enclave index across five US states. METHODS: Using cancer registry data, we identified 74,485 breast, 4,134 cervical, and 35,736 colorectal cancer tumors diagnosed in California, Florida, New Jersey, New York, and Texas from January 1, 2006, to December 31, 2017, in Asian American adults. Age-adjusted incidence rates and incidence rate ratios (IRR) were calculated for 2006 to 2011 and 2012 to 2017 for census tract (CT)-level enclave and poverty measures, separately and jointly. RESULTS: Breast and colorectal cancer incidence rates were lower among Asian American adults residing in the least culturally distinct neighborhoods compared with the most distinct [2012-2017: IRR 0.71; 95% confidence interval (CI), 0.65-0.76 in quintile 1 (Q1; low) compared with Q5 (high) for breast; IRR 0.62; 95% CI, 0.52-0.74 in Q1 vs. Q5 for colorectal cancer in males], whereas no association was found with enclave for cervical cancer. Higher cervical cancer rates were associated with high-poverty areas. For breast cancer, the highest incidence rates were observed in low-poverty enclaves, whereas for colorectal cancer, the highest rates were observed in high-poverty enclaves. CONCLUSIONS: Breast and colorectal cancer incidence rates were associated with residence in Asian American enclaves and CT poverty, though patterns differed by cancer site. IMPACT: Cancer prevention outreach may be beneficial within Asian American enclaves.