Asian Americans are often perceived as one of the “healthiest” populations in the United States. But this broad label masks major disparities in preventive health, chronic disease risk, and cancer outcomes across diverse Asian American communities.
In reality, many current U.S. screening guidelines were developed using predominantly White and Black populations and may fail to identify disease risk in Asian Americans early enough. As a result, conditions like diabetes, hepatitis B, liver cancer, cardiovascular disease, tuberculosis, and gastric cancer are frequently underdiagnosed or detected too late.
During AAPI Heritage Month, it’s important to recognize that “Asian American” is not a single health category. Filipino, Vietnamese, Korean, South Asian, Chinese, Hmong, Cambodian, and other communities each face unique health risks that require culturally informed and subgroup-specific preventive care.
Why Standard Preventive Screening Guidelines May Miss Asian Americans
Many Asian Americans develop chronic disease at lower body weights, experience higher rates of infection-related cancers, or have disease patterns that differ substantially from the general U.S. population.
Unfortunately, aggregating all Asian Americans into one category obscures these important differences.
Research increasingly shows that disaggregated, ethnicity-specific screening strategies are essential for improving health outcomes in Asian American populations.
1. Diabetes Screening Should Start at Lower BMI Thresholds in Asian Americans
Asian Americans develop type 2 diabetes at significantly lower body mass indexes (BMI) compared to White Americans due to higher visceral fat accumulation and different body fat distribution patterns.
While standard U.S. guidelines historically used a BMI cutoff of 25 kg/m² for diabetes screening, both the ADA and USPSTF now recommend screening Asian Americans beginning at a BMI of 23 kg/m².
BMI≥23 kg/m2BMI \geq 23\ \mathrm{kg/m^2}BMI≥23 kg/m2
Some studies suggest the equivalent diabetes-risk threshold may be even lower — closer to BMI 20 in Asian Americans.
The World Health Organization also recommends lower thresholds for overweight and obesity in Asian populations:
- Overweight: BMI ≥23 kg/m²
- Obesity: BMI ≥27.5 kg/m²
Waist circumference cutoffs are lower as well, especially in South Asians, reflecting the importance of abdominal adiposity in cardiometabolic disease risk.
Key Takeaway
Asian Americans may have “normal” BMIs by standard U.S. definitions while already developing:
- Prediabetes
- Type 2 diabetes
- Fatty liver disease
- Metabolic syndrome
- Cardiovascular disease
Early metabolic screening is critical.
2. Hepatitis B and Liver Cancer Screening Are Frequently Missed
Chronic hepatitis B disproportionately affects Asian American populations, especially individuals born in HBV-endemic regions across East and Southeast Asia.
The CDC now recommends universal one-time hepatitis B screening for all adults using triple-panel testing:
- HBsAg
- anti-HBs
- anti-HBc
However, many Asian Americans remain unscreened.
This is important because chronic hepatitis B can lead to hepatocellular carcinoma (HCC), even in patients without cirrhosis.
Liver Cancer Risk Is Significantly Higher in Some Asian Subgroups
Asian Americans are nearly 40% more likely to die from liver cancer than White Americans. Vietnamese, Hmong, Cambodian, and Laotian populations are particularly affected.
Patients with chronic hepatitis B often require ongoing liver cancer surveillance using a blood test and liver ultrasound every 6 months.
Unfortunately, this surveillance is not routinely incorporated into standard primary care workflows and is commonly overlooked.
Asian American Groups at Highest Risk
- Vietnamese Americans
- Hmong Americans
- Cambodian Americans
- Laotian Americans
- Chinese Americans
- Korean Americans
3. Gastric Cancer Screening May Be Appropriate for High-Risk Asian Americans
Routine stomach cancer screening is not recommended for the general U.S. population. However, newer guidelines recognize that certain Asian American populations face substantially higher risk.
The 2025 American Gastroenterological Association Clinical Practice Update identifies first-generation immigrants from high-incidence regions, including East Asia, as a higher-risk group who may benefit from endoscopic screening.
Asian Americans are approximately twice as likely to die from stomach cancer compared to White Americans.
Who May Benefit From Gastric Cancer Screening?
Potential higher-risk groups include:
- Korean Americans
- Japanese Americans
- Chinese Americans
- Individuals with family history of gastric cancer
- First-generation immigrants from East Asia
Some experts suggest considering:
- One-time upper endoscopy (EGD)
- Around age 40–45
- Particularly when undergoing colonoscopy
This is especially important because gastric cancer is often diagnosed late in the United States.
4. Cardiovascular Risk Is Often Underestimated in South Asians
Traditional cardiovascular risk calculators may not accurately estimate heart disease risk in South Asian populations.
South Asians:
- Develop cardiovascular disease younger
- Experience heart attacks earlier
- Develop insulin resistance at lower BMI levels
- Have higher rates of diabetes and visceral adiposity
The American Heart Association and ACC recognize South Asian ancestry as a cardiovascular “risk-enhancing factor.”
Why This Matters
Standard risk calculators may underestimate:
- Heart attack risk
- Stroke risk
- Atherosclerotic cardiovascular disease (ASCVD)
Many South Asians may benefit from:
- Earlier lipid screening
- Earlier diabetes screening
- Lipoprotein(a) testing
- Earlier lifestyle intervention
- More aggressive preventive care
Higher-Risk South Asian Populations Include
- Indian Americans
- Pakistani Americans
- Bangladeshi Americans
- Sri Lankan Americans
- Nepali Americans
5. Latent Tuberculosis Screening Remains Important
Tuberculosis screening is another frequently overlooked preventive health issue in Asian American communities.
The USPSTF recommends latent tuberculosis infection (LTBI) screening for individuals born in countries with higher TB prevalence — including many Asian countries.
Importantly:
- Reactivation can occur decades after immigration
- Risk persists even after long-term U.S. residence
Countries contributing many U.S. TB cases include:
- India
- Philippines
- Vietnam
- China
Appropriate screening may include:
- IGRA blood testing
- Chest imaging when indicated
- Preventive treatment if positive
6. Nasopharyngeal Cancer Awareness Is Critical in Southeast Asian Populations
Nasopharyngeal carcinoma (NPC) is rare in the general U.S. population but remains significantly more common in:
- Southern Chinese populations
- Southeast Asian populations
Risk is linked to:
- Epstein-Barr virus (EBV)
- Genetic susceptibility
- Dietary factors
Although no formal U.S. screening guidelines currently exist, clinicians should maintain heightened awareness in Asian American patients presenting with:
- Persistent cervical lymphadenopathy
- Nasal obstruction
- Hearing changes
- Cranial nerve symptoms
Early recognition can improve outcomes substantially.
7. Asian Americans Continue to Have Lower Rates of Standard Cancer Screenings
Even for well-established cancer screenings, Asian Americans consistently have lower screening rates compared to White Americans.
Examples include:
- Cervical cancer screening
- Colorectal cancer screening
- Breast cancer screening
Despite this, cancer remains the leading cause of death among Asian Americans — the only major racial/ethnic group in the United States for whom this is true.
Why Screening Rates Remain Lower
Barriers include:
- Language differences
- Limited culturally tailored healthcare
- Insurance access
- Health literacy gaps
- Cultural beliefs about preventive care
- The “model minority” myth
These disparities worsened during and after the COVID-19 pandemic.
Why Disaggregated Data Matters in Asian American Health
One of the biggest challenges in Asian American healthcare is data aggregation.
Lumping all Asian Americans into a single category hides profound subgroup differences.
Examples of Disparities Hidden by Aggregation
Filipino Americans
Higher rates of:
- Hypertension
- Diabetes
- Coronary artery disease
- Stroke
Korean Americans
Higher burden of:
- Gastric cancer
- Colorectal cancer
- Lower screening uptake
Hmong Americans
Higher rates of:
- Hepatitis B
- Liver cancer
- Low HBV screening and treatment rates
South Asians
Higher rates of:
- Premature cardiovascular disease
- Diabetes at lower BMI
- Elevated lipoprotein(a)
Precision prevention requires recognizing these differences.
A More Personalized Approach to Preventive Care
AAPI Heritage Month is an opportunity to move beyond one-size-fits-all medicine.
For Asian American patients, culturally informed and subgroup-specific screening strategies may help detect disease earlier, reduce cancer mortality, and improve long-term cardiometabolic health.
Preventive healthcare should account for:
- Ethnicity-specific risk
- Immigration history
- Family history
- Cultural context
- Language access
- Social determinants of health
The future of preventive medicine is personalized — and that includes recognizing the diversity within Asian American communities.
References
Key references include guidelines and studies from:
- American Diabetes Association
- U.S. Preventive Services Task Force
- Centers for Disease Control and Prevention
- American Association for the Study of Liver Diseases
- American Gastroenterological Association
- American Heart Association
- American Cancer Society
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