Disaggregating cancer risk among Asian American and Pacific Islander solid organ transplant recipients

Solid organ transplantation has emerged as a well-established and life-saving treatment option for patients with end-stage organ diseases.This process involves the identification of a suitable transplant donor and the use of lifelong immunosuppression to minimize the risk of graft rejection.However, prolonged immunosuppression increases the risk of viral infections and the subsequent onset of virus-mediated malignancies due to the prevention of tumor clearance and immune control.For instance, Epstein-Barr virus-associated Hodgkin and non-Hodgkin lymphoma, human papillomavirus-associated anogenital cancers, and herpesvirusassociated Kaposi sarcoma have historically occurred at elevated rates among solid organ transplant recipients. 1 Asian Americans and Pacific Islanders have historically experienced high rates of cancer morbidity and mortality, with cancer representing the leading cause of death in Chinese, Filipino, Korean, and Vietnamese American people. 2 Native Hawaiian and Pacific Islander people have 2 to 3 times higher rates of mortality from cervical, stomach, and endometrial cancers compared with non-Hispanic White people.Some virus-mediated cancers, such as nasopharyngeal cancer, present at rates 7 times higher among Asian Americans and Pacific Islanders than among non-Hispanic White Americans, with rates up to 14 times and 10 times higher among Laotian Americans and Chinese Americans, respectively, compared with non-Hispanic White Americans. [3]][5] Given these salient differences in cancer risk, in this issue of the Journal, Tao et al. 6 sought to explore the link between solid organ transplant recipient status as a risk factor for elevated cancer incidence among Asian American and Pacific Islander populations.Specifically, this retrospective observational cohort study evaluated rates of cancer incidence among Asian American and Pacific Islander solid organ transplant recipients compared with nonrecipients and non-Hispanic White populations, disaggregated by ancestry and cancer subtype.The study used the US Scientific Registry of Transplant Recipients database, which consists of 34 population-based cancer registries from which the authors extracted data on cancer cases among solid organ transplant recipients for Asian American, Pacific Islander, and White populations.The authors calculated incidence rates for each cancer subtype, disaggregated by Asian American, Pacific Islander, or non-Hispanic White populations, and found striking