Breast cancer is a disease in which the cells in the breast grow abnormally and uncontrollably, forming a tumor that can invade nearby tissues or spread (metastasize) to other parts of the body. Common symptoms include a lump or thickening in the breast or underarm, changes in breast shape or size, skin changes such as redness or dimpling, nipple changes like inversion or discharge, and, less commonly in early stages, pain.
Prevalence
This is the most commonly diagnosed cancer among women in the United States (except some skin cancers) and the second leading cause of cancer-related deaths among women [1,2]. Breast cancer is expected to account for 29% of all new cancers in women in the United States [1]. The incidence of breast cancer continues to rise among South Asian American women, a demographic that includes Sikhs, many of whom trace their roots to Punjab, India [3,4]. Studies also suggest that South Asian American women are more likely to be diagnosed at a younger age [5].
Genetic and environmental risk factors
Breast cancer is a multifactorial process that can be caused by both genetics and environmental factors. Research conducted in Punjab highlights genetic polymorphisms that may predispose individuals to breast cancer. For example, the GG genotype of the MCP-1-2518 A/G polymorphism has been linked to increased breast cancer risk in women from Punjab, India [7]. Although a large population has been migrated from this region to the US, no exact data is available on the Sikh population in the US. A study revealed that in low- and middle-income countries, breast cancer incidence is projected to increase due to the westernization of lifestyles, characterized by delayed pregnancies, reduced breastfeeding, early onset of menarche, insufficient physical activity, and poor dietary habits [9,10]. Since these lifestyle factors are already widespread in the United States, breast cancer incidence is likely to remain high or continue rising. Moreover, obesity is associated with an increased risk of breast cancer [9]. Studies have shown rising obesity rates among South Asian Americans, including Sikhs. Contributing factors include reduced physical activity and dietary shifts away from traditional plant-based, home-cooked meals [12].
Underrepresentation in research data
Sikhs in Clinical Research (SICR) have encountered numerous Sikh families affected by breast cancer during outreach events across the US. Although there is currently no national dataset capturing cancer rates specifically among Sikhs in the U.S., community-level experiences suggest that breast cancer is a pressing concern.
Despite South Asians being among the fastest-growing immigrant populations in the U.S., there is a lack of detailed data on breast cancer outcomes in this group. Often, Asian populations are aggregated into a single racial category in research, masking critical differences in risk profiles, diagnosis patterns, and treatment outcomes [5,6]. Moreover, participation of the Asian population in breast cancer clinical trials is relatively low, and Sikh communities are no exception. In U.S. breast cancer trials, racial and ethnic minorities, who make up about 40% of the national population, are consistently underrepresented. In U.S. breast cancer clinical trials, Asian participation has often been reported at less than 5%, a clear underrepresentation relative to population size [13]. This underrepresentation in research reflects real-world barriers faced by Sikh communities, including language and demographic barriers, and a lack of awareness about clinical trials.
Cultural and linguistic barriers to care
SICR’s outreach also reveals significant challenges faced by Sikh patients and families, particularly in navigating healthcare and accessing native language resources. A Stanford-based study exploring cancer experiences among South Asian women sheds light on several barriers faced by the community, including linguistic hurdles and culturally hard-to-accommodate healthcare recommendations. “My parents found it hard to digest the information coming to them,” said Anu Gupta, a breast cancer survivor. “They would have been inclined to ask more questions if they had been able to speak to someone in Punjabi or Hindi.” This sentiment is echoed in dietary consultations as well. For example, many Indian patients are vegetarian, so being advised to eat more white or lean red meat does not align with their cultural or dietary norms [8]. Other reports have documented barriers specific to Punjabi and Sikh communities, including shyness, language differences, and lack of awareness, that extend beyond clinical care into participation in clinical research [11].
Call to Action: Research, Representation, and Resources
To address this growing concern, several steps must be taken:
- Disaggregated Data: Future cancer registries and research efforts should differentiate between various Asian subgroups to better understand risks and outcomes in subpopulations.
- Genomic and Clinical Research: Studies should investigate whether genetic predispositions observed in Punjab, India, persist among Sikh Americans, particularly those with family histories of cancer. At the same time, efforts must be made to increase the representation of Sikhs in clinical research. Greater participation will not only address existing data gaps but also help generate evidence that can guide more personalized treatment strategies for this community.
- Culturally Competent Care: Healthcare institutions must provide translated materials, culturally appropriate care and dietary guidance, and outreach in native languages such as Punjabi and Hindi.
- Community-Driven Advocacy: There is a need to raise awareness of clinical trials and promote health screenings in Sikhs and the South Asian community.
References
1. American Cancer Society. (n.d.). How common is breast cancer? In Breast cancer. Retrieved August 14, 2025, from https://www.cancer.org/cancer/types/breast-cancer/about/how-common-is-breast-cancer.html
2. Centers for Disease Control and Prevention. (2025, June 10). Breast cancer statistics. Retrieved August 14, 2025, from https://www.cdc.gov/breast-cancer/statistics/index.html
3. Kohler, R. E., Dharamdasani, T., Tarn, J., Macenat, M., Ferrante, J. M., Mathur, S., … Satagopan, J. M. (2025). Breast cancer beliefs and screening behaviors among South Asian immigrant women living in the United States. BMC Women’s Health, 25(1), 98. https://doi.org/10.1186/s12905-025-03634-1
4. Satagopan, J. M., Stroup, A., Kinney, A. Y., Dharamdasani, T., Ganesan, S., Bandera, E. V., … Demissie, K. (2022). Breast cancer among Asian Indian and Pakistani Americans: A SEER-based study. International Journal of Cancer, 150(2), 180–189. https://pmc.ncbi.nlm.nih.gov/articles/PMC8544783/
5. Mukherjea, A., Ivey, S. L., Shariff-Marco, S., Kapoor, N., & Allen, L. (2018). Overcoming challenges in recruitment of South Asians for health disparities research in the USA. Journal of Racial and Ethnic Health Disparities, 5(1), 195–208. https://pmc.ncbi.nlm.nih.gov/articles/PMC11877708/#CR7
6. Sambyal, V., Guleria, K., Kapahi, R., Manjari, M., Sudan, M., Uppal, M. S., & Singh, N. R. (2015). Association of the −2518 A/G polymorphism of MCP-1 with breast cancer in Punjab, North-West India. Asian Pacific Journal of Cancer Prevention, 16(16), 7243–7248. https://pubmed.ncbi.nlm.nih.gov/28364371/
7. Muralidhar, S., Li, X., Park, H., & Choudhury, P. P. (2025). Understanding disparities in breast cancer care among immigrant women: A mixed-methods approach. Cancers, 17(7), 1543. https://pubmed.ncbi.nlm.nih.gov/26514518/
8. Richter, R. (2023). Keeping breast cancer secret: For South Asian women, stigma stands in the way of asking for support. Stanford Medicine. https://stanmed.stanford.edu/stigma-breast-cancer-south-asian-women/
9. Łukasiewicz, S., Czeczelewski, M., Forma, A., Baj, J., Sitarz, R., & Stanisławek, A. (2021, August 25). Breast cancer—Epidemiology, risk factors, classification, prognostic markers, and current treatment strategies—An updated review. Cancers (Basel), 13(17), 4287. https://doi.org/10.3390/cancers13174287
10. Porter, P. (2008). “Westernizing” women’s risks? Breast cancer in lower-income countries. New England Journal of Medicine, 358(3), 213–216. https://doi.org/10.1056/NEJMp0708307
11. Hareena. (2024, July 11). Stay ahead of breast cancer: A guide to screening. Sikh Women’s Health Initiative. Retrieved August 14, 2025, from https://sikhwhi.org/2024/07/11/stay-ahead-of-breast-cancer-a-guide-to-screening/
12. Bharmal, N. H., McCarthy, W. J., Gadgil, M. D., Kandula, N. R., & Kanaya, A. M. (2018). The association of religious affiliation with overweight/obesity among South Asians: The Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study. Journal of Religion and Health, 57(1), 33–46. https://doi.org/10.1007/s10943-016-0290-z
13. Clarke, S., Chin, S. N., Dodds, L., George, S. H. L., & Badal, S. (2022, August 5). Racial disparities in breast cancer preclinical and clinical models. Breast Cancer Research, 24, Article 56. https://doi.org/10.1186/s13058-022-01551-x
