This cancer targets Malaysian Chinese men… and it’s caused by fish?!

If you heard about a disease that almost exclusively targets one race, you’d think it was some kind of conspiracy. But nope, this one’s 100% real. Nasopharyngeal carcinoma (NPC) is a type of head and neck cancer that has a shockingly high rate among Malaysian Chinese men.

To put it into perspective, a study in the 90’s found that for every 100,000 Chinese men, 10.7 would kena this cancer, which is way more than the Malay rate of 1. Because of that, Malaysia ranks 4th highest in the world for NPC cases. And before anyone tries to blame it on some chiibai Western agenda or ‘weak Chinese genes’, science already has a prime suspect:

Cantonese-style salted fish.

Yes, the same one your ah ma has been frying up since you were a kid. But how exactly does it cause cancer?

The fish curing process produces this dangerous thing called nitrosamine

But before we get into that, what exactly is this Cantonese salted fish?

If you grew up in a Chinese household, you absolutely know what we’re talking about. That pungent, salty, sometimes borderline stinky slab of fish that turns a bland bowl of porridge into an umami bomb. Who would’ve thought this household staple is actually one of the biggest dietary risk factors for NPC .

If you’re wondering why, it’s because of how it’s made.

Traditional Cantonese salted fish is cured in salt and fermented for long periods to achieve that distinctive taste. But that process also produces a lovely little compound called nitrosamine aka a known carcinogen. And here’s where things get even worse.

A 2012 study looked into how salted fish is made, and, uh… let’s just say you might not look at it the same way again:

• The fish isn’t always cleaned properly, and some producers even skip the gutting step to preserve flavour, meaning all the fishy insides stay put.
• Sometimes the fish is fermented longer than necessary because some people prefer that ‘soft meat’ texture, which means letting it rot just a little more.
• Pests like flies and bacteria swarm the fish while it’s drying outdoors, and all that contamination helps convert nitrates into nitrites, which then react with the fish to form nitrosamines.

Basically, your favourite umami fish is playing host to a cancer-causing experiment before it reaches your plate.

But why is this hitting Malaysian Chinese men so hard?

So here’s the deal. NPC is extremely rare in Western countries, but ridiculously common in Southern China and Southeast Asia. And while genetics might play a role, scientists have found that environment and diet matter just as much, if not more.

This is where the whole ‘Malays eat less salted fish’ thing comes into play.

Salted fish has been a staple in Cantonese households for centuries, while Malay and Indian diets traditionally rely more on fresh seafood, dried fish, or different preservation methods. So, if you grew up eating salted fish regularly, especially as a kid… bad news . You’re at a much higher risk for NPC than someone who only had it once in a while.

And this isn’t just a theory. Studies show that kids who consume salted fish before the age of 10 have significantly higher NPC risks compared to those who start eating it as adults. And that’s because kids’ bodies are still developing, and their cells are more vulnerable to the DNA damage caused by nitrosamines.

What really puts this down on paper is the fact that people feed salted fish to babies especially as a weaning diet… y’know that thing that happens when moms wanna stop breastfeeding their kids? Yikes.

So should we stop eating salted fish completely?

Okay, look. No one’s saying you need to swear off salted fish forever. If you’re an adult, your risk is much lower than someone who grew up eating it as a baby. And compared to 30 years ago, fewer families are using salted fish in baby food today, which is a good thing.

Most of the research on NPC zeroes in on Cantonese salted fish, mayhaps because of how it’s prepared and how early some people start eating it. Other types of dried or salted fish don’t seem to catch the same heat, so no need to start a whole ikan masin purge lah.

That said, it wouldn’t hurt to cut back.

Think about it this way: We now know smoking causes lung cancer, but some people still smoke. The difference is, now they do it knowing the risks. It’s kind of the same thing here. If you can’t live without salted fish, go ahead and enjoy it. Just maybe don’t make it a daily thing, and for the love of all things holy, don’t give it to your toddler.