Elevated risk of lung cancer among Asian American women who have never smoked: an emerging cancer disparity

Lung cancer is a leading cause of cancer mortality for most ethnic groups of Asian American women, including Chinese, Korean, Japanese, and Vietnamese Americans, a striking pattern given the exceedingly low prevalence of smoking among Asian American women in the general population. Recent research demonstrates that among Asian American women with a lung cancer diagnosis, the vast majority of patients have never smoked, a rate as high as 80% among Chinese and Asian Indian American women. Despite declining rates in lung cancer overall in the United States, rates among Asian American women who have never smoked appear to be increasing. This commentary articulates extant knowledge, based on studies in Asia, of a range of risk factors, such as a family history of lung cancer; a history of lung diseases, including tuberculosis and chronic obstructive pulmonary disease; exposure to cooking fumes and second-hand smoke; and various putative risk factors. Unique mutational profiles at the tumor level, including a higher prevalence of EGFR variations among Asian populations, highlight the importance of tumor genomic testing of newly diagnosed patients. Additional research is essential, given the high burden of disease among Asian American women who have never smoked and the limited knowledge regarding contributing risk factors specific to Asian American women, because the risk factors identified in Asian people living in Asia may not apply.