Why More Asian-American Women Are Being Diagnosed with Lung Cancer

Since 2006, rates of lung cancer in the United States have declined by 2.6% per year for men and 1.1% for women. However, among Asian-American women, the rates have increased by 2% each year, studies show, and more than 50% have never smoked.

“Research is underway to better understand this rise, and nail down a risk profile that can help determine when they should get lung cancer screening,” says Dr. Gina Villani, chief of oncology and hematology at NewYork-Presbyterian Queens. “I encourage Asian-American women who have no history of smoking to be involved in screening programs through clinical trials. This can help gather data to ultimately get answers.”

Health Matters spoke with Dr. Villani to better understand the increasing lung cancer incidence rate among Asian-American women, especially those who do not smoke.

Smoking is a well-known risk factor for developing lung cancer, but in cases of people who do not smoke, what are other risk factors?
Dr. Villani: Risk factors of lung cancer other than smoking are second-hand smoking, radon, air pollution, occupational exposures, such as to asbestos, and having a family history of lung cancer.

We do tend to see clustering of lung cancer cases within families. Does that mean that it is a genetic issue? Not at all. We have not found a gene as we have for breast cancer, such as BRCA, that is contributing to a family history of lung cancer. However, if someone has a family history of lung cancer, their risk of getting it is higher than the general population.

We need to find a gene to hang our hat on when it comes to lung cancer in non-smokers. We do know that having a mutation in a gene called the epidermal growth factor receptor (EGFR) can also increase risk.

What is EGFR, and what happens in the body when this mutation occurs?
EGFR is a protein that is present in a myriad of cells in the body that help them grow. In our bodies, we have cells that grow and then they die off, or we are constantly shedding old cells and creating new ones. The balance of cell division and cell death is important. When the EGFR is mutated, the balance is off and there is a constant signal for cells to grow. Too much cell growth is one factor of cancer development.

According to the American Lung Association, EGFR-positive lung cancer generally appears in a subtype of non-small cell lung cancer called the adenocarcinoma, which are cancers that come from the lining of the lung. About 80% to 85% of cases are non-small cell lung cancer, estimates the American Cancer Society.

An EGFR mutation is not inherited — it is acquired. It is important to understand how this mutation is acquired, but we have not figured that out yet. Research shows that this mutation makes up the largest proportion of lung cancer in non-smokers Rates are as high as about 60% to 74% in non-smoking East Asian women with lung cancer.

Why are Asian-American women getting this mutation that ultimately leads to excess cell growth and lung cancer? We do not have that answer and that is what the studies are working to understand.

What are the current screening guidelines for lung cancer and how can they be improved?
Lung cancer screening has been shown to reduce the risk of dying of lung cancer by 20%. To be eligible for screening, a person must have a 15 pack-year smoking history and be between ages 45 to 75. But uptake in lung cancer screening is very low to begin with. The number of people who qualify for screening and are getting it done is critically low — around 13% of people who are eligible get screened.

But in this scenario, we are talking about Asian-American women who are not smokers. And the problem is that we do not have any guidelines for how to screen these women. Right now, there are studies looking at Asian-American women. We have to hone in on risk factors to eventually develop a risk profile that can help us determine who should be screened.

What are the signs and symptoms of lung cancer?
If you have persistent symptoms like a cough, shortness of breath, coughing up blood, weight loss, and chest pain, express this with your doctor, plus any other risk factors you may have, such as a exposure to radon or a family history. We do not want somebody thinking they have lung cancer because they had a cough for a week. But certainly, if something is persistent, visit your primary care doctor who can help you look into it by recommending a low dose computed tomography (LDCT) scan.

What does treatment for lung cancer look like?
Course of treatment would be surgery if the cancer is localized to the lung, as well as chemotherapy, radiation therapy, and immunotherapy like immune checkpoint inhibitors. Immune checkpoint inhibitors uses the immune system to attack cancer to help slow or stop the growth of cancer cells and keeps cancer from spreading, and helps the immune system destroy cancer cells.

In terms of adenocarcinoma caused by an EGFR mutation, we know the source of the defect is the mutation. There have been targeted medications that aim at the receptor so it blocks the overgrowth of cells. And those drugs are oral agents. People can take them at home and the treatment has minimal toxicity — they can be effective not only for people who have advanced disease, but we now have moved those drugs up to help prevent recurrences in people who have early-stage disease. So, if somebody had an early-stage lung cancer that was operated on, we now use those targeted oral agents to prevent recurrence of disease.

We have come a long way in terms of treatment. And with people participating in clinical trials and helping to advance science, we are going to find more cures — it is just a matter of working together. If there are clinical trials that are available, for example, the trials of screening just Asian women, they shouldn’t be afraid to be involved in a clinical trial. I would highly encourage Asian women to be involved in screening programs. What we want to do is gather the data to ultimately get answers.

Dr. Gina Villani serves as chief of hematology and oncology at NewYork-Presbyterian Queens, where she built an interdisciplinary medical oncology cancer program in hematological and solid tumor malignancies. Dr. Villani is an expert in studying and providing cancer care and education to low-resourced, underserved populations.