by It was the fall of 2021, and Aurora Lucas had a persistent cough and chest pain. However, her doctors dismissed the symptoms, telling her to drink warm water and honey.
After three months of hospital visits, Lucas was diagnosed with stage 3 lung cancer at the age of 28, despite never having smoked. Lucas, a Filipina American, is a worrying trend for researchers.
According to a study in California, lung cancer rates are falling for all groups except Asian American women who don’t smoke – for which they are actually increasing by 2% per year.
Although lung cancer is traditionally associated with cigarettes, up to 20% of US cases occur in people who never smoke each year. Among Asian American women with lung cancer, more than 50% had never smoked. And for Chinese and American Indian women with lung cancer, the percentage without smoking rises to 80% to 90%.
This pattern is puzzling scientists, and has led to a recent surge in research. In two ongoing studies at the University of California, San Francisco, and New York University, they are searching for reasons why Asian-American women are at high risk and ways to catch their tumors earlier.
“It’s such a high rate; there yes to be an explanation then,” said Lucas.
In May, NYU researchers shared preliminary data at the American Society of Clinical Oncology conference showing that lung cancer screening in Asian American women who do not smoke works as well, if not better, than screening in older adults. , mostly white smokers.
Now, doctors are raising the alarm about the increasing number of lung cancer cases in this community and are working to reform the screening guidelines to better include Asian American women.
“As an Asian woman, I was taught to be quiet,” Lucas said. “I had a lot of respect for doctors and medical staff, so I would never question what they were telling me,” even when they didn’t understand what was wrong.
Understand the risk factors
UCSF epidemiologist Scarlett Gomez was born in Taiwan before immigrating to the US at age 7, her parents working in Chinese restaurants in Washington state. But that also meant they were constantly, unknowingly exposed to toxic cooking oil fumes.
“Like many immigrant families, my parents worked in industries that were their training,” Gomez said. “That’s the work they had to do to make it here.”
To date, studies of female non-smokers in Asia have identified risk factors such as cooking oil fumes, second-hand smoke, air pollution and indoor heating with coal, but no research has focused on Asia. American women, Gomez said.
However, there is probably some overlap. For example, a 2019 study found that Asian Americans breathe 73% more particulate pollution than white Americans, likely due to greater exposure to construction, industrial and vehicle emissions where they live.
Air pollution can also lead to genetic changes so that Asian patients have some of the highest rates of the cancer-causing epidermal growth factor receptor mutation, which causes healthy cells to divide and grow uncontrollably in tumors.
“I hope we’ll see more studies to address these extraordinary disparities that are emerging among Asian Americans that we haven’t paid attention to before,” Gomez said.
Because of the lack of clarity, Gomez and Iona Cheng, a fellow epidemiologist at UCSF, launched the Asian Women Never Smoker study, or FANS, in 2021. It is a case-control study, in which the team is studying nonsmoking Asian American women who were smokers. were recently diagnosed with lung cancer (the cases) or had never had lung cancer (the controls).
Although the two groups are matched in terms of ethnicity and age, the researchers hope to find some differences in genetics, as assessed by saliva samples, and environmental exposure, determined by surveys asking people about past. “The whole goal of this study is to identify risk factors,” Gomez said.
However, FANS cannot show a cause-and-effect relationship, said Dr. Latha Palaniappan, a doctor at Stanford University, who is not involved in the study.
For one, women with lung cancer may be more likely to remember their exposure to chemicals and toxins than women without lung cancer because they are thinking harder about their risk factors—a phenomenon called “bias recall.”
However, Palaniappan emphasized the novel nature of FANS, because “we can certainly understand associations, and the study can give us an idea for more rigorous analyzes in the future.”
Making lung cancer screening more equitable
At NYU, Dr. Elaine Shum, an oncologist, after seeing so many non-smoking Asian American women with lung cancer, many with stage 4 disease. And it’s always frustrating: lung cancer screening, through the low-dose CT scan, helping those women find their tumors earlier, at easier-to-treat stages.
But insurance plans typically cover screening only for people between the ages of 50 and 80 who have a heavy smoking history – all but Asian American women. And the recommendations were based on the National Lung Screening Trial, a clinical trial of 53,000 elderly smokers, over 90% of whom were white.
So Shum started her own clinical trial in 2021, screening 1,000 non-smoking Asian American women for lung cancer. Her initial results, which she presented at a major cancer conference, showed that Asian women had a higher detection rate of lung cancer than the original national trial – 1.5% compared to 1%. “Based on these preliminary data and other ongoing efforts, Asian women represent another high-risk population in need of screening,” Shum said.
Palaniappan, who is also not affiliated with the Shum trial, tends to agree: “It’s extraordinary that the screening in this population resulted in a lung cancer incidence similar to the original trial. But Palaniappan also cautioned that better inclusion of Asian American women in screening guidelines is still a long way off, and that many more studies are needed to confirm and build on Shum’s findings. “We’re just at the beginning,” she said.
“There is hope; there’s a lot of progress being made in the world of lung cancer,” says Lucas. “I can’t change the system because it’s broken, but I can help people support themselves and learn.”
Why Asian American women were left behind
When Lucas was diagnosed with lung cancer, she was in the second year of her Ph.D. program, while working as a special education teacher in Chicago. She always thought of herself as healthy, so she initially put the chest pain and cough down to stress. Now, she knows that Asian American women are at high risk of lung cancer, but she still doesn’t understand how her doctors didn’t.
Although the research at UCSF and NYU is promising, it is not clear why, in 2024, some of the first and only studies focused on Asian American women with lung cancer.
On one level, it’s a problem of awareness.
“A lot of Asian patients are very private and don’t want others to know about their diagnosis,” Shum said — often because they don’t want to be a burden to their friends and family or because they are concerned about the stigma of lung cancer. . Perhaps as a result, the most common reaction of Asian-American women when they hear about Shum’s work in lung cancer is “I didn’t even know this was an issue,” a she said.
And that lack of awareness is exacerbated by poor-quality data, according to Stella Yi, who directs the Innovations in Data Equity for All Lab at NYU. That is, Asian Americans are often lumped into the “Other” category in surveys or in overbroad groups such as Asian Americans, Native Hawaiians, and Pacific Islanders, or AANHPI, that hide their data.
Most national databases collect information in English and sometimes in Spanish, which means many people don’t get the chance to be included. “So when you look at data reports where Asian Americans look healthier than everybody else, it’s because you’re just having the highest income, the highest education, ” said Yi.
As a result, lung cancer cases among Asian American women are likely underreported, and the data reinforce racial stereotypes. “Asian Americans are thought to be healthy; they are a model minority,” Yi continued, referring to the myth that all Asians are academically and economically high achievers. “They’re doing tai chi in the park, so why would they be getting lung cancer? Why would they have health disparities?”
For scientists trying to disrupt that situation, it can be extremely difficult, as only 0.17% of the National Institutes of Health’s budget over 26 years has been spent on AANHPI research. “We hear a lot of stories from patients with lung cancer whose primary care doctor said, ‘You don’t need this; you are not in great danger,’” said Shum. With poor data and a lack of research among Asian-American women, “lung cancer is put on the back burner.”
That’s why Lucas thinks it took her three months for a doctor to take her symptoms seriously and make a diagnosis. “My doctors were in denial that cancer could happen,” she said, as the staff drifted from a sore throat to tuberculosis to the idea that there was nothing wrong with her.
“I needed it treatment, somebody doesn’t tell me it’s going to be okay,” she continued. By the time they diagnosed her with cancer, she had three tumors in her lungs, the largest the size of a lime.
Lucas didn’t cry then. “Honestly, I felt relieved, because the worst part was fighting the insurance and even getting that diagnosis,” she said.
In many ways, it’s no surprise that Cheng, Gomez and Shum—three Asian American women—are leading similar studies, because who else would be motivated enough to jump through all the hoops and push through the doubt?
“It’s a very personal matter for us,” Cheng said. “As Asian Americans ourselves, we see this in our community. It just adds another dimension to us being committed to highlighting this inequity.”
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This article was originally published on NBCNews.com
