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Digging Into the Increasing Lung Cancer Rate for Female, Asian, Never Smokers: Dr Jeffrey Velotta


Jeffrey Velotta, MD, FACS, attendee and presenter of CHEST Annual Meeting 2023, talks about the phenomenon of an increase in female, Asian, nonsmokers developing lung cancer, and what is being done to address this rise.

Jeffrey Velotta, MD, FACS, Clinical Assistant Professor at the University of California San Francisco School of Medicine, Clinical Professor Kaiser Permanente Bernard J. Tyson School of Medicine, attendee and presenter of the CHEST Annual Meeting 2023 talks about the work being done to address growing lung cancer incidence in nonsmoking, Asian women.


In the study "Trends in Smoking-Specific Lung Cancer Incidence Rates Within a US Integrated Health System, 2007-2018," it was found that more research needs to be done on adults who develop lung cancer but never smoke, especially those of Asian and Pacific Islander (API) origin.

What research is needed to better understand the causes and patterns of lung cancer among adults who have never used tobacco and why is it important to include API populations in that research?

The most important thing that we found from this study was that lung cancer is decreasing in incidence for all populations, smokers and nonsmokers, except for Asian American, female, nonsmokers. That is the only group across the board where lung cancer is actually increasing in that group. We found that it was increasing 2% per year, a significant amount, versus everybody else across the board who was decreasing.

I think that's something that's really important: why are Asian American female nonsmokers’ incidence increasing, whereas for everybody else, lung cancer is going down? The reason why that's important is because we don't have all the answers right now. We think it could be the biology related to it, it could be secondhand smoke, it could be pollution, all those different things.

What this study really showed is that “hey, this is an issue." Among Asian American, female, nonsmokers, lung cancer is rising, more women are being affected by lung cancer. Why is that? We have to find out more of the causes. I think that this brings to the forefront, that this is a problem, we need to study this problem, and we need to take it more seriously.

Something that we're working on next is to figure out, what is the issue? What are the main causes?

We have a current study that we're looking at right now in collaboration with Kaiser Permanente in Northern California and UCSF [University of California San Francisco] called the FANS study, which is Female Asian Never Smoker study. It’s relatively simple, but it's a survey and a saliva test, as well as a tissue specimen test where we test the molecular markers of the tissue for all Asian females in this California region that we're collecting, and we're looking at some of the causes, based on their survey results of with what they cook with, where in Asia they were from, were they born here in the United States, do their spouses or significant others smoke?

We already know that they [Asian women] don't smoke, so what are the other causes behind the causes of lung cancer? Once we figure that out, this will be the first large study to ever look at the causes, then we can figure out the next steps about what to do and for potential treatments.

Because we are located in Northern California, California actually has the highest amount of Asian Americans in the United States per number. Hawaii actually has a higher concentrated amount, but we have the highest number in terms of overall population. What we're seeing over the last several years, clinically—and me, as a thoracic surgeon, doing surgery for lung cancer that we were seeing, many of my patients were Asian female, smoker or nonsmoker, but many of my patients were females—really, we're seeing a rise, overall, just in lung cancer that we're removing in the operating room.

So, that's why we wanted to study this. We're like, “is this really true? Or is this something that I am thinking subjectively?” Now it does back it up with the research with this study, when we looked at it in our database that, indeed, it is not just subjectively, it's objectively, we do have patients that are significantly getting more lung cancer and they just happen to be Asian female nonsmokers.

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