It was the fall of 2021, and Aurora Lucas had a persistent cough and chest pain. However, his doctors ignored the symptoms and told him to drink hot water and honey.
After three months of hospital visits, Lucas was diagnosed with stage 3 lung cancer at the age of 28, even though he had never smoked. Lucas, who is Filipino American, represents a worrying trend for researchers.
Lung cancer rates are falling for every group except non-smoking Asian American women, according to a California study; In fact, these rates are increasing by 2% per year.
While lung cancer has traditionally been associated with smoking, 20% of cases in the United States occur in never-smokers each year. More than 50% of Asian American women with lung cancer have never smoked. Among Chinese and Indian American women with lung cancer, the rate of nonsmokers increases to 80% to 90%.
Scientists have been puzzled by this pattern, which has led to increased research recently. Two blockbuster studies underway at the University of California, San Francisco, and New York University are looking for reasons why Asian American women are at particularly high risk and ways to catch their tumors earlier.
“This is such a high rate; There have Let there be an explanation,” Lucas said.
In May, NYU researchers shared preliminary data at the American Society of Clinical Oncology conference showing that lung cancer screening in non-smoking Asian American women works just as well, if not better, than screening mostly white older smokers.
Now doctors are sounding the alarm about the rising number of lung cancer cases in this community and trying to revise screening guidelines to better include Asian American women.
“As an Asian woman, I was taught to be quiet,” Lucas said. “I had great respect for doctors and medical staff, so I would never question what they told me.” Even if they don’t understand what’s wrong.
Understanding risk factors
UCSF epidemiologist Scarlett Gomez was born in Taiwan before immigrating to the United States at age 7; his parents worked in Chinese restaurants in Washington state. But this also meant that they were unknowingly constantly exposed to toxic cooking oil fumes.
“Like many immigrant families, my parents were working in industries that were beneath their education,” Gomez said. “This is the work they had to do to get here.”
To date, studies of nonsmoking women in Asia have identified risk factors such as cooking oil smoke, second-hand smoke, air pollution, and indoor coal heating, but no studies have focused on Asia. American women,” Gomez said.
There’s probably some overlap, though. For example, a 2019 study found that Asian Americans breathe in 73% more small pollution particles than white Americans; This was likely because they were more exposed to construction, industrial and vehicle emissions where they lived.
Air pollution can also lead to genetic changes; Asian patients have some of the highest rates of cancer-causing epidermal growth factor receptor mutation; This mutation causes healthy cells to divide uncontrollably and develop into tumors.
“I’m hopeful that we’ll see more work to address these unusual, emerging disparities among Asian Americans that we haven’t paid attention to before,” Gomez said.
Given the lack of clarity, Gomez and Iona Cheng, an epidemiologist at UCSF, launched the Asian Female Never-Smoker (FANS) study in 2021. This was a case-control study in which the team examined Asian American women who did not smoke. either recently diagnosed with lung cancer (cases) or never had lung cancer (controls).
Although the two groups are matched on ethnicity and age, the researchers expect to find some differences in genetics, assessed through saliva samples, and environmental exposures, determined by surveys that ask people about their background. “The whole purpose of this study is to identify risk factors,” Gomez said.
However, Dr. from Stanford University, who was not involved in the research. Latha Palaniappan said FANS failed to show cause-effect relationships.
First, women with lung cancer may be more likely to remember exposure to chemicals and toxins than women without lung cancer because they think more about risk factors—this is called “recall bias.”
Still, Palaniappan emphasized the groundbreaking nature of FANS because “we can definitely understand the relationships, and the work can give us an insight into more rigorous analyzes going forward.”
Making lung cancer screening more equitable
Dr., an oncologist at NYU. Elaine Shum has seen dozens of non-smoking Asian American women, most with stage 4 lung cancer. And it’s always frustrating: Screening for lung cancer through low-dose CT scanning could have helped these women find their tumors at earlier, more treatable stages.
But insurance plans generally only cover people ages 50 to 80 with a history of heavy smoking; Except for Asian American women. The recommendations were based on the National Lung Screening Trial, a clinical trial of 53,000 older smokers, more than 90% of whom were white.
So Shum launched its own clinical trial in 2021, screening 1,000 Asian American women who had never smoked for lung cancer. Preliminary results, presented at a major cancer conference, showed that the lung cancer detection rate in Asian women was higher than in the original national trial; 1% versus 1.5%. “Based on these preliminary data and other ongoing efforts, Asian women represent another high-risk population requiring screening,” Shum said.
Palaniappan, who was not involved in Shum’s case, agreed: “It’s remarkable that screening in this population revealed a similar incidence of lung cancer as the original trial.” But Palaniappan also cautioned that better inclusion of Asian American women in screening guidelines is still a long way off, and 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 is so much progress in the world of lung cancer,” says Lucas. “I can’t change the system because it’s broken, but I can help people advocate for themselves and learn.”
Why are Asian American women left behind?
Lucas was in his second year of his doctorate when he was diagnosed with lung cancer. program, while also working as a special education teacher in Chicago. He had always thought of himself as healthy, so he initially attributed the chest pain and cough to stress. She knows that Asian American women are at high risk for lung cancer, but she still can’t understand how their doctors didn’t realize it.
While the studies at UCSF and NYU are promising, it is unclear why these are some of the first and only studies focusing on Asian American women with lung cancer in 2024.
At one level this is a question of awareness.
“Many Asian patients are very private and do not want others to know about their diagnosis,” Shum said. This was often because they did not want to be a burden to their friends and family or were worried about the stigma of lung cancer. . Perhaps as a result, the most common response from Asian American women when they heard about Shum’s work on lung cancer was, “I didn’t even know it was a problem.”
This lack of awareness is exacerbated by poor quality data, according to Stella Yi, co-chair of Innovations in Data Equity for All Laboratories at NYU. That is, Asian Americans are often included in the “Other” category in surveys or other overly broad groups like Asian Americans, Native Hawaiians, and Pacific Islanders, or AANHPI, which hides their data.
Most national databases also collect information in English and occasionally in Spanish; This means many people never have the chance to be included. “When you look at the data reports showing that Asian Americans appear to be healthier than everyone else, that’s because you’re only reaching the highest-income, highest-educated segment,” Yi said.
As a result, lung cancer cases among Asian American women are likely underreported, and the data reinforces racist stereotypes. “Asian Americans are thought to be healthy; they are the model minority,” Yi continued, referring to the myth that all Asians have high academic and economic achievement. “They do tai chi in the park, so why would they get lung cancer? Why would there be health disparities?”
For scientists who want to disrupt this narrative, this can be incredibly difficult because for 26 years, only 0.17% of the National Institutes of Health budget was allocated to AANHPI research. “For patients with lung cancer, their primary care doctors say, ‘You don’t need this; You’re not at high risk,’” Shum said. Among Asian American women, “lung cancer is being pushed aside” due to insufficient data and lack of research.
That’s why Lucas thinks it took three months for a doctor to take his symptoms seriously and make a diagnosis. “My doctors were denying the possibility of cancer,” he said, and the team was left with the idea that nothing was actually wrong with him, from a sore throat to tuberculosis.
“I needed treatment“Nobody told me everything was going to be okay,” he continued. When he was diagnosed with cancer, he had three tumors in his lungs, the largest the size of a lemon.
Lucas didn’t cry then. “I’m honestly relieved because fighting insurance and even trying to get a diagnosis was the worst part,” she said.
In many ways, it’s no surprise that Cheng, Gomez, and Shum (three Asian American women) are pioneering studies that are the first of their kind, because who else would be motivated enough to jump through all the hoops and overcome skepticism?
“This was a very personal matter for us,” Cheng said. “As Asian Americans, we see this in our society. “This adds another aspect of our dedication to addressing inequality.”
For more from NBC Asia America, sign up for our weekly newsletter.
This article first appeared on NBCNews.com.