May is AANHPI Month. As we celebrate the heritage, resilience, and contributions of Asian American, Native Hawaiian, and Pacific Islander communities, I also think of a poorly recognized health disparity within our community: lung cancer disproportionately affecting women who have never smoked. I was one of these women. Exactly five years ago in May 2021, I underwent major thoracic lung surgery that literally saved my life. The shocking diagnosis made me aware of a persistent misconception, one that even I, a seasoned emergency physician, held: that only smokers get lung cancer. But in the AANHPI population, lung cancer in nonsmokers is not as rare as most people think. In fact, 57 percent of AANHPI patients diagnosed with lung cancer have never smoked compared with only 15-20 percent of the rest of the U.S. population. The disparity is especially striking in Chinese American women: 90 percent of us with lung cancer have never smoked. This is an unrecognized statistic that has received much less attention than it deserves.
Since I was initially diagnosed, whenever I share my story, the response is typically a puzzled look followed by: “But you don’t smoke, do you?” As I explain that I never have, the inevitable follow-up question is, “Do we know why?” Well, the short answer is: We are still trying to figure that out. Even though there are several studies ongoing, we are far from finding out the cause of lung cancer in nonsmokers. That is why efforts to raise awareness and more research are so important.
But, I’m hopeful. We are learning more about lung cancer in nonsmokers than ever before through studies like the Female Asian Nonsmoker Screening Study out of Perlmutter Cancer Center in NYC, the Female Asian Nonsmoker Study (not related) out of UCSF, and the TALENT study out of Taiwan. Stanford’s Center for Asian Health Research and Education Center (CARE) has emerged as a leader in educating the public and the medical community about nonsmoker lung cancer. Research continues to expand. Treatments are improving. And more people are beginning to recognize that it isn’t just smokers who get lung cancer.
Every conversation helps. Every bit of awareness matters. And every story shared makes it a little easier for the next patient to be seen, heard, and diagnosed earlier. Nonsmokers are at the highest risk of late diagnosis when the prognosis is poor. So this fifth anniversary of my life-saving lung surgery is not only about being spared the devastation of cancer. It is about advocacy for future progress, improved treatments, research breakthroughs, and earlier detection through the establishment of routine screening of nonsmokers. That is my hope for the AANHPI community.
Alice S. Y. Lee is an emergency physician.
