Background: Despite a decline in lung cancer in the U.S., lung cancer among never-smoking Asian American (AsA) women is rising, and subgroup aggregation obscures heterogeneity. We compared primary lung cancer prevalence across disaggregated AsA subgroups and examined factors associated with prevalence such as personal- and family-cancer histories versus Non-Hispanic Whites (NHWs). Methods: This cross-sectional study analyzed electronic health records of AsA women (≥18) in a large Northern California health system (2010–2022). Lung cancer cases were obtained from the hospital registry and categorized by smoking status and self-reported ethnicity. Adjusted prevalence ratios (aPRs) were estimated using targeted maximum likelihood estimation, accounting for sociodemographic, smoking, and clinical covariates. Results: Among 1,843,119 women, 8651 had primary lung cancer; 2429 were never-smokers. In AsA never-smokers, aPRs and 95% confidence intervals versus age-matched NHW were: Chinese (3.36, 3.20–3.53), Filipino (2.68, 2.55–2.82), Vietnamese (2.07, 1.96–2.18), Japanese (1.99, 1.89–2.10), Korean (1.90, 1.80–2.00), and Other Asian (0.35, 0.33–0.37). Personal cancer-history reflected an increase in prevalence among Korean patients (2.91, 2.76–3.06) while family cancer-history demonstrated increased prevalence among Chinese patients (1.51, 1.42–1.60). Among women with uterine cancer, Chinese patients had higher lung-cancer prevalence than NHW (1.91, 1.58–2.31). Conclusions: Never-smoking disaggregated AsA women show heterogeneous lung cancer prevalence, with higher prevalence in Korean women with personal cancer-history and in Chinese women with family cancer-history compared with NHW, supporting history-informed and ethnic-specific lung cancer screenings.
Kaur et al. (Sat,) studied this question.