Lung cancer in a low-smoking caribbean population: clinicopathological and molecular characteristics from Martinique (2020–2023)

Lung cancer epidemiology varies considerably across populations. Martinique, a French Caribbean territory with a predominantly Afro-Caribbean population and a daily smoking prevalence approximately half that of mainland France, represents an informative setting to characterize lung cancer in a low-smoking context. We aimed to describe the clinicopathological and molecular profile of patients diagnosed with primary lung cancer in Martinique and to identify factors independently associated with EGFR mutation status. We conducted a retrospective single-centre study at the University Hospital of Martinique, the sole referral centre for thoracic oncology on the island. All adult patients with a histopathologically confirmed primary lung cancer diagnosed between January 2020 and December 2023 were included. Demographic, clinical, histological, molecular, and therapeutic data were collected. A directed acyclic graph (DAG) was constructed to identify an appropriate adjustment set for the association between smoking and EGFR mutation status, and these variables were included in a multivariable logistic regression model. Among 296 patients (45.9% women; median age 67.9 years), 45.0% were never-smokers. Adenocarcinoma predominated (79.1%) and 75.3% presented with stage IV disease. EGFR mutations were identified in 39.2% of patients who underwent EGFR molecular testing (85/217), ALK rearrangements in 4.2% (6/142), and ROS1 rearrangements in 6.3% (9/142). PDL1 expression ≥ 50% was observed in 22.9% of patients with available assessment (51/223). Overall, 28.7% of patients received no oncological treatment. In multivariable analysis, smoking history was significantly associated with a lower likelihood of EGFR mutation (OR 0.06, 95% CI 0.02–0.14). Lung cancer in Martinique exhibits a distinctive profile, characterized by a high proportion of never-smokers, a predominance of adenocarcinoma, and a high proportion of EGFR mutations among tested patients. These findings highlight the need for territory-adapted prevention and diagnostic strategies and support further investigation of screening approaches, while emphasizing the importance of equitable access to molecular testing and targeted therapies.