Fang Lei

PhD, MPH, MSN

University of Minnesota Twin Cities

Assistant Professor

NLST (Learn more about this study)

NLST-1419

Apr 21, 2025

Unraveling the Paradox: High Lung Cancer Incidence Among Asian American Women Despite Low Smoking Prevalence-A Secondary Data Analysis

Lung cancer is the leading cause of cancer-related deaths among women in the United States. Among Asian American women, a paradoxical trend has emerged: despite having the lowest smoking prevalence among all racial/ethnic and gender groups, they exhibit disproportionately high rates of lung cancer incidence, particularly adenocarcinoma. Current lung cancer screening guidelines, including those used in the National Lung Screening Trial (NLST), are heavily based on smoking history, potentially leading to under-recognition and under-screening of high-risk individuals in populations like Asian American women.

This project proposes a secondary data analysis of the NLST dataset to examine non-smoking-related risk factors and their potential contribution to lung cancer incidence among Asian American women. The NLST provides a unique opportunity to explore these questions due to its comprehensive collection of demographics, clinical, imaging, and follow-up data, including Asian American women diagnosed for lung cancer.

The findings from this project will contribute to a more nuanced understanding of lung cancer risk among non-smoking Asian American women and may inform the development of more inclusive screening criteria, ensuring that high-risk individuals are not excluded based on smoking history alone. This research directly supports national efforts to reduce health disparities and improve cancer outcomes through personalized, evidence-based screening strategies.

Aim 1: To characterize the demographic and clinical profiles of Asian American women in the NLST cohort.
We will identify and describe the Asian American female participants in the dataset, summarizing their demographic, smoking history, occupational/environmental exposures, family history of lung cancer, comorbidities, etc.

Aim 2: To investigate the role of non-smoking-related risk factors in predicting lung cancer incidence among Asian American women.
We will use multivariable logistic regression to examine associations between lung cancer outcomes and non-smoking factors such as second-hand smoke exposure, family history, comorbidities, occupational/environmental exposures, etc.