Personal and Family History of Cancer and Primary Lung Cancer Prevalence Among Never Smoking Disaggregated Asian American Women
by
, , , , , ,
Bani Kaur
1,2,†, 
Avinav Biswas
1,2,†,
Tyler Chervo
3,
Woo Jin Ahn
1,2,
Shangzi Gao
1,2,
Dang Nguyen
1,2,4,
Carissa A. Villanueva
5,
Seth J. Tivakaran
1,2,
Malathi Srinivasan
1,2,
Nicholas L. Panyanouvong
1,2,
Lester Andrew V. Uy
1,2,
Nitya Rajeshuni
1,2,
Robert J. Huang
1,2,
Neil Kamdar
1,2,6,7,
Osamu Yasui
1,2,
Gloria S. Kim
1,2,
Latha Palaniappan
1,2 and 
Jeffrey B. Velotta
3,8,9,10,* 1
Stanford University School of Medicine, Palo Alto, CA 94305, USA
2
Department of Medicine, Stanford Center for Asian Health Research and Education, Palo Alto, CA 94304, USA
3
Division of Research, Kaiser Permanente Northern California, Pleasanton, CA 94588, USA
4
Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
5
Department of Surgery, University of California, San Francisco-East Bay, Oakland, CA 94602, USA
6
Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC 27599, USA
7
Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI 48109, USA
8
Department of Surgery, UCSF School of Medicine, San Francisco, CA 94143, USA
9
Department of Clinical Sciences, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA 91101, USA
10
Kaiser Permanente Northern California Oakland, Oakland, CA 94612, USA
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Cancers 2026, 18(12), 1862; https://doi.org/10.3390/cancers18121862
Submission received: 1 May 2026
/
Revised: 28 May 2026
/
Accepted: 4 June 2026
/
Published: 6 June 2026
(This article belongs to the Special Issue Lung Cancer Risk, Disparities, and Outcomes: From Epidemiology to Multimodality Care)
Simple Summary
The rise in the prevalence of primary lung cancer in never-smoking Asian American women compared to their Non-Hispanic White (NHW) counterparts suggests additional factors associated with prevalence (personal or family history of cancer) in this demographic. However, the aggregation of a large, diverse group of Asian Americans often obscures the heterogeneity and specific factors associated with prevalence in a certain ethnicity. In this study, we analyzed the association of having a family or personal history of cancer to explain the high prevalence of lung cancer in disaggregated Asian Americans (Chinese, Japanese, Korean, Vietnamese, Filipino, and Other Asian). We found that Korean women with a personal history of any cancer and Chinese women with a family history of any cancer have a higher prevalence of primary lung cancer compared to their NHW counterparts. Our findings call for history-informed and ethnic-specific lung cancer screenings to identify higher-prevalence subgroups.
Abstract
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.
