Incidence of lung cancer among never-smoking asian american, native hawaiian, and pacific islander females

Background: Although lung cancer incidence rates according to smoking status, sex, and detailed race/ethnicity have not been available, it is estimated that over half of Asian American, Native Hawaiian, and Pacific Islander (AANHPI) females with lung cancer have never smoked.

Methods: We calculated age-adjusted incidence rates for lung cancer according to smoking status and detailed race/ethnicity among females, focusing on AANHPI ethnic groups, and assessed relative incidence across racial/ethnic groups. We used a large-scale dataset that integrates data from electronic health records from two large healthcare systems-Sutter Health in Northern California and Kaiser Permanente Hawai'i-linked to state cancer registries for incident lung cancer diagnoses between 2000-2013. The study population included 1,222,694 females (n = 244,147 AANHPI), 3,297 of which were diagnosed with lung cancer (n = 535 AANHPI).

Results: Incidence of lung cancer among never-smoking AANHPI as an aggregate group was 17.1 per 100,000 (95% confidence interval [CI] = 14.9, 19.4), but varied widely across ethnic groups. Never-smoking Chinese American females had the highest rate (22.8 per 100,000, 95% CI = 17.3, 29.1). Except for Japanese American females, incidence among every never-smoking AANHPI female ethnic group was higher than that of never-smoking non-Hispanic White females, from 66% greater among Native Hawaiian females (incidence rate ratio = 1.66; 95% CI = 1.03, 2.56) to over 100% greater among Chinese American females (incidence rate ratio = 2.26; 95% CI = 1.67-3.02).

Conclusions: Our study revealed high rates of lung cancer among most never-smoking AANHPI female ethnic groups. Our approach illustrates the use of innovative data integration to dispel the myth that AANHPI females are at overall reduced risk of lung cancer and demonstrates the need to disaggregate this highly diverse population.