While it has been firmly established that smoking tobacco products causes lung cancer, nearly 20 percent of people with lung cancer have never smoked. Among Asian females with lung cancer, the proportion of never-smokers is estimated to be as high as 40 percent.
That is why Elaine Shum, MD, assistant professor in the Department of Medicine and medical oncologist at NYU Langone Health’s Perlmutter Cancer Center, is conducting a clinical trial to determine the incidence of lung cancer in non-smoking females of Asian descent in the New York City area. Current lung cancer screening guidelines only apply to patients who have a smoking history; for patients who have never smoked, insurance companies will not cover screening. There is an unmet need to detect lung cancer at earlier stages in this patient population, Dr. Shum says.
“We need more research to learn what some of the causes of lung cancer might be in non-smoking Asian females,” Dr. Shum says. “But we also need to see if the screening we’re doing in this study might help identify a high-risk population that we haven’t been able to discern previously.”
Researchers do not know why female Asian non-smokers have a greater likelihood of developing lung cancer. Asians, in general, have a higher incidence of gene mutations that drive lung cancer. For example, mutations in the EGFR gene are seen at higher frequency in Asian patients with lung cancer. Dr. Shum plans to use the study to collect data, such as environmental and World Trade Center dust exposures, family history, and other factors that might contribute to the development of lung cancer in non-smokers. If any cancers are detected, the team will also explore additional potential contributors in patients with lung cancer, such as the microbiome or germ-line mutations through a separate study.
The study is currently enrolling females of Asian descent throughout New York City’s five boroughs and Long Island. Eligible participants are 40 to 74 years old, have never smoked cigarettes or smoked less than 100 cigarettes in their lifetime, and who do not have a history of cancer. Participants will receive up to three free low-dose CT scans of the chest, the same test that is done for lung cancer screening for patients with a history of smoking, during the three-year study period.
In addition, more advanced screening tools would aid in the early detection of malignancy. To this end, the lung cancer screening study is incorporating a blood-based assay in collaboration with Delfi Diagnostics. Delfi is developing a new type of liquid biopsy that analyzes genome-wide cell-free DNA fragmentation profiles in the blood by using advanced machine learning algorithms. The results of this blood test will be correlated with the results of the low-dose CT scans of the chest to evaluate the assay performance.
Dr. Shum says the goal of the study is to create a database and biorepository of Asian female non-smokers in the New York City area. The researchers will report how many lung cancers are detected during this time and aim to determine the feasibility of this type of screening study in a never-smoker population. Ultimately, their findings could lead to changes in lung cancer screening guidelines for non-smokers in general.
“This is a small-scale study, but if we can produce results with our relatively small number of patients, our goal is to expand this to larger populations as well as to academic medical centers throughout the country,” Dr. Shum says. “Our ultimate goal is to expand lung cancer screening guidelines to Asian female non-smokers, and hopefully one day, to all non-smokers.”
Women of Asian descent interested in participating can call 212-731-6212 (Mandarin and Cantonese speakers are available to answer calls if needed) or email firstname.lastname@example.org. Language interpretation and translated materials are available.