Journal of Asian Health

Lung Cancer in Never Smoking Asian Populations

2025-06-30T20:39:01+00:00

Introduction: Lung cancer incidence is disproportionately higher in Asian individuals who have never smoked compared with non-Asian counterparts. While epidemiologic determinants remain unclear, risk factors appear to include environmental exposures, oncogenic drivers, and sex-specific patterns. Understanding these factors may lead to effective screening and treatment. This narrative review synthesizes the current state of research on lung cancer in never-smoking Asian populations, comparing disease characteristics between persons from Asia and the Asian diaspora.

Methods: Literature related to lung cancer in never smoking-Asian populations living in and out of Asia and published during January 1, 2018–August 17, 2024, were included. PubMed was searched for observational studies, interventional studies, and existing systematic reviews for articles published in English. Independent reviewers screened and conducted full text review and then synthesized insights from the articles by consensus.

Results: Studies published during 2018–2024 indicated that lung cancer among Asians who have never smoked is influenced by genetic, environmental, and lifestyle factors, with a higher incidence of adenocarcinoma and younger age of diagnosis among Asian and Asian American women. Increased lung cancer incidence was observed among populations who have never smoked, especially within Asian populations. Targeted therapies, in addition to standard surgical resection, have improved survival in patients with epidermal growth factor receptor, anaplastic lymphoma kinase-positive, and other actionable mutations, which are common in this population. However, treatment resistance and limited benefit from immunotherapy constrain longterm outcomes. Future strategies, such as novel targeted agents, combination regimens, and biomarker-driven monitoring, were found to extend progression-free survival and personalize care.

Conclusions: Lung cancer among Asian populations who have never smoked represents a biologically distinct, often targetable disease entity that necessitates rethinking of screening eligibility and treatment paradigms. Limitations of smoking-based risk models, emerging resistance to therapies, and geographic disparities in diagnostic and treatment access, both within Asian and across communities of the Asian diaspora, highlight the urgent need for more inclusive screening criteria, improved resistance management strategies, and equity in precision oncology deployment across Asian subpopulations. Improvements for screening programs should aim to maximize accurate detection while minimizing overdiagnosis.

Lung cancer screening in Asians and Asian Americans Who Have Never Smoked: A Scoping Review

2025-08-14T10:51:39+00:00

Introduction: A growing trend of lung cancer diagnoses is occurring among Asians and Asian Americans who have never smoked, driving increased interest in implementing lung cancer screening (LCS) in this population. Current data, however, remain insufficient to support such efforts. This scoping review summarizes studies evaluating LCS using low dose computed tomography (LDCT) among Asians and Asian American nonsmokers, reporting lung cancer detection rates and highlighting the heterogeneity across studies that limits the generalizability of results.

Method: A scoping review was conducted of studies from East Asia and the United States that utilized LDCT to screen for lung cancer among Asians and Asian Americans or a subset of these populations. Data on study design, screening eligibility criteria, screening protocols, and primary outcomes, including lung cancer detection rates and stages, were extracted and summarized descriptively.

Results: A total of 1,334 studies published during 2003–2025 were identified. Of these, 28 met inclusion criteria and originated from Taiwan, Korea, Japan, China, and the United States. Among eight studies that included only Asian and Asian American individuals, four were prospective and four were retrospective. Twenty studies which included both smokers and Asian and Asian American participants were comprised of one randomized control trial, nine prospective, and ten retrospective studies. Substantial variation was observed in definitions of smoking status, screening eligibility criteria (including age thresholds), LDCT protocols, and nodule reporting and follow-up practices. Among the 28 studies, 24 reported lung cancer detection rates in the range of 0.05–4.1% among Asians and Asian Americans who had never smoked.

Conclusions: Although several studies have evaluated LCS using LDCT in Asians and Asian Americans who have never smoked, marked heterogeneity across study designs and protocols limits the ability to synthesize findings or draw meaningful conclusions. This review underscores these gaps and may inform the design and focus of future studies to guide evidence-based LCS recommendations for this population.

Lung Cancer Screening in Asians Who Have Never Smoked: We Still Need to Figure Out the Who and How

2025-06-23T21:44:31+00:00

Despite major advances in treatment, lung cancer remains the leading cause of cancer-related mortality in the United States and worldwide. Early detection via annual screening with low-dose computed tomography (LDCT) imaging has been shown to improve mortality in certain high-risk populations with a significant smoking history and is currently standard of care in the United States. However, a significant proportion of lung cancer occurs in people who have never smoked and do not meet the screening criteria, especially among women and individuals from countries in East Asia. There have been several observational studies conducted in East Asia that show LDCT screening detects lung cancer in never smokers, though they were not designed to show a mortality benefit and there is concern that the lung cancers detected largely represent overdiagnosis of indolent cancers. How to go about screening these populations requires careful consideration as every screening protocol needs to have its benefits balanced against the risks. More research is needed to determine the best screening strategy for this population.