It is well known that cigarette smoking and having a history of tobacco use increase the risk of lung cancer. But according to Julia Rotto, MD, thoracic medical oncologist at the Dana-Farber Cancer Institute in Boston, MA, it’s not the only risk factor.
“Lung cancer can also affect people you might not expect. So, for example, young patients, without a history of tobacco use. And this is really where the data becomes important for the EGFR mutation,” says Roto.
Roto refers to epidermal growth factor receptor or EGFR mutated lung cancer. It is a cancer that mainly affects young people, especially women, who have little or no smoking history. Research also shows that this form of lung cancer is also particularly common in East Asian populations.
,[The] The rate can range from 50% to 60%. So this is an important subgroup of lung cancer that should be recognized at the time of diagnosis, Roto said at the 2023 annual meeting of the American Society of Clinical Oncology (ASCO).
EGFR is a type of protein that can be found in your normal cells and helps them grow. But if you have an EGFR mutation – an error in the structure of your DNA – it can cause cells to multiply too quickly. This can lead to cancerous tumors.
“In lung cancer cells, ie [EGFR] “A mutation can cause it to be abnormally active, causing it to turn on when it shouldn’t,” Roto says.
There are several types of EGFR mutations. Depending on what information is missing or added to your DNA sequence, it can affect the type of cancer you develop. If you have an EGFR mutation that causes cells to become cancerous, grow and spread through your body, experts call this a “driver mutation”.
According to Roto, the EGFR driver is the most common type of mutation. Young people or people with no history of smoking who are diagnosed with lung cancer are “significantly more likely” to have this mutation.
Knowing the exact cause of mutation-related cancer can help your doctor give you effective targeted therapy.
“More than 50% – maybe even more than 75% – may have a [EGFR driver mutation], And in many cases these can be treated with targeted therapy pills,” says Roto. “It is most common in young people, young women, and people of Asian descent.”
Studies show that more than half of Asian American women diagnosed with lung cancer were never smokers. Among these, women of Chinese origin are more at risk. 8 out of 10 women diagnosed with lung cancer have never smoked.
And compared to other ethnic groups, Asian American women who have never smoked are nearly twice as likely to develop lung cancer.
“It’s the leading cause of cancer death for this population,” Roto says.
So what’s the link?
In the lung cancer screening study presented by Ellen Shum, MD, of New York University at the 2023 ASCO Annual Meeting, more than 200 Asian women under age 40 with little or no smoking history received three annual chest CT scans. This is an imaging test that allows doctors to get a closer look at your lungs.
Shum found that about 2% of a young, non-smoking population of Asian women had lung cancer.
“All of the lung cancers they identified were EGFR-mutated and could proceed with adjuvant EGFR-targeted therapy,” says Roto.
adjuvant targeted therapy A type of additional or follow-up treatment given after your main treatment plan, such as surgery or chemotherapy. These treatments target and destroy cancer cells that may have been left behind after your main treatment. This reduces the chances of your cancer coming back.
According to Under current lung screening guidelines established by the US Preventive Services Task Force, annual tests and scans are recommended for people aged 50 to 80 with a smoking history of 20 packs per year.
“That means one pack of cigarettes a day for 20 years, two packs a day for 10 years, and so on,” says Roto. In addition, to be eligible, they must be a current smoker or have quit smoking within the past 15 years.
Screening is also important when you have lung cancer.
By doing regular lung exams, doctors can find lung cancer early. This not only makes it more treatable, Roto said, but also improves survival rates. However, the guidelines have limitations and do not always include everyone who may be at high risk.
“For example, We know that there are racial and ethnic differences in both access to lung cancer screening and eligibility for screening based on current guidelines,” Roto said.
In addition, the turnout percentage for lung cancer screening is often low. Only 3 out of 10 people sign up for screening.
This, says Roto, is “really a missed opportunity.” Early-stage lung cancer detection, which has become much easier to treat with advanced options, can improve your overall outcome. This includes EGFR-mutated lung cancer found in non-smoking, high-risk Asian women.
“This points to the importance of thinking not only about our traditional high-risk patient population, which should certainly receive 100% screening if we can achieve it, but also about these other less common patient populations that may benefit from potential screening strategies,” says Roto.
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