The prevalence of primary lung cancer among women with previous personal and/or family history of cancer in an integrated health system

Objective: To evaluate whether personal and/or family history of cancer increases the prevalence of new primary lung cancer in adult women, regardless of smoking status. Methods: A retrospective review was performed using the data from Kaiser Permanente Northern California region electronic health record between January 1, 2010, and December 31, 2022. We included all adult women without a previous personal history of lung cancer and with at least 1 year of membership during the study period. We estimated the prevalence ratio (PR) of new primary lung cancer among people with a personal or family history of cancer using targeted maximum likelihood estimation adjusting for smoking status, race/ethnicity, age, Charlson comorbidity index, and Neighborhood Deprivation Index. Results: We identified 2.8 million patients who met the selection criteria. A previous personal history of any cancer was associated with an 88% increased prevalence of lung cancer (PR, 1.88; 95% CI, 1.84-1.92); a family history of any cancer also was associated with increased prevalence (PR, 1.23; 95% CI, 1.20-1.26). Specifically, a previous personal history of breast, cervical, uterine, or ovarian cancers was also associated with increased prevalence. Conclusions: Personal history of previous malignancy and family history of malignancy were associated with increased prevalence of future lung cancer in our population. It suggests that smoking status alone in our population is not sufficient for gauging clinical suspicion of new primary lung cancer. Reevaluation and expansion of guidelines of screening criteria for use of lung cancer screening tools may be prudent.