Purpose

“ADENOCARCINOMA OF THE lung, bronchogenic type. ”My life stopped the second I got this diagnosis, a subtype of Stage IV metastatic non-small cell lung cancer (NSCLC). It was July 3, 2017. I was 35 years old, had never smoked and had no family history of any cancer. Lung cancer? Seriously? Three days earlier, I had graduated from my ob-gyn residency. My life has always been nontraditional. I had two boys, both unplanned, as a teenager. When I got pregnant the first time, at 17, most people told me I was ruining my life by having my baby. My parents had emigrated from mainland China before I was born— I am American—yet Chinese extended family members, originally from China like my parents but now living somewhere in the Bay area, were calling to lecture me without even telling me who they were. I commuted to UC Berkeley as an undergraduate with my two babies in the back seat. I used my determination to fuel my goal of becoming an ob-gyn to serve young women like me. It was a struggle getting through a rigorous medical school education at UCSF and an even more challenging residency training at Harbor– UCLA Medical Center. Along the way, my relationship with the father of my children failed, and I had to separate from my two boys for four years when my residency match took me far away. I regretted missing a crucial part of their childhood, but I knew I would be able to serve my purpose once all was said and done. I was finally on my way to trailblaze and change the world by working with teen moms and underserved communities. But my last year of residency, I had a cough that wouldn’t go away. I shrugged it off, thinking I had to put my work and patients first. The day I was diagnosed, I thought back to my first year in medical school in 2009. In the oncology block, I learned that lung cancer was the leading cause of cancer death in the United States, and it had a clear cause: smoking tobacco. I had never smoked. Check! I was low risk. Whew! But after a few slides, my professor noted that there was a subset of nonsmoking women in Japan who were dying of a specific type of NSCLC. Given that they were nonsmokers, they were often diagnosed at a late stage, making them ineligible for early intervention, such as surgery, which, if done early, could be, in some cases, curative. The thought occurred to me: There is an “Asian lady lung cancer” correlated with being a never smoker, and there is no treatment other than chemo and radiation. I was moderately startled but steeled myself to dismiss it, although not before I filed it in the back of my mind. It won’t happen to me, I told myself. Now it had. I became very ill, to the point that I felt near death and had to give up my yet-to-start new job. I was never physically able to practice outside of residency. Instead, I gave in to the sad cancer patient story. I could no longer support myself and relied on the generosity of friends, family and even people I did not know. My mind became foggy, as the cancer had progressed to my brain. To my bones. To my lymph nodes. I could not think, speak or write as clearly as I could before. Three years into my diagnosis, with the help of two seasoned lung cancer patients, I started to wake up and look more closely at my life. I remembered the old me—brave, strong and determined. In rebuilding myself, I joined the Asian American Research Center on Health at UCSF and met Scarlett Lin Gomez, MPH, PhD, a champion epidemiologist whose research has revealed countless health disparities. I am now a research associate for her FANS (Female Asian American Never Smoker) lung cancer study. So do I count as one of the Asian lady lung cancer cases that I had learned about in lecture way back when? Yes and no. That type, EGFR-mutation-driven lung cancer, characterizes Japanese never-smoking females in Japan.

“I AM A FEMALE ASIAN-AMERICAN NEVER SMOKER”

It turns out that there are also many other driver mutations causing lung cancer in Asian-American women who never smoked. Did you know that 57% of Asian-American women and 80% of Chinese-American women who are diagnosed with lung cancer are never smokers? There are also distinct differences between never-smoking Asian females abroad and those born in America. Although there are plenty of EGFR FANS in the U.S., I belong to a lung cancer group different from EGFR, namely ALK-positive gene rearrangement. I have a handful of Asian lady moms who are all ALK positive. The truth is, there are minimal data on this important health care issue. FANS is looking at possible risk factors and exposures that are distinct to lung cancer patients in the Asian-American population. We are literally dying to find out why Asian-American women who never smoked tobacco are being disproportionately diagnosed with lung cancer! The FANS study, with me on board, is on it. So where am I now? Just as I have fought tooth and nail for everything I worked for in my life, I have done the same with my cancer. I survived four years. I saw my boys graduate from high school and go to college. I intend to care for teen moms from high-need communities more holistically in the future. I had cultivated a whole career in which I could provide group prenatal care for pregnant teen/young adult women and teach them mindful parenting skills. I devised my own version of a mindful teen pregnancy program when I attended graduate school between medical school and residency. It enables young pregnant women to develop tools for embracing all experiences—especially those where individuals have little control—as well as for all of the impending parenting to come in a social support group setting. The goal is to break the intergenerational cycle of poor outcomes that result from the ingrained socioeconomic and health care disparities in the United States. Now, I am not only surviving but living fully in the face of cancer. Cancer has made me stop, slow down and reflect. I am reclaiming my purpose, tweaking it, so I can be fully myself. Again.