By Nina Huang
NORTHWEST ASIAN WEEKLY
When Dr. Jeffrey Velotta, Clinical Professor of Clinical Science at Kaiser Permanente Bernard J. Tyson School of Medicine (KPSOM), returned to the Bay Area in 2014 after years of thoracic surgery training in Boston, New York, and Los Angeles, he thought he understood the landscape of lung cancer.
“I expected to treat the typical patients you learn about in training—older male smokers,” he said. Instead, his first years at KPSOM delivered a shock.
“All of a sudden, my patients were Asian. And many of them were women. And they weren’t smokers. I wasn’t seeing this anywhere else.”
Velotta, now a leading thoracic surgeon, says that moment changed the trajectory of his career.
“It hit me sometime in 2014 and 2015: we’re missing something huge. These women were younger, Asian, female, healthy—and still getting lung cancer. I realized we had to do something because no one was talking about it.”
Since then, Velotta has emerged as one of the nation’s strongest voices calling attention to a largely unrecognized crisis. His recent publications—three major papers released in the last two months—use real-world data to document the disproportionate rise of lung cancer among Asian American women, especially non-smokers.
“People think lung cancer is a smoker’s disease,” he said. “But that’s just not true. It’s actually more prevalent in women than men, regardless of smoking status. And here in Northern California, Asian non-smoking women are the fastest-growing group.”
Velotta explained that lung cancer often develops from a combination of influences—genetics, air quality, secondhand smoke, and even everyday household exposures such as fumes from high-heat cooking oils commonly used in Asian kitchens.
For decades, researchers have described what’s known internationally as the “Asian never-smoker phenomenon,” but Velotta said it never gained traction in American medicine.
“Dr. Heather Wakelee at Stanford was talking about this as early as 2002,” he said. “But no one teaches it. It wasn’t until we published the CHEST study showing lung cancer was increasing at double the rate in Asian women while declining in every other group that people finally started paying attention.”
Even with mounting evidence, awareness among patients remains extremely low. Lung cancer screening—through a low-dose CT scan that takes less than a minute—can catch the disease early and save lives. Yet Velotta notes that only about 4% of eligible people are screened, compared to 80% to 90% for other cancers.
He calls it an equity issue: “Currently, there are no guidelines or recommendations for lung cancer screening in Asian women who have never smoked, so it poses an issue.”
The challenge is even greater for Asian American women because most don’t qualify for screening under current U.S. guidelines, which require a significant smoking history.
“These women are at real risk, but they don’t meet the criteria. So by the time they come in with symptoms—a cough that won’t go away, chest discomfort, fatigue—it’s often already stage 4,” Velotta said.
Velotta points out that lung cancer is often a “silent disease,” and many early cases are accidentally discovered—during scans for shoulder pain, abdominal discomfort, or after a car accident.
He said that the earlier they can catch the cancer, the better the survival, but for many Asian women, it’s being caught too late.
To fill this gap, Velotta is leading a first-of-its-kind U.S. screening study focused on Asian American non-smoking women aged 50 and over with a family history of lung cancer—an approach rooted in research from Taiwan showing that family history dramatically increases risk.
The study aims to enroll 200 Kaiser members and could reshape national screening guidelines. The goal is to show that detection rates are high in this population to ultimately push for change in screening criteria.
Velotta’s research also highlights major differences among Asian subgroups. When they disaggregated the data, they found that Chinese patients had the highest lung cancer screening rates, while Filipino patients had the lowest. Pacific Islander communities also weren’t doing well, he added. These findings were surprising and it also shows that there is a need for culturally-specific outreach, such as translators, navigators, and community partners.
That community connection hasn’t always come easily. Velotta is a fourth-generation Japanese American who grew up in Walnut Creek in what he describes as a “very homogenous Caucasian environment.” His father, adopted by an Italian American family, didn’t speak Japanese.
“Sometimes Chinese or Vietnamese community leaders would look at me almost like an outsider,” he admitted. “I had to adapt—bring translators, listen more, show up consistently. When we started doing that, the outreach took off.”
Now, through partnerships with Asian Health Services, Asian Pacific Fund, and other local clinics, Velotta and his team hold multilingual educational events and help patients navigate screening access. He also brings medical students from the Kaiser School of Medicine into the work—many of whom are Asian American women.
Dr. Jeffrey Velotta is joined by KPSOM student Elaine Liang who participated in the school’s SCORE rotation.
“We have this unique SCORE rotation where students from Kaiser Permanente Bernard J. Tyson School of Medicine spend six weeks with us doing clinical, research, and community outreach,” he said. “A lot of them are passionate because they see people who look like them facing this hidden disparity.”
Velotta’s commitment is deeply personal. His grandfather died of lung cancer. When he started seeing more and more Asian women with late-stage disease, he knew he had to focus on this.
For Lung Cancer Awareness Month, Velotta emphasizes the importance of paying attention to persistent symptoms, especially a lingering cough. He urges Asian American women not to assume they’re safe simply because they don’t smoke and encourages anyone with a family history of lung cancer to advocate for timely evaluation. Velotta stresses that this community is being disproportionately affected, and increasing awareness is essential to saving lives.
Nina can be reached at newstips@nwasianweekly.com.
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