Phuong Ho: Developing Awareness of a Surprising Lung Cancer Risk

In 2019, Dr. Phuong Ho started experiencing a mild cough and tightness in her chest. Being an emergency room physician who cared for many patients with similar conditions, Phuong thought she was developing asthma and treated herself with inhalers. Unfortunately, her symptoms persisted. “I felt worse when I got sick, even with a minor cold. So, by the time COVID-19 hit, I realized that I was putting myself at risk and could potentially develop a more serious condition than most patients,” Phuong said. She decided to seek medical care to find out whether she had underlying asthma, so she could better protect herself.

Phuong’s primary care physician ordered chest X-rays and pulmonary function tests, which came back fine. She continued using inhalers, but her symptoms did not improve. At this time, Phuong decided to consult a pulmonologist, who ordered a CT scan of her chest. The scan revealed an almost 2-centimeter mass on the upper lobe of her right lung. Then she underwent a lung biopsy. “I still remember the day when I received the phone call from my physician. I was told that I had stage IA lung cancer and the pathology report indicated adenocarcinoma,” Phuong recalled.

The diagnosis came as a shock. “I consider myself a healthy person. I exercise regularly. I don’t smoke. So, when I was diagnosed with lung cancer, it was a shock. I was able to share with my husband, but I had a very difficult time explaining to my young children,” she said. Phuong was also alarmed to learn about the rise in the incidence of lung cancer among Asian females who have never smoked.

Right after her diagnosis, Phuong met with her pulmonologist and an oncologist to decide on the next steps. She underwent a series of CT scans and PET scans to make sure that her cancer had not spread. Once the scans were completed, and it was confirmed that the cancer was localized, Phuong had a consultation with a surgeon. “The definitive treatment for stage IA lung cancer is either wedge resection, which is a partial lung resection, or removal of the entire upper lobe. After discussing with my thoracic surgeon and doing my own research, we made the decision to have the whole right upper lobe removed,” Phuong said. During her surgery, she also had her lymph nodes removed to confirm that there was no spread of cancer anywhere else in her chest.

Phuong’s surgery was successful. The cancer had not spread. Her oncologist recommended that her tumor be tested for biomarkers, which showed an alteration in the EGFR protein. “But based on my own research and discussion with my oncologist, there is no further treatment indicated,” she said. She wondered whether adding chemotherapy would prevent a potential future recurrence of the cancer. However, there is not enough evidence currently to support such treatments. “I don’t need to be on any chemotherapy.”

Phuong considers herself fortunate. “As a physician I understand my symptoms and was able to seek out immediate medical attention and receive the screening test early. I understood the process of the diagnosis, treatment, and recovery, and everything went well. I am thankful that I did not encounter any of the barriers that other patients might encounter under the same situation,” said Phuong.

Phuong has been cancer free for the last 3 years. “I am doing great now,” she said. While she is still working on improving her lung capacity and overall health through regular exercise, Phuong is thankful. She feels fortunate to be able to work and spend time with her family cooking, eating out, playing in the yard, hiking, and traveling. “I enjoy every moment and realize that just to be able to be here around family is the best gift that I have now.”

Phuong’s experience with cancer has made her a passionate advocate for health education, especially for minority communities. She also feels strongly about raising awareness among physicians about the rise in lung cancer cases among Asian females who have never smoked. Her message to other providers is to provide screening when patients come in with similar symptoms like she did. “Keep in mind that lung cancer is a differential diagnosis even though the patient might not be smoking, and there is an increased risk for Asian female non-smokers.”

Phuong recognizes that language is a barrier for many Asian patients. “They might not be able to express their symptoms or even seek medical attention. Breaching that barrier would require health educators who speak in their native language.”

As an advocate for the Asian community, Phuong is participating in the Female Asian Never Smokers (FANS) study at the University of California San Francisco. The research aims to identify possible causes of lung cancer in non-smokers. “I
do promote the study to the Asian communities through my friends and family, spreading the word to enroll because we need participation for this important research.”

Phuong urges policymakers to promote research that addresses disparities in cancer screening, especially for minority and underserved populations. “The Asian community, especially, might not have the awareness, health education, or access to medical care to have screening tests done, or even to seek out medical attention.”

Phuong also urges our lawmakers to continue to provide the support and funding for medical research. “We still need research to promote early detection for cancer and to bridge the gap of disparities in early cancer detection and treatment for racial and ethnic minorities and medically underserved populations. Continual support would improve health and save lives.”