Lung cancer in Martinique shows high never-smoker share and frequent EGFR mutations

Lung cancer on the French Caribbean island of Martinique presents a distinctive profile: 45.0 percent of patients diagnosed there had never smoked, and among those who underwent molecular testing, 39.2 percent carried mutations in the EGFR gene. The finding comes from a retrospective single-centre study at the University Hospital of Martinique, the island’s sole referral centre for thoracic oncology, which analysed all 296 adults with histopathologically confirmed primary lung cancer diagnosed between January 2020 and December 2023. The work, published open access in BMC Cancer, describes the clinicopathological and molecular characteristics of lung cancer in a predominantly Afro-Caribbean population where daily smoking prevalence is approximately half that of mainland France.

Of the 296 patients, 45.9 percent were women and the median age at diagnosis was 67.9 years. Adenocarcinoma accounted for 79.1 percent of cases, and the disease was frequently advanced at diagnosis: 75.3 percent of patients already had stage IV disease. Among patients who underwent EGFR testing, 39.2 percent — 85 of 217 — harboured an EGFR mutation, while ALK rearrangements were found in 4.2 percent of 142 tested patients and ROS1 rearrangements in 6.3 percent. High-level PD-L1 expression of 50 percent or more was observed in 22.9 percent of the 223 patients with available assessment.

To examine the relationship between smoking and EGFR mutation status, the researchers first constructed a directed acyclic graph, a formal tool from causal inference that maps how demographic and clinical factors may influence one another, in order to identify an appropriate adjustment set. That set then fed into a multivariable logistic regression model. The analysis found that a history of smoking was significantly associated with a lower likelihood of carrying an EGFR mutation, with an odds ratio of 0.06 (95 percent confidence interval 0.02 to 0.14). This is an association observed within the cohort, not a demonstration of a causal mechanism.

The study also documented a substantial gap in care. Overall, 28.7 percent of patients received no oncological treatment. The authors connect this to the late stage at diagnosis and emphasise the importance of equitable access to molecular testing and targeted therapies. Because Martinique has a single referral centre for thoracic oncology, the dataset captures essentially the island’s diagnosed cases, but the retrospective, single-centre design means the findings describe patients who reached diagnosis, not the true incidence of lung cancer in the wider population.

The authors argue that prevention and diagnostic strategies calibrated to mainland smoking patterns may not fit Martinique, and they call for further investigation of screening approaches suited to a population in which a large share of lung cancers arises among never-smokers. They also stress that molecular testing must reach all patients, since the 39.2 percent EGFR mutation rate among those tested means targeted therapy is potentially relevant to a substantial fraction of the island’s diagnosed lung cancer cases, but only if testing and treatment access are equitable. With 75.3 percent of patients diagnosed at stage IV and more than a quarter receiving no oncological treatment, the study underscores that the island’s challenge is not only which molecular alterations drive the cancer, but how early it is found and how completely its molecular profile is characterised.

Subject of Research: Clinicopathological and molecular characteristics of lung cancer in a low-smoking Afro-Caribbean population in Martinique

Article Title: Lung cancer in a low-smoking caribbean population: clinicopathological and molecular characteristics from Martinique (2020–2023)

Article References: Moranton, M., Metanmo, S., Marlin, R., Zouzou, A., Boukadoum, N., Hurlot, Q., Rakotonarivo, J.-M., Negamiyimana, G., Bougas, S., Dramé, M., Jougon, J., Kouiten, D., Aldea, M., Colomba, E., & Agossou, M. (2026). Lung cancer in a low-smoking caribbean population: clinicopathological and molecular characteristics from Martinique (2020–2023). BMC Cancer. https://doi.org/10.1186/s12885-026-17226-1

Image Credits: AI Generated

DOI: 10.1186/s12885-026-17226-1

Keywords: lung cancer, Martinique, EGFR mutation, never-smokers, adenocarcinoma, Caribbean health, molecular testing, stage IV disease, retrospective study, BMC Cancer, Lung, cancer