Importance Score: 72 / 100 🔴
Lung Cancer in Non-Smokers: A Growing Concern
Amy Clark, like many others, received a shocking diagnosis: stage four lung cancer despite never smoking. This rising prevalence of lung cancer in non-smokers baffles scientists and highlights the need for greater awareness and understanding of this deadly disease. This article looks into the possible causes and offers hope for earlier diagnosis and better therapeutics.
A Young Woman’s Shocking Diagnosis
Amy Clark was celebrating the conclusion of her GCSE exams with companions when an unfortunate incident occurred. While sitting on a fence, she lost her balance and fell, landing awkwardly on her back.
Initially, the then 16-year-old Bristol resident seemed unharmed. However, over the subsequent two years, she experienced recurrent back discomfort, which she attributed to the fall.
4K Ultra HD Portable Foldable Projector Screen 100/120 Inch 16:9 with Stand & Carry Bag, Lightweight 1.5 Gain Polyester Material for Indoor Outdoor Home Theater ...
? Coupon price [$42.96]
[Stylish PU Jacket] Stylish Modern Mens Outdoor PU Jacket - Warm Fleece-Lined Motorcycle Coat, Tough Guy
? Coupon price [$34.29]
UNZHUO MAKE Mens High-Top Camouflage Work Boots - Non-Slip, Durable for Hiking, Outdoor & Mountaineering, Nylon Upper, Rubber Sole, EVA Insole
? Coupon price [$48.40]
Upon completing her education, Amy decided to seek medical advice. She scheduled an appointment with a back specialist, who recommended a scan. Although the scan revealed no abnormalities in her back, it uncovered a concerning spot on her right lung.
“I was promptly referred to a respiratory consultant,” Amy recounted. “The consultant informed me that such findings were typically observed in long-term smokers and alcoholics, not someone my age.”
Initially, doctors opted to monitor the lesion to determine if it would resolve spontaneously. Unfortunately, a follow-up scan and biopsy eight months later delivered devastating news.
Amy was diagnosed with stage four lung cancer. The disease had already metastasized from her right lung to her lymph nodes and back ribs, rendering it incurable. She was merely a month away from her 21st birthday.
“It was an incredible shock; I hadn’t experienced any symptoms whatsoever. Cancer had never even crossed my mind,” she expressed. “I had believed that lung cancer primarily affected long-term smokers, and I had never smoked.”
“I was concerned about my family and their reaction. But the question, ‘How did this happen?’ kept replaying in my mind.”
Amy Clark received her stage four lung cancer diagnosis just a month before turning 21.
Jules Fielder was 37 years old when she noticed a lump on her neck, leading to her diagnosis.
Jules mentioned visiting her physician multiple times regarding back and elbow pain, only to be diagnosed with sciatica and tennis elbow.
The Rising Trend of Lung Cancer in Never-Smokers
While Amy’s situation is startling, it’s not as uncommon as one might think.
She belongs to a growing demographic of young individuals who develop lung cancer despite having no history of smoking, historically considered the primary cause, and lacking any genetic predisposition to the illness. This phenomenon has perplexed and concerned scientists.
As smoking rates and associated cancers decrease, instances like Amy’s are on the rise. Notably, women are disproportionately affected, accounting for nearly 70% of cases.
Currently, approximately 20% of lung cancer diagnoses occur in individuals who have never smoked. Research indicates that this percentage is expected to increase. If never-smoker lung cancer were classified as a separate disease, it would rank as the 8th leading cause of cancer-related deaths in the UK and 7th globally.
Air Pollution as a Potential Trigger
Researchers now suggest that air pollution may be a significant factor. “The connection between air pollution and lung cancer is well-established, but we believe it may be particularly relevant to patients who have never smoked,” explained Dr. William Hill, a researcher at the Francis Crick Institute in London. His team is actively investigating this phenomenon. “Our research has revealed that inhaling these minuscule solid particles present in the air can trigger an inflammatory response in the lungs, potentially promoting cancer development. We have also observed a correlation between elevated levels of these particles and increased rates of specific types of lung cancer in individuals who have never smoked.”
Lung Cancer Statistics and Trends
With approximately 48,000 diagnoses annually, lung cancer remains the third most prevalent cancer in the UK and the leading cause of cancer-related mortality.
Currently, smoking accounts for about 85% of lung cancer cases, where chemicals damage lung cells and induce cancer-causing DNA mutations. However, this percentage is declining.
Consultant oncologist Dr. Alexandros Georgiou noticed this trend at his clinic at Guy’s and St. Thomas’ Hospital in south-east London and decided to investigate.
Dr. Georgiou’s team discovered that the proportion of patients without a smoking history was increasing each year. In 2010, only 5% had never smoked; by 2021, it had risen to 14%.
Another concerning finding was that the majority of never-smoker lung cancer patients were female, comprising 68% of cases. These individuals were also younger, on average, than those with smoking-related lung cancers.
“This demographic shift is partially attributable to the growing prevalence of non-smokers in society, expanding the pool of non-smokers susceptible to lung cancer,” stated Dr. Georgiou. “However, I don’t believe this fully explains the change we are observing.”
Challenges in Diagnosis
Professor Matt Evison, associate medical director for the Cancer Alliance, explains that one of the challenges with lung cancer in non-smokers is that it often spreads to other parts of the body by the time it’s detected.
“Diagnosis is difficult because common lung cancer symptoms can have various other explanations,” he says. “A cough, shortness of breath, chest pain, or upper back pain can be attributed to other, more probable causes.”
“Lung cancer is rarely the initial diagnosis for a patient presenting with a cough.”
Another challenge is that lung cancer symptoms in non-smokers can differ from those typically associated with smoking-related cases and tend to manifest later.
Consultant clinical oncologist Dr. James Wilson notes, “In never-smokers, lung cancer is more likely to manifest as a dry cough than smoking-related cancer, which can cause patients to cough up blood.”
“Symptoms can also be more generalized and less specific to the lungs, such as weight loss or fatigue. As it progresses, it’s more likely to present with breathlessness and pain in various body areas than in cancers caused by smoking.”
“This is partially due to patients being young and fit and the type of cancer they tend to develop—adenocarcinoma—usually growing in the lung’s periphery. Conversely, cancer from smoking causes tumors around the central airway, increasing the likelihood of bleeding and causing patients to cough up blood or phlegm.”
As a result, both patients and medical professionals may be quick to dismiss symptoms, says Prof. Evison. “In medicine, we may have preconceived notions about the type of person who gets lung cancer,” he explains.
“Two individuals presenting with the same symptoms may have lung cancer placed differently on the list of likely causes.”
This means approximately 90% of never-smokers with lung cancer are diagnosed only when the disease has reached an advanced and incurable stage.
This was Jules Fielder’s experience. She was only 37 when diagnosed with incurable lung cancer, despite never smoking. “We’d just returned from camping on the Isle of Wight, and I was putting on jewelry in the bathroom when I noticed a lump at the base of my neck, near my collarbone,” recalls the mother-of-one.
After undergoing numerous tests, Jules received a phone call from her doctor on Christmas Eve, confirming she had lung cancer that had spread to her lymph nodes, spine, and pelvis.
“It was a devastating blow,” she says, “especially being told it was incurable—knowing I couldn’t do anything about it.”
Jules had previously consulted her doctor multiple times about back and elbow pain, only to be diagnosed with sciatica and tennis elbow. “It was like piecing together a jigsaw puzzle. These were all signs that could have been detected earlier,” she adds.
Experts now believe that breakthrough findings identifying the causes of these cancers could benefit women like Jules and Amy in the future.
Unraveling the Causes: Air Pollution and Genetic Mutations
Numerous studies have connected air pollution to lung cancer, with a 1950 paper implicating both outdoor pollutants and fossil fuels. However, the precise mechanisms remained unclear until recently.
A significant risk factor for lung cancer in non-smokers is a mutation in the EGFR gene, responsible for regulating cell growth and division. This mutation can trigger uncontrolled growth and tumor formation and is found in approximately 20% of adenocarcinomas in non-smoking women.
These mutations are typically not inherited, and lung cells carrying them usually remain dormant and harmless. However, Dr. Hill explains, “We’ve discovered that air pollution appears to activate these cells.”
While air pollution has decreased over the past half-century, the most significant reductions in indoor wood burning, coal burning, and vehicle exhaust within cities and towns occurred in the last two decades. Given that gene mutations can occur up to 30 years before cancer develops, the number of cases is expected to continue rising.
Experts suggest that if air pollution continues to decrease, these cancer rates could also decline.
The Role of Hormones and Autoimmune Diseases
However, others suggest hormones may also play a role.
“Some hypothesize that the increased risk of lung cancer in women who have never smoked could be hormonal, with estrogen potentially contributing,” says Dr. Robert Hynds, a senior research fellow in biology and cancer development at University College London. “Others speculate that women’s higher susceptibility to autoimmune diseases, which cause inflammation in the body, could increase cancer risk.”
“It’s not as straightforward as with tobacco smoking, which we know definitively causes lung cancer. While we believe both indoor and outdoor air pollution promotes lung cancer in some way, it’s not yet as well understood and studied.”
Dr. Hill states that recent findings bring researchers closer to identifying high-risk individuals and preventing the disease.
Advancements in Treatment
Treatments for gene-mutated lung cancers are already more advanced than those for many other types. Instead of undergoing grueling chemotherapy, patients are often prescribed targeted drugs called tyrosine kinase inhibitors. These daily tablets block the faulty gene’s activity, halting tumor growth and keeping the cancer at bay, often for years.
For Amy, targeted therapy has allowed her to live a relatively normal life since her diagnosis. Now 26, she continues to work, enjoys walking, hiking, and spending time with friends, and has even attended Glastonbury five times.
“I thought it was long Covid – it wasn’t”
In 2020, Mel Erwin, then 51, initially suspected her breathlessness was caused by long Covid
When Mel Erwin began experiencing breathlessness and fatigue in 2020, at age 51, she assumed it was long Covid, a lingering effect of a severe bout of the virus she had contracted months earlier.
When she eventually consulted her GP, she underwent a chest X-ray and blood tests, receiving a phone call the same afternoon.
“My blood work was normal, but they discovered a mass in my left lung,” Mel recalls. “I inquired if it was Covid or cancer, and he stated it could be cancer.”
The day after her 52nd birthday, Mel had half of her left lung removed. However, two years later, a scan revealed new lesions across both lungs that were too small for biopsy.
After another two years of monitoring, Mel was diagnosed with advanced, incurable lung cancer.
Currently, she is undergoing targeted therapy, called Osimertinib, to inhibit the gene mutation responsible for the cancer’s growth and spread. “It’s enabling me to live well, and I intend to live for decades,” says Mel, who is training for Sir Chris Hoy’s fundraising charity bike ride, Tour de 4.
Looking ahead, she hopes more people will recognize the possibility of developing lung cancer without a smoking history and advocate for themselves if they experience any symptoms.
“Don’t worry about being a nuisance. If something feels wrong, be persistent,” she urged.