Lung Cancer in Never-Smokers: The Unusual Reality

Understanding the Unexpected Lung Cancer in Non-Smoking Women

Women who never smoked getting lung cancer – why?

Lindi Campbell vividly remembers the day she received the shocking news: December 6, 2017. She was diagnosed with lung cancer, despite never having smoked a single cigarette in her life. “I was so shocked,” she recalls. Being a “never-smoker” with lung cancer made her feel isolated, as she couldn’t find anyone else who could relate to her experience.

Instead of letting her diagnosis define her, Campbell took matters into her own hands. One year later, she founded Breath of Hope Kentucky, a nonprofit organization dedicated to lung cancer advocacy and outreach. Through her organization, Campbell has connected with over 20 never-smokers in her state, but she noticed something peculiar—only one of them is male.

This gender disparity in never-smokers with lung cancer is just one puzzling aspect of a larger mystery that has baffled scientists for years. Why are women more susceptible to lung cancer than men, even when they never smoked?

We all know that smoking is the leading cause of lung cancer, but what about those who have never lit a cigarette? In the United States, 15% to 20% of lung cancer cases occur in never-smokers. Surprisingly, women make up about two-thirds of these cases, defying the general trend of cancer being more common among men.

“In the last 5 years, there’s been a lot of attention on, Why is this happening? And why are women disproportionately affected?” says Alice Berger, a laboratory researcher at the Fred Hutchinson Cancer Research Center in Seattle.

Take, for instance, the case of Dana Reeve, the late wife of actor Christopher Reeve, who died of lung cancer at age 44. Reeve had never smoked, but her cancer was already advanced when it was discovered. Cases like hers continue to confound experts.

So, why is lung cancer affecting never-smokers, especially women, so disproportionately? While the exact reasons remain unclear, researchers are investigating various factors, including differences in the immune system between women and men, gene variants, hormones, and environmental factors like air pollution and radon.

Although Campbell didn’t smoke, she was exposed to secondhand smoke growing up in a household of smokers. “I was the youngest and the only one who got lung cancer,” she laments. Interestingly, lung tumors in never-smokers are often distinct from those in smokers, with unique differences in the immune landscape, according to Ramaswamy Govindan, a professor of medicine at Washington University in St. Louis.

What offers hope for never-smokers with lung cancer is the discovery that most of them have specific gene mutations that may respond to targeted drugs. As many as 78% to 92% of these individuals have this “targetable” gene change, such as the epidermal growth factor receptor (EGFR) mutation. Genetic tests are essential to identify these biomarkers and guide treatment with FDA-approved drugs. However, it’s crucial to ensure thorough testing to uncover all possible options.

While there are promising treatment avenues for never-smokers, such as targeted therapies and immunotherapies, the lack of clear screening guidelines poses a significant challenge. Yearly screenings are currently recommended for high-risk groups, typically heavy smokers aged 50 to 80. However, for never-smokers, there are no established guidelines for early detection, even with a family history of the disease.

The absence of effective screening methods means many never-smokers with lung cancer are diagnosed by chance. It’s often the incidental discovery of abnormalities during unrelated medical exams that leads to a diagnosis. Early symptoms of lung cancer in never-smokers may be vague or easily mistaken for other common ailments, such as a dry cough, coughing up blood, hoarseness, shortness of breath, or persistent lung infections that don’t respond to antibiotics.

For Lindi Campbell, her journey to diagnosis involved multiple doctors and scans over several years. It was a long and arduous process, but she considers herself fortunate to have received an early diagnosis and life-extending treatment. Campbell wishes for improved funding and research dedicated to lung cancer among never-smokers, to raise awareness and remove the stigma surrounding the disease.

While there’s still much to be understood about lung cancer in never-smokers, experts like Roy Herbst, chief of medical oncology at Yale Cancer Center/Smilow Cancer Hospital, are optimistic. They anticipate that advancements in screening and detection methods will continue to improve, potentially leading to the ability to differentiate between benign and malignant abnormalities with just an X-ray.

In the meantime, it’s crucial for everyone, regardless of smoking history, to pay attention to their health and be proactive. If you experience persistent or unusual symptoms or have a family history of cancer, speak up and push for further tests. Early detection remains the key to better outcomes and increased chances of successful treatment.

Together, we can raise awareness and support individuals like Lindi Campbell, proving that lung cancer in never-smokers is a reality we must acknowledge. Remember, “We’re here! We’re here!”