Lung Cancer in Nonsmokers: Rising Among Women and Younger Adults
Guest Contributor
For many years, the image of lung cancer has been stubbornly fixed in the public mind: an older man with a long history of smoking. Yet that image no longer reflects reality. Lung cancer is increasingly affecting women, younger adults, and people who have never smoked. The recent news of Pope Leo XIV’s early stage lung cancer diagnosis, despite reports that he is not a smoker, has brought this shift into sharp focus and renewed attention to lung cancer in nonsmokers.
Lung cancer remains the leading cause of cancer death among women, surpassing breast, ovarian, and colorectal cancer combined. According to the American Lung Association, lung cancer rates in women have risen by 79% over the past 44 years while rates in men have dropped by 43%. For the first time on record, more young women than young men are being diagnosed. This reversal challenges old assumptions about who is at risk and highlights the need for better awareness of lung cancer risk factors beyond traditional cigarette smoking.
The article’s author, a thoracic oncologist, describes seeing more younger women and never smokers walk into clinic with new lung cancer diagnoses. For these patients, the diagnosis often comes as a shock. Neither they nor their physicians expected lung cancer to be the cause of persistent cough, fatigue, or chest pain. As a result, there can be delays in diagnosis, and in lung cancer timing is critical. Early stage cancer, like that of Pope Leo XIV, can often be cured with surgery. When cancer is discovered later, treatment becomes more complex and outcomes are generally poorer.
Why are lung cancer rates rising among women in particular? One explanation is historical. Women as a group began smoking later than men, so their peak in smoking-related lung cancer has occurred later as well. Many women also started smoking when filtered cigarettes were popular. Filters changed the way smoke was distributed in the lungs and have been linked to increased rates of adenocarcinoma, a common type of lung cancer that often develops in the outer regions of the lungs.
Some studies suggest that women may be more susceptible to the carcinogenic effects of tobacco and secondhand smoke. They may develop lung cancer after fewer years of smoking compared to men. Yet this is only part of the picture. The author notes that most people currently diagnosed with lung cancer are not active smokers. About 20% of women with lung cancer have never smoked at all, a proportion that is higher than in men with lung cancer who have never smoked.
Lung cancer in nonsmokers points to a broader range of risk factors. Besides active smoking and secondhand smoke, important contributors include a family history of cancer and environmental exposures such as asbestos, radon, and air pollution. In some regions and workplaces, people remain exposed to inhaled carcinogens such as arsenic, beryllium, cadmium, silica, and nickel. These exposures may not be as visible as a cigarette in someone’s hand, yet they carry real risk. Potential risks from e-cigarettes and marijuana smoke are still being studied and remain areas of concern, although the article emphasizes that evidence is still emerging.
Genetics is another key piece of the puzzle. Researchers have identified families in which multiple relatives develop lung cancer, suggesting an inherited susceptibility. This is somewhat analogous to BRCA1 and BRCA2 in breast cancer, where inherited mutations significantly raise risk. In lung cancer, scientists have not yet pinpointed specific inherited mutations that clearly predispose carriers to the disease. Even so, by studying these high-risk families, researchers are uncovering potential susceptibility genes and learning how they interact with environmental exposures. This kind of work may eventually yield biomarkers for earlier detection in people who would not be flagged by standard lung cancer screening criteria.
Lung cancer screening has evolved in recent years, but it still largely centers on smoking history. In 2021, the United States Preventive Services Task Force expanded its guidelines. Screening with low-dose CT scans is now recommended for adults between 50 and 80 years old who have smoked at least a pack a day for 20 years, and who either still smoke or quit within the past 15 years. These updated criteria broaden eligibility, especially for women who may have smoked less heavily or for fewer years than men. Researchers estimate that the new guidelines will increase the number of women eligible for screening by about 40%.
Yet uptake remains strikingly low. While more than 70% of eligible women receive breast cancer screening, fewer than 6% of eligible smokers undergo lung cancer screening. This gap means many opportunities to catch lung cancer early are missed. I found this detail particularly striking because it shows that policy changes alone are not enough. Awareness, access, and a shift in perception about who is at risk are all essential if screening is to fulfill its potential.
Beyond screening, treatment for lung cancer has changed significantly. A deeper understanding of the genetic and molecular changes that drive tumor growth has led to targeted therapies that hone in on specific mutations. Immunotherapies that harness the body’s own immune system have also improved outcomes for many patients. According to the author, women in particular often have a better prognosis than men, especially if they are never smokers whose tumors carry changes that can be attacked with targeted drugs. These advances do not erase the seriousness of a lung cancer diagnosis, but they do offer more hope and more options than existed a generation ago.
One persistent challenge is that early lung cancer symptoms are often vague, especially in women and younger adults. Coughing, shortness of breath, overwhelming fatigue, and pain in the back, chest, or shoulder can easily be mistaken for infections, muscle strain, or the effects of stress. Because women tend to be slightly younger when diagnosed, they may put off seeking help, assuming they are too young to have a serious lung disease. Physicians, seeing a younger patient without a significant smoking history, may also be slower to consider lung cancer as a possible diagnosis.
The story emerging from this research is clear. Lung cancer is no longer a disease confined to older male smokers. It is affecting more women, more never smokers, and more younger people worldwide. Recognizing the early symptoms, broadening the conversation about risk factors to include environmental exposures and genetics, and continuing to refine screening guidelines are critical steps. Equally important is ensuring that anyone diagnosed with lung cancer receives appropriate molecular testing so that the best targeted or immune-based therapies can be considered.
News about Pope Leo XIV’s early, surgically treatable lung cancer underscores the power of early detection. For both smokers and nonsmokers, finding lung cancer at an early stage can mean the difference between cure and chronic management. Raising awareness of the changing face of lung cancer, especially lung cancer in women and in never smokers, is an important step toward earlier diagnosis, better treatment, and ultimately fewer lives lost to this disease.