Summary
Lung cancer in never smokers is becoming more prominent – especially in women. 12% of U.S. lung cancer patients are never-smokers and it is increasing.
Lung Cancer in never smokers: Sharon Begley died of complications of lung cancer on Jan. 16, just five days after completing this article. She was a never-smoker.
A growing share of lung cancer cases is turning up in never smokers, especially women never smokers.
Breast cancer wouldn’t have surprised her; being among the 1 in 8 women who develop it over their lifetime isn’t statistically improbable. Neither would have colorectal cancer; knowing the risk, Mandi Pike “definitely” planned to have colonoscopies as she grew older.
But when a PET scan in November 2019 revealed that Pike, a 33-year-old oil trader, wife, and mother of two in Edmond, Okla., had lung cancer — she had been coughing and was initially misdiagnosed with pneumonia — her first reaction was, “but I never smoked,” she said. “It all seemed so surreal.”
Join the club. Cigarette smoking is still the single greatest cause of lung cancer, which is why screening recommendations apply only to current and former smokers and why 84% of U.S. women and 90% of U.S. men with a new diagnosis of lung cancer have ever smoked, according to a study published in December in JAMA Oncology. Still, 12% of U.S. lung cancer patients are never-smokers.
Lung cancer in never-smokers increasing
Scientists disagree on whether the absolute number of such patients is increasing, but the proportion who are never-smokers clearly is. Doctors and public health experts have been slow to recognize this trend, however, and now there is growing pressure to understand how never-smokers’ disease differs from that of smokers, and to review whether screening guidelines need revision.
“Since the early 2000s, we have seen what I think is truly an epidemiological shift in lung cancer,” said surgeon Andrew Kaufman of Mount Sinai Hospital in New York, whose program for never-smokers has treated some 3,800 patients in 10 years. “If lung cancer in never-smokers were a separate entity, it would be in the top 10 cancers in the U.S.” for both incidence and mortality.
A 2017 study of 12,103 lung cancer patients in three representative U.S. hospitals found that never-smokers were 8% of the total from 1990 to 1995 but 14.9% from 2011 to 2013. The authors ruled out statistical anomalies and concluded that “the actual incidence of lung cancer in never smokers is increasing.” Another study that same year, of 2,170 patients in the U.K., found an even larger increase: The proportion of lung cancer patients who were never-smokers rose from 13% in 2008 to 28% in 2014.
