When someone is diagnosed with lung cancer, that person’s smoking habits often are scrutinized by family, friends, and acquaintances.
While smoking tobacco remains the leading cause of lung cancer in the United States – responsible for 80% to 90% of related deaths – 10% to 20% of lung cancer patients have never smoked, according to the U.S. Centers for Disease Control and Prevention.
That’s between 20,000 and 40,000 never-smoking Americans diagnosed with lung cancer each year.
“And we’re probably underestimating that number,” says Dr. Timothy Burns, MD, PhD, a medical oncologist at UPMC Hillman Cancer Center. “There are patients who smoke and get lung cancer not related to smoking, just like there are patients who drink but get liver failure from a virus.”
An associate professor of medicine at the University of Pittsburgh and a lung cancer researcher studying targeted therapies, Dr. Burns hopes to improve targeted therapies for patients developing a resistance to treatments.
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“Never-Smoking” Lung Cancer: Understanding Risk Factors
Never-smoking lung cancer would be one of the top ten most common cancers in the United States if researchers separated these cases from smoking-related ones, says Dr. Burns.
Roughly 60% to 70% of never-smokers diagnosed with the disease have a type of non-small cell lung cancer called adenocarcinomas, which develops in the glands lining the organs.
Outside of cigarette smoke, a history of lung disease and environmental factors can increase lung cancer risk. According to the American Lung Association, these include exposures to substances such as:
- Radon gas
- Air pollution
Radon is the leading cause of lung cancer among nonsmokers, the U.S. Environmental Protection Agency estimates.
When the odorless, radioactive gas concentrates inside homes built on soil with natural uranium deposits, it can be deadly. The Pennsylvania Department of Environmental Protection estimates roughly 40% of Pennsylvania homes have radon levels above EPA action guidelines.
Never-smoking lung cancer patients are more likely to present symptoms, Dr. Burns says, because they are often screened later than high-risk smokers.
“In smokers, we have CT scans so it can be detected at an earlier stage,” he says. “The symptoms we associate with more advanced lung cancer, like cough, shortness of breath, chest pain, and weight loss are usually more common in advanced cancer. CT screenings are not approved for never-smokers, and it’s tough because we’d essentially have to screen the entire population.”
Screening and Treatment for Lung Cancer in Non-Tobacco Users
Lung cancer screenings are currently recommended for adults (50 to 80 years old), longtime smokers, or people who have quit smoking within the past 15 years, according to the American Cancer Society, because the risks associated with low-dose CT scanning may outweigh the benefits for those less likely to develop lung cancer.
“For a relatively common cancer, we don’t have good ways of detecting it in never-smokers,” Dr. Burns says.
Lung cancer patients have a variety of treatment options available at UPMC Hillman Cancer Center, including tumor removal, radiation, anticancer drugs, and other targeted therapies.
Patients may undergo surgery, chemotherapy, and targeted gene therapy to address tumor mutations found in lung cancer patients who have never smoked. These anticancer drugs can lengthen a person’s chance of survival by years, Dr. Burns says.
“Some of these patients can do much better than your average lung cancer patient with targeted therapies,” he says. “The tumors are generally less complex, meaning they don’t have as many mutations as smoking-associated lung cancers.”
This is especially crucial for people with advanced lung cancer that has spread, he says.
“Thirty-five percent of our patients with metastatic lung cancer will need targeted therapy,” Dr. Burns says. “With these, they can expect the tumor to shrink, and sometimes it won’t progress for years. In fact, we have a particular type of lung cancer called ALK positive NSCLC where the five-year overall survival rate is 62%.”
For perspective, Dr Burns says the average median survival rate for someone with metastatic lung cancer is 12 to 14 months. “So, finding these genetic alterations and treating them appropriately can extend that by years,” he adds.
Editor's Note: This article was originally published on , and was last reviewed on .
When you are facing cancer, you need the best care possible. UPMC Hillman Cancer Center provides world-class cancer care, from diagnosis to treatment, to help you in your cancer battle. We are the only comprehensive cancer center in our region, as designated by the National Cancer Institute. We have more than 70 locations throughout Pennsylvania, Ohio, and New York, with more than 200 oncologists – making it easier for you to find world-class care close to home. Our internationally renowned research team is striving to find new advances in prevention, detection, and treatment. Most of all, we are here for you. Our patient-first approach aims to provide you and your loved ones the care and support you need. To find a provider near you, visit our website.