For decades, lung cancer has been viewed as a disease of older men who smoked. Now, cases among young, fit, non-smoking women are rising, and doctors are struggling to explain why. Becca Smith, a 28-year-old personal trainer and yoga studio owner from Chester, was diagnosed with stage four lung cancer in 2020 after experiencing persistent back pain. Despite being young, active, and a non-smoker, the cancer had spread to her spine and brain. Doctors initially gave her two weeks to live, but she survived after treatment.
Analysis of lung cancer patients at Guy’s and St Thomas’ hospital in London shows a clear shift. Between 2010 and 2021, the proportion of non-smoking patients rose from 5% to 14%. Of these, 68% were women, compared with 43% of those with a smoking history. Non-smoking patients were also younger: 16% were under 50, versus 5% of smokers. Additionally, 17% of non-smoking cases were Black patients, compared with 5% of smokers, and a higher proportion were Asian.
Dr Alex Georgiou, consultant medical oncologist at Guy’s and St Thomas’, noted that the biology of the cancer also differs. Two-thirds of non-smoking patients presented at stage four, and 38% had brain metastases. “It’s not only that the demographics are different,” he said. “The biology of the cancer is different too.” These trends mirror global patterns, but the causes remain unknown.
Air pollution is one suspected factor, though no definitive link has been proven. Cecilia Pompili, a thoracic surgeon at Hull York Medical School, said that for too long, lung cancer was not considered a disease of young women, and they were often excluded from clinical research. Screening in England is currently only available for those over 55 with a smoking history, meaning young non-smoking women like Smith are typically diagnosed late, when the cancer has already spread.
