You might think lung cancer only affects smokers. But thousands of people in the United States who have never smoked, not even a single cigarette in their lifetime, are diagnosed with lung cancer each year.
While the overall rate of lung cancer is decreasing because of screening and early detection, the percentage of cases in what experts call “never-smokers” is increasing.
“Lung cancer risk is never zero, even for those who have never smoked,” said John Breard, MD, a thoracic surgical oncologist with Banner MD Anderson Cancer Center. “Though your risk can be significantly reduced by quitting smoking or never smoking, there are certain things you can encounter outside of smoking that can increase your risk.”
If you’ve never smoked or quit a long time ago, learn more about what steps you can take to reduce your risk.
Why it happens: Causes of lung cancer
Smoking is the leading cause of lung cancer. But it’s not the only factor. For people who have never smoked, lung cancer may develop for other reasons.
Gene mutations
Like all cancers, lung cancer begins with changes (mutations) in DNA. These mutations affect the genes that normally control how cells grow and stop cells from dividing.
Dr. Breard explained it this way: cancer develops when the gene that initiates cell division gets stuck “on” and the gene that stops cellular division stops working.
“In a healthy body, some genes act like a switch, signaling cells to grow,” he said. “Others act like a different switch, slowing things down or stopping growth when it’s needed. Mutations in both these genes cause cells to grow out of control and form tumors.”
Environmental
Even if you’ve never smoked, your lungs might still be exposed to harmful substances, including:
- Secondhand smoke: Breathing in tobacco smoke from other people.
- Radon gas: A natural radioactive gas that can build up in homes.
- Diesel exhaust and air pollution: Long-term exposure can damage the lungs.
- Workplace chemicals: Such as asbestos, arsenic, or chromium, to name a few.
- Other smoke: Repeated exposure to any smoke, such as wildfires or wood-burning fireplaces, can harm lung tissue.
- Vaping: Exposes the lungs to chemicals, toxins and heavy metals. While vaping alone has not been shown to directly cause lung cancer, studies are ongoing.
- Marijuana smoking: Inhaling smoke from any burning material is carcinogenic and can irritate and damage the lungs over time.
Family history
Having a family history of lung cancer also raises your risk. If a parent, brother or sister was diagnosed, especially before age 50, your own risk might be higher.
Other medical factors
Certain health conditions and past treatments may also raise your risk:
- HIV infection: People living with HIV face a higher risk of developing lung cancer, even if they don’t smoke.
- Previous chest radiation: If you received radiation treatment for another cancer in the chest area (such as Hodgkin’s lymphoma or breast cancer), your risk of lung cancer could increase later in life.
There are also growing concerns about thirdhand smoke (the residue left behind after someone smokes indoors, even if the smoke is gone) and cooking fumes but more research is necessary in these areas.
Common types of lung cancer in never-smokers
The two main types of lung cancer are small cell lung cancer and non-small cell lung cancer. Among never-smokers, the most common type is adenocarcinoma, a subtype of non-small cell lung cancer. It often starts in the outer part of the lungs and may grow slowly before symptoms appear.
Symptoms of lung cancer to watch for
Symptoms of lung cancer are the same, whether or not you have smoked. “Regretfully, lung cancer often has no symptoms in the earliest stages,” Dr. Breard said.
Some signs to be aware of include cough, shortness of breath, chest discomfort, tiredness, hoarseness or unexplained weight loss. Most people who notice these symptoms do not have lung cancer, but if any of these symptoms persist for more than a couple of weeks, it’s a good idea to see your provider.
If you believe you are at greater risk for lung cancer, talk to your provider about current screening guidelines.
Advances in lung cancer treatment
The outlook for lung cancer is more hopeful today than ever before. The type of treatment will depend on the specific type and stage of the cancer, as well as your overall health. Treatment options include:
- Surgery to remove a tumor, usually for early-stage lung cancer. Surgery can also be used to treat conditions caused by lung cancer, such as pleural effusion, which is fluid around the lung.
- Radiation therapy (sometimes combined with chemotherapy) to destroy cancer or reduce a tumor’s size before surgery. It can be used to treat early-stage lung cancer in patients who don’t want surgery or where surgery is not an option.
- Chemotherapy to shrink a tumor’s size before surgery, to try to eliminate any remaining cancer cells after surgery or when surgery is not an option, such as in patients with late-stage lung cancer.
- Targeted therapy to target specific parts of cancer cells to slow their growth and spread.
- Immunotherapy to activate your immune system to identify and eliminate cancer cells.
At Banner MD Anderson, specialists use genetic testing to understand the unique features of each patient’s cancer. This way they can build a personalized plan that gives patients the best chance for recovery.
How to reduce your risk of lung cancer
You can’t control your genes or family history, but you can take steps to lower your risk:
- Stay away from tobacco smoke: Avoid smoking and secondhand smoke and try not to inhale smoke of any kind.
- Test your home for radon: Kits are affordable and easy to use.
- Protect yourself at work: Wear proper safety gear if your work exposes you to chemicals, aerosols or dust.
- Limit air pollution exposure: Avoid heavy traffic when possible and be mindful of high pollution advisories.
Takeaway
Yes, you can develop lung cancer even if you’ve never smoked. However, being aware of the risks and taking steps to reduce those risks can make a difference.
If you think you might be at risk, contact a Banner MD Anderson specialist today. We have experts in lung cancer, advanced genetic testing and targeted therapies, as well as a supportive team that cares for your emotional and physical needs.
