We may all be guilty of picturing the same person when we hear that someone has lung cancer—an older man who smoked for many years. The truth is, millions of people with lung disease have never smoked a single cigarette. Children, women who have never smoked, and even athletes can suffer from life-altering respiratory disorders, too.
Recent studies have also shown that individuals who need preventive screenings are often the least likely to receive them due to various socioeconomic factors. As healthcare facilities work to reach at-risk populations, a whole new population may be overlooked – those with low risk. Yes, you heard that correctly. Nonsmokers may benefit from lung cancer screenings just as much as smokers.
A Missed Population
A new analysis out of the Guangzhou Institute of Respiratory Disease shows that low‑dose CT screening (LDCT) detects cancer in lifelong nonsmokers at rates similar to those seen in current and former smokers. The team, led by Dr. Caichen Li, calls for guidelines to expand beyond a 20‑pack‑year threshold and embrace risk factors such as family history, environmental exposures, and geography, given the high rates of lung cancer and respiratory disease in many Asian countries.
Globally, up to 25% of lung cancers now arise in people who have never smoked; in parts of East Asia, that figure climbs above 50%. Without screening, they are often diagnosed at stage III or IV because neither patients nor clinicians perceive them as high‑risk.
However, when LDCT finds stage I disease, the five-year survival rate exceeds 80%.
Women are often a big part of this missed population. Lung cancer is the leading cause of cancer deaths in women, surpassing even breast cancer. Research indicates that women are more susceptible to certain types of lung cancer, such as adenocarcinoma, even if they have never smoked.
The number of women being diagnosed with lung disease is on the rise (The Respiratory Health Association notes that nearly 21 million American women live with lung disease), and women are usually diagnosed at a later stage and dying from lung disease at higher rates than men.
Why are women more at risk? Physicians aren’t sure, but early research suggests that women’s lungs may absorb more of the carcinogens in cigarette smoke compared to men’s, potentially increasing their risk of developing lung cancer even with lower levels of smoking or secondhand smoke.
Hormonal factors, such as estrogen, have also been implicated in lung cancer development. Studies have shown that estrogen receptors present in lung tissue can interact with carcinogens, influencing tumor growth.
Smoking Isn’t the Only Thing That Can Cause Lung Cancer
Smoking and vaping are terrible for lung health and should be avoided at all costs; however, they aren’t the only factors that can lead to lung cancer. Environmental and occupational exposures can also play a significant role. Exposure to radon, a naturally occurring gas, can increase the risk of lung cancer. Testing your home for radon is essential to ensure the levels are low. Testing is recommended if the home has never been tested before, you are selling your home or buying a new home, you are doing substantial renovations to the house, and you live in a state with higher natural radon levels (like Alaska), or are using a lower level like a basement for a bedroom. Certain substances in air pollution or workplaces, such as asbestos, silica, and diesel exhaust, can also contribute to the development of lung cancer. Other factors include a family history of lung cancer or lung disease(which can be due to a genetic mutation or all living in a polluted environment), previous radiation therapy in the chest area, and HIV.
Encouraging Patients to Pursue Testing
All patients, regardless of age, sex, or smoking history, should make a doctor’s appointment for new or worsening lung symptoms, especially those with other risk factors, such as living in a polluted region. However, it’s often much easier said than done. Here are some practical tips for healthcare professionals to encourage patients to undergo early lung disease testing:
Tailored Risk Assessments
Conduct personalized risk assessments to identify individuals at increased risk of developing lung diseases, such as smokers, those exposed to secondhand smoke regularly, workers with occupational exposures, or those with a family history of lung conditions. Tailor your recommendations for early testing based on each patient’s unique risk profile.
Education & Communication
Educating patients about the importance of early detection and its benefits is essential. You can explain how low-risk and straightforward tests, like low-dose CT scans, can detect lung cancer early. Be sure to approach discussions about early lung disease testing with empathy and sensitivity, recognizing that patients may have concerns or fears about undergoing testing or receiving a diagnosis.
Collaborate with Multidisciplinary Teams
Collaborate with multidisciplinary healthcare teams, including primary care physicians, pulmonologists, radiologists, and allied health professionals, to ensure coordinated and comprehensive care for patients undergoing early lung disease testing.
Lung disease doesn’t discriminate, and neither should our screening guidelines. While smokers remain a high-risk group, emerging research clearly shows that nonsmokers, particularly women and individuals with environmental or occupational exposures, are also significantly vulnerable. By continuing to center screening efforts solely around smoking history, we risk missing a growing population of patients who could benefit from early detection. Healthcare providers must push for broader screening criteria.