More “Never Smokers” Are Getting Lung Cancer

February 9, 2021 | Healthspan, Science

Dev Mishra, M.D.

Founder and President, Sideline Sports Doc

Medical Director, Apeiron Life

Fellow, American Academy of Orthopaedic Surgeons

Institute For Joint Restoration, Menlo Park, CA


February 9, 2021

Key Points:

  • Lung cancer is increasingly found in people who have never smoked
  • Part of the reason is statistical, there are fewer smokers than non-smokers, but the absolute number of cases in never-smokers is also increasing
  • At present, it appears that female never-smokers are at higher risk for developing lung cancer than males but much more research is needed to identify risk factors

This week I’m going to venture off track from my usual posts and write briefly about the fact that lung cancer is increasingly being

Handsome husband and young wife touching each other’s heads

diagnosed in an unlikely group of people- those who have never smoked and have no obvious risk factors.

Smoking remains the single biggest risk for lung cancer, with about 88% of new lung cancer diagnoses each year conclusively linked to a person’s smoking history. There’s nothing good that will come to you from smoking. Still, that leaves 12% of these new cancer diagnoses in those who have never smoked.

Identifying very early screening tools for lung cancer is an emerging field. In the near future we will have “liquid biopsies”, meaning blood tests to pick up very early stages of various cancers. Until then, there’s much we still need to learn.

The Numbers 

When one of my high school best friends’ wife was diagnosed with non-small cell lung cancer several years ago I was truly shocked. They lived incredibly clean, with attention to nutrition and regular fitness. She was the last person I’d expect to get lung cancer.

There are statistical reasons why we might see more lung cancer cases in non-smokers, namely, the number of smokers in the population is going down each year.  Smoking prevalence was 15% in 2015 compared to 42% in 1965. With fewer smokers, out of every 100 lung cancer patients more of them will be never-smokers.

But that doesn’t tell the whole story, as it appears that the absolute number of lung cancer cases in never-smokers is on the rise. Regardless if this is the case or not, a massive point remains: The estimated number of lung cancer deaths for 2021 is 131,880. Smoking is linked to about 80-90% of these deaths. That means that more than 26,000 deaths from lung cancer are not attributable to smoking.

If we put lung cancer deaths in never-smokers in its own category, it would be the seventh leading cause of death among cancer types.

Common Threads

This article points out that screening for lung cancer using currently available methods (such as low-dose CAT scan) would be more effective if we could identify ahead of time those individuals amongst nonsmokers are at higher risk.

At present there are only a few common threads. One of the emerging common threads: gender. Worldwide, 15% of male lung cancer patients are never-smokers, but 50% of female lung cancer patients never smoked. Beyond that, not much is known so far about the risk factors.

Despite the amazing efforts of the specialists at the Huntsman Cancer Institute at the University of Utah, my friend’s wife ultimately passed away from the disease.

What makes the article referenced above even more poignant is that it was published posthumously, written by the extraordinary science journalist Sharon Begley. She died of complications of lung cancer just five days after completing the article. She never smoked.


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