"Lung cancer is not just a disease that affects people in their 60s and 70s who spent the majority of their life as smokers. It can happen to anyone."
That's the message shared by Heather Wakelee, MD, Stanford’s lead medical oncologist for cancers of the chest. According to work by Wakelee and other Stanford affiliated investigators, of all women who get lung cancer, 20 percent have never smoked. Of men with lung cancer, 10 percent have never smoked. Lung cancer in people who have never smoked, if considered a separate disease, is the seventh most deadly cancer.
"What my colleagues in this country and around the world seem to be seeing is an increase in the number of people who get lung cancer who have never smoked," says Wakelee, associate professor of medicine in oncology. "Unfortunately, we don’t really know why." There are lots of theories surrounding environmental toxins, second-hand smoke and pollutants, but no one factor holds true for all cases.
However, targeted therapies, many of which are only available through clinical trials, work well in some lung cancer patients who have never smoked, she says. There is frequently a distinct difference in the biology of lung cancer in never smokers that shows a differential response to drugs that target the epidermal growth factor receptor (EGFR) or other altered pathways. Patients who have never smoked are more likely to have targetable mutations and thus higher response rates to these agents and better survival than current or former smokers.
"Clearly if somebody is young and has a cough, lung cancer is not the first diagnosis to consider," says Wakelee. "But it should also not be something that is not thought of at all. Physicians should consider a screening chest x-ray for patients of any age who have persistent symptoms."