Lung Cancer Does Strike Those Who've Never Smoked

Santwona Behera was not yet 40 when a cough began to nag at her, a cough that didn't yield to the allergy treatments prescribed for her. The mother of two little girls, she was also a full-time software engineer who ate healthy foods, stayed physically active and never smoked. But that strange symptom, that persistent cough, just would not go away. Finally a friend persuaded her to see a lung specialist.

"It doesn't look like pneumonia," Behera recalls that doctor saying. "It looks like something else."

It was a lung cancer diagnosis. "That was a shock for me," Behera said. "How can I get lung cancer? I didn't believe I had cancer. I thought only smokers get it."

Certain non-smokers are vulnerable to lung cancer diagnosis

Behera's lung cancer diagnosis put her squarely into a group of people whose lung cancer is of growing concern to doctors. Only recently, in Stanford-based research, did a new reality become apparent: As many as 20% of women and 10% of men diagnosed with lung cancer have never smoked. The other curious lung cancer statistic was that many of these women were of Asian ethnicity. "What my colleagues in this country and around the world are seeing is an increase in the number of people who get lung cancer who have never smoked," said Heather Wakelee, MD, Stanford's lead medical oncologist for cancers of the chest. "Unfortunately, we don't really know why." Lung cancer screening protocols for this group of patients have not yet evolved, although the early signs of lung cancer—that nagging cough—were part of Behera's symptoms.

Behera, strongly committed to being treated at the best lung cancer hospital and by the best lung cancer doctor available, found Wakelee. "In our first meeting, she had us also meet with the surgeon and the radiologist," Behera said. "She made me feel that something was going on, that my health was her first priority. I felt really, really good."

The best lung cancer treatment for a specific tumor

Surgery to remove as much of the tumor as possible was followed by radiation and chemotherapy. The combination allowed Behera to return to work and to fully active parenting.

But, as sometimes happens, her cancer returned in her other lung and in the lining of her brain. This time, advanced technology allowed her Stanford doctors to identify her tumor's particular genetic mutation, something called ROS1. It's part of a small group of mutations scientists have frequently found after a lung cancer diagnosis in non-smokers.  Doctors are working to find other mutations beyond ROS1 that could be causes of lung cancer. They don't know yet how the mutations occur, Wakelee said, "but we do know how to look for them and, when we find them, how to treat patients differently."

What that meant for Behera was radiation for the cancer in her brain, followed by maintenance chemotherapy with a drug known to work well in lung cancers with the ROS1 mutation.

New lung cancer treatment options available

Even if her cancer stops responding to her current therapy, she knows that she has other options—and that there are new lung cancer treatments in development. "I don't think about what's going to come next because Dr. Wakelee has given me a plan," Behera said.

"Having options targeted to a tumor's specific genetic makeup go some way to moving lung cancer more toward being treated as a chronic disease that can be controlled," Wakelee said. The increased understanding of such mutations also builds knowledge for the earlier identification of lung cancer risk in non-smokers. "We have some hints," Wakelee said, "but we're not there yet."

Behera, who went undiagnosed for six months, advises those like her to learn more about lung cancer. "If you have a cough that doesn't go away, then you should go to the doctor and find the root cause," she said. "It's better to find something earlier than later. And don't lose hope. Every month, they're coming up with new things. It's not like cancer was 10 years ago. It's not like that now. You have hope."