Still a mystery, but here is what we have found so far. While the overall rate of lung cancer has been declining, a notable trend has emerged: lung cancer in people who have never smoked is increasing. This poses a challenge to the traditional understanding of the disease, which is heavily associated with tobacco use. Research suggests that for some, lung cancer in non-smokers is a distinct disease from that in smokers, driven by different factors and presenting in a different form.

Environmental and Lifestyle Factors

A major contributing factor to lung cancer in non-smokers is exposure to environmental carcinogens.

• Cooking Fumes: Fumes from burning wood and frying oils can contain cancer-causing agents [https://aacrjournals.org/cancerres/article/66/9/4961/532914/Dose-Response-Relationship-between-Cooking-Fumes]. Studies in some Asian countries, where non-smoking women may spend more time cooking and are more likely to have lung cancer than their male counterparts, suggest a link between cooking and lung cancer in non-smokers [https://aacrjournals.org/cebp/article/9/11/1215/180250/Fumes-from-Meat-Cooking-and-Lung-Cancer-Risk-in]. A 2022 Gallup poll found that women tend to cook more than men in many countries [https://news.gallup.com/opinion/gallup/512918/gender-gap-home-cooking-grows.aspx] with an exception in Italy were men cook 0.4 more meals per week than women.
• Radon Gas: According to the U.S. Environmental Protection Agency, radon gas is the leading cause of lung cancer in non-smokers and is second only to cigarettes for all lung cancers [https://www.epa.gov/radon/health-risk-radon]. Radon is a naturally occurring, odorless, and colorless radioactive gas that can accumulate in homes, particularly those built on soil with high uranium levels [https://www.cancer.gov/about-cancer/causes-prevention/risk/substances/radon/radon-fact-sheet]. At See The Air we have reviewed various radon monitors aranetRn and Airthing Wave.
• Other Exposures: Other well-known carcinogens that can affect non-smokers include secondhand smoke [https://www.cdc.gov/lung-cancer/nonsmokers/index.html] and workplace hazards like asbestos [https://www.cancer.org/cancer/risk-prevention/tobacco/health-risks-of-smoking-tobacco.html].

Genetic Mutations

Genetic factors are also a key component in the rise of lung cancer in non-smokers.

• EGFR Mutation: A mutation in the Epidermal Growth Factor Receptor (EGFR) gene is a significant risk factor [https://medlineplus.gov/genetics/gene/egfr/#conditions]. This mutation can lead to uncontrolled cell growth and cancer [https://www.lung.org/lung-health-diseases/lung-disease-lookup/lung-cancer/symptoms-diagnosis/biomarker-testing/egfr]. Individuals with this mutation have a higher chance of developing lung cancer, even without a history of smoking [https://pmc.ncbi.nlm.nih.gov/articles/PMC11014425/pdf/nihms-1977779.pdf]. This mutation is more prevalent in some Asian populations, which may explain the higher incidence of non-smoking-related lung cancer in those areas [https://pmc.ncbi.nlm.nih.gov/articles/PMC4367583/].
• Treatment: Lung cancer in non-smokers often presents as a specific type called adenocarcinoma [https://www.lung.org/lung-health-diseases/lung-disease-lookup/lung-cancer/basics/lung-cancer-types], which can be more treatable with modern medications like EGFR inhibitors [https://pmc.ncbi.nlm.nih.gov/articles/PMC5650459/].

Overcoming Stigma

The stigma associated with lung cancer as a “smoker’s disease” can lead to delayed diagnosis and treatment [https://www.lung.org/blog/making-lung-cancer-stigma-past]. It is important to remember that anyone with lungs can get lung cancer, regardless of their smoking history [https://www.dana-farber.org/health-library/cancer-mythbusters-smoking-lung-cancer]. Overcoming this stigma is crucial for ensuring that all patients receive timely and appropriate care.

For more information, visit the following websites:

• Centers for Disease Control and Prevention: https://www.cdc.gov/lung-cancer/nonsmokers/index.html
• World Health Organization: https://www.who.int/news/item/16-01-2024-tobacco-use-declines-despite-tobacco-industry-efforts-to-jeopardize-progress
• National Cancer Institute: https://seer.cancer.gov/statfacts/html/common.html
• National Institutes of Health: https://pmc.ncbi.nlm.nih.gov/articles/PMC5342645/
• American Cancer Society: https://www.cancer.org/cancer/risk-prevention/tobacco/health-risks-of-smoking-tobacco.html
• American Lung Association: https://www.lung.org/
• Lung Cancer Research Foundation: https://www.lungcancerresearchfoundation.org/
• Environmental Protection Agency: https://www.epa.gov/radon/
• Prevent Cancer Foundation: https://preventcancer.org/
• Gallup: https://www.gallup.com/analytics/512897/global-cooking-research.aspx
• Yale Medicine: https://www.yalemedicine.org/conditions/lung-cancer-in-nonsmokers