Why Is Lung Cancer Surging among Young Women?

Lung cancer remains the deadliest cancer among women in the United States, and a growing share of cases involve younger, never-smoking women. In this episode, thoracic surgeon Jonathan Vienna explains the drivers behind this trend, the crucial role of early screening, and the ways treatments are evolving. He highlights risk factors for never-smokers such as radon exposure, secondhand smoke, environmental factors, and genetics, and discusses why screening uptake is still very low. The conversation covers treatment options by cancer stage, including surgical removal for early disease and advances in targeted therapies and immunotherapy that harness the body’s own immune system to fight cancer. The episode offers practical guidance on assessing risk and seeking care early.

Overview and Key Facts

Lung cancer is the leading cause of cancer deaths in the United States for both men and women. In 2025, the American Cancer Society projects approximately 226,000 new cases with about half resulting in mortality. While incidence is decreasing in men, the decline is slower in women, and there is a notable rise among younger adults, especially women who have never smoked. This episode features Jonathan Vienna, a thoracic surgeon at New York Presbyterian/Weill Cornell, who discusses the surprising demographics and the factors driving them.

Screening: The Frontline for Early Detection

Screening for lung cancer using CT imaging is designed to identify disease before symptoms appear, much like mammography for breast cancer. However, uptake remains alarmingly low. Only about 6% of eligible individuals participate in screening, due to gaps in awareness, clinical knowledge, and patient attitudes tied to guilt around smoking. Vienna emphasizes that screening misses never-smokers, underscoring the need for broadened criteria or alternative risk-based approaches.

"6% of people actually get lung cancer screening, so it's dismally low" - Jonathan Vienna, thoracic surgeon

Never-Smokers: Beyond Traditional Risks

About 20% of lung cancers occur in people who have never smoked. Risk factors for this group include radon exposure, secondhand smoke, certain environmental exposures, and genetic predispositions. Vienna explains that radon is a detectable, modifiable risk factor that individuals can test for and mitigate in homes. Environmental or occupational exposures to specific chemicals can also play a role, and awareness of family cancer history can guide clinicians toward more proactive testing and monitoring.

"Approximately 20% of lung cancers occur in people who have never smoked in their entire lives" - Jonathan Vienna, thoracic surgeon

Genetics and Targeted Therapies

Genetic factors contribute to lung cancer risk, and certain mutations are more prevalent in subgroups such as never-smokers. The EGFR gene mutation is a key example. Although EGFR mutations occur in about 15% of all lung cancers, rates are much higher among never-smoking Asian women. There are targeted therapies that specifically inhibit these mutations and have demonstrated significant efficacy across disease stages.

"EGFR mutations occur in about 15% of all lung cancers, but among never-smoking Asian women the rate can reach around 60%" - Jonathan Vienna, thoracic surgeon

Immunotherapy and the Evolving Treatment Landscape

Two major advances are transforming outcomes: targeted therapy for specific mutations and immunotherapy, which stimulates the patient’s own immune system to attack cancer cells. Immunotherapy has produced remarkable responses, including durable disease control in some patients with advanced disease, and targeted therapies offer effective options for tumors harboring particular genetic alterations. These treatments complement, and in some cases replace, traditional chemotherapy for certain patients and stages.

"Targeted therapy for specific mutations and immunotherapy that reawakens the immune system have changed the landscape and can lead to impressive results, even in stage 4 patients" - Jonathan Vienna, thoracic surgeon

Practical Guidance: What to Do Now

Vienna stresses the importance of understanding personal risk, staying attuned to body signals, and not delaying medical consultation. Coughs lasting more than two weeks, a concerning symptom that warrants evaluation, is highlighted as a potential early warning sign. Family history and genetic predisposition should inform conversations with clinicians. The episode underscores the potential impact of early detection through screening and the opportunities created by precision medicine to tailor treatment to individual tumor biology.

Conclusion and Takeaways

The conversation alerts listeners to the evolving landscape of lung cancer in women, especially younger and never-smoking individuals. It emphasizes screening as a life-saving tool, clarifies non-traditional risk factors for never-smokers, and highlights the promise of targeted therapies and immunotherapy in extending survival and potentially achieving cures in select cases. The overall message is clear: awareness, proactive screening where appropriate, and collaborative care that leverages genetic and molecular insights can meaningfully improve outcomes for women facing lung cancer.