At the end of 2019, Becca Smith's life seemed perfect. At 28, she had invested her savings in renting a space in Chester, transforming it into her own yoga studio, while also working as a personal trainer. Her busy schedule, starting at 5 a.m., left her little time to address persistent back pain.
"The pain kept moving, affecting a different area of my back each day," she recounted. "I had to use heat patches and ice packs just to be able to work." Despite consulting a general practitioner (GP), a physiotherapist, and a chiropractor, the initial diagnosis was always a muscle tear.
One day in 3/2020, the pain became so intense that Smith was bedridden. When she woke up, a splitting headache and blurred vision led her to an ophthalmologist. The doctor discovered bleeding in her eye and immediately sent her to the hospital. After a week of extensive tests, including MRIs, CT scans, and a biopsy of cells in her back, a devastating truth was revealed.
Smith was alone in her hospital room when two doctors entered, drew the curtains, and informed her that she had late-stage lung cancer that had spread to her spine and brain. "They said there was nothing more they could do," Smith choked back tears. "I just remember calling my mom and screaming and crying on the phone." The doctors even told her parents she likely had only two weeks to live.
In the early days of the Covid-19 pandemic, Smith decided to go home for palliative care. "My friends all came to say goodbye. They would sit at the end of the bed and cry their eyes out," she recalled. "I still have a book of letters they wrote to me."
For decades, lung cancer was viewed as a disease of older, smoking men, facing significant stigma and a severe lack of research funding. A 2010 analysis revealed that the disease received only 6% of research funding, despite being the third most common cancer in the UK. However, in recent years, the patient profile has shifted. Smoking remains the primary risk factor, but cases among young, healthy, non-smoking women have risen considerably.
While lung cancer screening programs in the UK focus on individuals over 55 with a history of smoking, enabling 76% of cancers to be detected at an early and treatable stage, young, non-smoking women like Smith are often diagnosed only after the cancer has metastasized.
Dr. Alex Georgiou, a consultant oncologist at Guy’s & St Thomas, analyzed patient data to understand these changes. "From 2010 to 2021, the number of never-smoker patients in our clinic has increased year on year. In 2010, this was 5% of cases, by 2021 it had risen to 14%," he said.
Among non-smoking lung cancer cases, 68% were women, compared to 43% in the smoking group. The proportion of younger patients was also higher: 16% of non-smokers were under 50, compared to 5% of smokers. There were also more Black and Asian patients.
"We might predict the high Asian proportion, as lung cancer in never-smokers is very common in southeast Asia," Georgiou explained.
In Vietnam, lung cancer in non-smokers mainly occurs in women, mostly non-small cell lung cancer. Between 15% and 35% of these cases are attributed to secondhand smoke exposure. Other risk factors for lung cancer development in non-smokers include age, genetics, cooking fumes, environmental pollution, underlying lung disease, and cancer-causing viruses.
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Sarah Li was diagnosed with lung cancer last year. Photo: The Guardian |
Sarah Li was diagnosed with lung cancer last year. Photo: The Guardian
These findings reflect global trends but remain largely unexplained. Cecilia Pompili, a consultant thoracic surgeon and senior clinical lecturer at Hull York Medical School, believes we are only beginning to ask the right questions. "For a long time, we didn't think about lung cancer in young women, they weren't even included in clinical research trials," she said.
Adenocarcinoma is the most common type of lung cancer diagnosed in non-smokers. While some women experience the "classic" symptoms of a persistent cough and coughing up blood, others have more vague symptoms like weight loss or back pain. Pompili noted: "We know from some of the patient groups that a healthy 40-year-old woman with a persistent cough is more likely to be diagnosed with allergies, asthma, or an infection than an older smoking man, who would be sent for a chest X-ray."
Determining why lung cancer is increasing in women requires more research. Hormones may play a role. Globally, air pollution has also been identified as a significant risk factor. Another crucial, yet poorly understood factor, is the role of genetic mutations, particularly in young, non-smoking women. Mutations in the epidermal growth factor receptor (EGFR) are the most common, thought to cause 10-15% of lung cancers in the UK. Recent research has identified how air pollution can "awaken" dormant cells in the lungs carrying these cancer-causing mutations, driving their growth.
Sarah Li, a 42-year-old freelance filmmaker, was diagnosed with lung cancer (EGFR mutation-positive) last year. Li lives in London, is a non-smoker, and a vegetarian. "I had a persistent cough but wasn't worried," she shared. "I initially had a cold and the cough just seemed to linger afterwards."
However, after 4 months, when the cough worsened, Li visited her GP, hoping for antibiotics. Instead, she was referred for a chest X-ray and then a rapid CT scan. In 4/2024, Li learned she had inoperable lung cancer, with a tumor in her left lung and cancer also present in nodules in her right lung.
"Even now, I find it strange to say I have lung cancer," Li shared. "I can say I have cancer, but the thought of lung cancer is still quite alien. How can I be the poster child for lung cancer? When I was first diagnosed, I reviewed everything, wondering, ‘Why? What have I done?’".
After years of underfunding, groundbreaking treatments are rapidly developing, particularly for cancers like Li's, caused by genetic mutations. In the past decade, the National Institute for Health and Care Excellence (NICE) has recommended 48 new treatments for lung cancer, six times more than in the previous decade. Li's initial round of chemotherapy, radiotherapy, and immunotherapy significantly reduced her tumors. However, in January, a small lesion was found on her brain. She is currently on targeted therapy, a daily pill, and further chemotherapy.
"Life feels more intense now," she said. "I know that eventually the cancer cells will outsmart the treatment I’m on. Hopefully, by then, there will be another treatment available."
Smith is in a similar situation. A few weeks after starting palliative care, her family received a phone call informing them that the biopsy taken from Smith's back revealed a genetic mutation, ALK-positive lung cancer, and that there was a treatment available. She started taking eight pills daily, targeted cancer drugs, ALK inhibitors, along with monthly blood tests and scans every three months. "It went really well, the tumors shrunk loads. After two years, there was a bit of progression in my brain, so I’m now on a second line of treatment," she said.
Smith is now a Pilates instructor. This summer, during a trip to Bali, her partner, Sammy, proposed on the beach. Smith said the ordeal completely changed her perspective, helping her realize "the things you think are important really aren’t". Her priorities now are family, friends, and health.
While admitting the fear is still there every time she has a scan, she has learned to cope. "It sounds cliche, but five years on, I really do live for today and I can finally be grateful for that," Smith expressed.
Binh Minh (The Guardian)
