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Over the past 25 years, the number of non-smokers suffering from lung cancer has increased, while at the same time more cases of early-stage lung cancer (before the age of 50) have occurred.
HealthyWomen spoke with Mohana Roy, MD, a medical oncologist and clinical assistant professor at Stanford University School of Medicine, about why early-onset lung cancers are on the rise and what experts are doing about it.
Do we know why lung cancer diagnoses are increasing among young people, especially among people who don’t smoke?
We don’t know why. Part of this has to do with improvements in imaging, such as X-rays and CT scans. We can now see the lung nodules, tiny areas of dense tissue smaller than the size of a pea. I think we’re just discovering more cancers because of the images we have now.
When it comes to lung cancer in people who don’t smoke, I think it’s one of the most difficult things in medicine. Obviously we think of cancer as a disease associated with smoking (we don’t really use the word “cause”), but we are now identifying more and more cases of lung cancer that are linked to mutations.
Mutations are genetic changes that occur in your DNA, so changes that occur within the body, not things that are inherited. A lot of research suggests that mutations are the reason we’re seeing more and more lung cancer in people who don’t smoke. However, we still don’t know why some people develop these mutations.
Read: Why do people who don’t smoke get lung cancer? >>
Are certain mutations in early-onset lung cancer more common in younger people?
Yes it is. Epidermal growth factor receptor or EGFR mutation is the most common known mutation in non-smokers. The other two that we see most often, although they are relatively rare compared to all lung cancers, are ALK and ROS1. These are the three main mutations that we see most often in non-smokers and also in younger patients.
We really get to know the composition of the pie chart. So if you look at the pie chart of all lung cancers, we used to only know about these three mutations, which are small snippets because they are relatively rare. Now we are finding more and more mutations associated with lung cancer, so there are more and more elements in the diagram. But RFCE, ALK and ROS1 are still the most common.
What treatments are most commonly used for cancers with mutations?
If one of these mutations is found, it is usually treated with tablets, which is actually rare in lung cancer. Lung cancer almost always requires chemotherapy. We’ve been doing this for many, many years. But for some of these mutations, we can now avoid chemotherapy because we have scientific evidence that pills are actually more effective than chemotherapy. This was a huge revelation in our field and has been the standard for about 15 years.
These pills are a type of targeted treatment. This means they are designed to selectively attack cancer cells that have something wrong with them and hopefully stop them from spreading. Many of these treatments are called tyrosine kinase inhibitors. Tyrosine kinase is one of the enzymes that allows cancer to spread and these pills block it.
Not all patients with mutations only receive pills. We find that for many patients with the EGFR mutation and stage 4 or metastatic cancer, when the cancer has already spread and is considered incurable, it may be beneficial to use chemotherapy and the pills.
Read: Lung Cancer Treatment: Next Steps After Diagnosis >>
Are there additional considerations regarding treatment side effects and clinical outcomes in young adults with lung cancer?
I think fertility is something we think about a lot more. In most cancer centers, we haven’t always had the most robust system because, logically, we are used to caring for older people. But I actually think there’s a lot of awareness across the country about the need to have conversations about fertility.
When it comes to targeted treatment pills, there is very little information about how the treatment affects fertility. But generally speaking, people shouldn’t be pregnant when taking these pills, so let’s talk about that beforehand.
Many of these targeted treatments cause a significant amount of rash and skin problems that impact body image and can also be painful. We have a very good team at Stanford who we call caring dermatologists whose job it is to help us manage the side effects of these pills. We offer many creams and treatments to ensure that rashes are controlled and do not affect people’s daily lives.
Hair loss is usually minimal, even with the chemotherapies we use for lung cancer. I always tell my patients that my goal is to keep everything that happens in the clinic confidential so that no one finds out that they have just had cancer treatment when they go to the supermarket afterwards.
Are there differences in symptoms and survival rates between lung cancers in younger and older people?
Overall, the survival rate for lung cancer is very poor and is significantly behind many other types of cancer in terms of life expectancy after diagnosis. I think it’s just harder for younger people because our lungs are so resilient. What I mean by this is that our lungs are very good at hiding things, especially if someone is young, doesn’t smoke, and doesn’t have other lung diseases.
Unfortunately, someone could have a significantly large mass in their lungs and not show any symptoms. One of the scariest things is that we tend to find more stage 4 cancers in younger people. This is not necessarily statistical data. It’s exactly what I saw.
Patients with mutations generally have better survival rates. For example, we now have data that people with the ALK mutation live longer than five years with incurable lung cancer. I know that doesn’t sound like much, but that’s unusual with lung cancer that has spread, so we’ve made a lot of progress.
This educational resource was created with support from Merck.
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