The number of non-smokers developing lung cancer has increased over the last 25 years, and with it more cases of early-stage lung cancer (before the age of 50) have occurred.
HealthyWomen spoke with Mohana Roy, MD, medical oncologist and clinical assistant professor at Stanford University School of Medicine, about why early-onset lung cancer is on the rise—and what experts are doing about it.
Do we know why lung cancer diagnoses are increasing among young people, especially non-smokers?
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 lung nodules – small areas of dense tissue smaller than the size of a pea. I think we’re just discovering more cancers because of the images we take.
When it comes to lung cancer in non-smokers, I think this has been one of the biggest challenges in medicine. We obviously think of lung cancer as a smoking-related disease (we don’t really use the word “cause”), but now we’re finding more and more cases of lung cancer linked to mutations.
Mutations are genetic changes that happen in your DNA – they are changes that happen in the body, not things that are inherited. A lot of research suggests that mutations are the reason we see more lung cancer in non-smokers, but why some people get these mutations is still unknown.
Read: Why do more non-smokers get lung cancer? >>
Do you see certain mutations more frequently in younger-onset lung cancer?
We do, yes. Epidermal growth factor receptor (EGFR) mutation is the most common known mutation in non-smokers. The other two that we see most often – although they are still relatively rare when considering all lung cancers – are ALK and ROS1. These are the three main mutations that we see more often in non-smokers and also in younger patients.
We’re also really filling the pie, meaning if you look at a pie chart of all lung cancers, we only knew about these three mutations, which are small snippets because they’re still relatively rare. Now we are discovering more and more mutations linked to lung cancer, so the pie is getting bigger and bigger. But EGFR, ALK and ROS1 are still the three most common.
What treatments are most commonly used for cancers with mutations?
When one of these mutations is found, many drugs are used to treat it with pills, which is actually quite rare for 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 the pill actually works better 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 that they are designed to selectively attack the cancer cell with the specific agent that is wrong and hopefully stop it from growing. Many of these treatments are called tyrosine kinase inhibitors. Tyrosine kinase is one of the enzymes that allows cancer to grow and these pills block it.
However, not all patients with mutations only receive pills. For many patients with the EGFR mutation and stage 4 or metastatic disease where the cancer has already spread and is considered incurable, we are actually finding that additional chemotherapy in addition to the pill may be beneficial.
Read: Lung Cancer Treatment: Next Steps After Diagnosis >>
Are there additional considerations regarding treatment side effects and outcomes in younger adults with lung cancer?
I think fertility is something we think about a lot more. In most cancer centers we don’t always have the most robust system in place as we are understandably used to seeing older people. But I think there’s actually quite a bit of national awareness about the need for a fertility discussion.
With targeted treatment pills, there is very limited data on how the treatment affects fertility. But in general, you shouldn’t be pregnant when taking these pills, so let’s talk about that beforehand.
Many of these targeted treatments cause quite a bit of rashes and skin problems, which affects body image and can also be painful. We have a really good team at Stanford that we call supportive dermatologists whose sole job is really to help us manage the side effects of these pills. We develop many creams and treatments to ensure that the rash is under control and does not affect people’s everyday lives.
Normally hair loss is fairly minimal, even with the chemotherapies we use for lung cancer. I always tell my patients that my goal is for whatever happens in the treatment room to stay there so that no one knows they just received cancer treatment when they go to the grocery store afterwards.
Are there differences in symptoms and survival rates between younger and older lung cancer?
In general, the survival rate for lung cancer is still very low, and in terms of life expectancy, lung cancer is definitely behind many other cancers. I think it’s honestly a lot harder for younger people because our lungs are very 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 any other lung disease.
Unfortunately, someone can have a fairly large mass in their lungs and not show any symptoms. One of the scariest things is that we tend to find stage 4 disease more frequently in young people. This is not necessarily data. Just my experience.
Patients with mutations generally have better survival rates. For example, we now have data showing that people with the ALK mutation live longer than five years with incurable lung cancer. I know that doesn’t sound like much, but with lung cancer that has spread, that’s almost unheard of – so we’ve made a lot of progress.
This educational resource was created with support from Merck.
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