The diagnosis of lung cancer given to Pope Leo XIV on October 13, 2026, has sparked active discussions regarding the increase in the incidence of this disease among people who have never smoked. According to reports, Leo himself is not a smoker.
Possible causes for the development of the disease include environmental exposure and genetic factors. Therefore, it is crucial to be aware of various risk factors that can increase the likelihood of lung cancer in a person, regardless of their smoking history. This is necessary for timely and adequate screening and treatment.
Cancer detected at the earliest stages, as in the case of the Pope, can be surgically cured in both smokers and non-smokers. However, there is an issue that people who have never smoked are currently not included in lung cancer screening guidelines, and tumors are often discovered incidentally.
As a specialist in thoracic tumor treatment, I observe many young women who have never smoked presenting to my clinic with a new lung cancer diagnosis. Especially for those who have never smoked, lung cancer is a surprise for both patients and doctors, which often leads to diagnostic delays. Researchers note this trend of increasing lung cancer incidence among women in different parts of the world and are beginning to understand the reasons for this increase.
One explanation for the rising incidence of lung cancer among women is that many of them started smoking later than men, thereby delaying the peak of tobacco-related lung cancer diagnosis. Furthermore, women began smoking in years when filter cigarettes were most commonly used. This led to an increased risk of developing types of cancer such as adenocarcinoma, due to how filters distribute tobacco smoke to the outer parts of the lungs. Some studies suggest that women may be more susceptible to the carcinogenic effects of tobacco and cigarette smoke, including passive smoking, and may develop lung cancer after fewer years of smoking compared to men.
Nevertheless, it is important to note that most people diagnosed with lung cancer today are not active smokers. Approximately 20% of women with lung cancer have never smoked—a percentage higher than among men with lung cancer who have never smoked.
In addition to smoking and secondhand smoke, there are other risk factors for lung cancer. These include a family history of cancer, as well as exposure to asbestos, radon, and air pollution. Exposure to carcinogenic substances in the workplace in the form of inhaled chemicals such as arsenic, beryllium, cadmium, silicon dioxide, and nickel remains a problem in some parts of the world. The potential risk of lung cancer associated with e-cigarettes and marijuana is still being studied but is a cause for concern.
Recently, researchers have also found that genetics can play a role in the risk of lung cancer in some patients with a strong family history of the disease. Studies of these families have helped identify possible genes of susceptibility to lung cancer and environmental risk factors. Similar to BRCA1 and BRCA2 genes in breast cancer, changes in genes that promote or protect against tumor development can contribute to lung cancer. Researchers have not yet identified the specific mutations that could predispose people to lung cancer. However, studying hereditary predisposition can help understand how lung cancer develops and lead to the discovery of new biomarkers for early detection of cancer in high-risk groups.
In 2021, the U.S. Preventive Services Task Force updated its lung cancer screening guidelines to include younger patients with shorter smoking histories. Lung cancer screening is now recommended for adults aged 50 to 80 who have smoked at least a pack a day for 20 years, as well as current smokers and former smokers who quit within the last 15 years. Women at risk of lung cancer can discuss low-dose computed tomography for lung cancer screening with their doctors.
Across the country, over 70% of eligible women undergo breast cancer screening, but less than 6% of all eligible smokers undergo lung cancer screening. Researchers believe that these new screening guidelines will increase the number of eligible women for lung cancer screening by 40% by including younger women and those less exposed to tobacco.
In recent years, the growing understanding of genetic changes that can lead to cancer and ways to use the immune system to treat it has led to the development of new targeted therapies and immunotherapy, improving the prognosis for lung cancer patients. Women generally have a better prognosis for lung cancer than men, especially if they have never smoked and have tumors with molecular changes that can be treated with targeted therapy.
However, symptoms of lung cancer can remain unnoticed in women. Symptoms may include coughing, shortness of breath, severe fatigue, and pain in the back, chest, or shoulder, which can be mistaken for other illnesses. Since women are generally diagnosed at a younger age than men, patients may endure symptoms longer and delay seeking medical attention. Doctors may also not associate these symptoms with lung cancer due to the patient's young age.
Recognizing early signs of lung cancer, expanding opportunities for disease screening, and conducting genetic biomarker tests to select the best therapy are some of the measures that can help combat the global epidemic of lung cancer among women.
