‘i Was Told I Had Two Weeks To Live’ – Why Are So Many Young, Fit, Non-smoking Women Getting Lung Cancer?

Towards nan extremity of 2019, Becca Smith’s life was afloat and hectic. At 28, she had taken connected a portion successful Chester to person into a yoga studio, poured successful each her savings and hired teachers, while astatine nan aforesaid clip moving arsenic a individual trainer. Her days started astatine 5am; she was driven, stressed, excited, and had nary clip for nan backmost symptom that conscionable would not subside.

“It kept moving around,” she says. “Every time it would beryllium successful a different portion of my back. I was strapping connected power packs and crystal packs conscionable to get to work.” Smith saw her GP, her physiotherapist and a chiropractor, each of whom suspected a torn muscle. “What really worried me,” she says, “the worst-case scenario, was a slipped disc.” One time successful March 2020, nan symptom was truthful aggravated that Smith took to her bed, fell dormant and woke pinch a crashing migraine and blurred vision. Her mum took her to nan optician who shone a ray down Smith’s eyes, saw haemorrhaging and sent her consecutive to nan hospital. Once there, Smith was admitted, and complete nan people of a week, had an MRI, a CT scan, and a biopsy taken from nan cells successful her back.

Smith was unsocial successful her furniture erstwhile 2 doctors appeared, closed nan curtains, and told her that she had crab successful her lungs that had dispersed down her spine and up into her brain. It was shape four. “They said location was thing they could do for me,” says Smith. “All I retrieve is ringing my mum and screaming down nan phone. The doctors told my parents that I astir apt had astir 2 weeks to live.” This was nan early days of Covid, and Smith chose to spell location for palliative care. “I deliberation I’ve blocked a batch of it out, arsenic you do erstwhile you spell done trauma,” says Smith. “My friends each came to opportunity goodbye. They were sitting astatine nan extremity of my furniture crying their eyes out. I’ve still sewage a full book of nan letters they wrote me.”

Becca Smith had planned to unfastened a yoga workplace earlier she became ill. Photograph: Handout

For decades, lung crab has been viewed arsenic a illness of older men, a “smokers’ disease”, heavy stigmatised and until very recently, grossly underfunded. One study from 2010 recovered it received only 6% of crab investigation funding, contempt being nan third astir communal crab successful nan UK.

In caller years though, nan diligent floor plan has shifted. Smoking remains nan main consequence factor, but cases among fit, young, non-smoking women person risen, some arsenic a proportionality and successful absolute numbers. And while screening is now disposable successful England for those complete 55 pinch a history of smoking – 76% of nan lung crab cases identified by screening are astatine shape 1 aliases 2 and potentially curable – young, non-smoking women for illustration Smith thin to beryllium diagnosed only aft nan crab has spread.

Dr Alex Georgiou, a advisor aesculapian oncologist astatine Guy’s and St Thomas’ hospital, has analysed nan information of his lung crab patients to understand these changes. “Between 2010 and 2021, nan number of patients astatine our session who haven’t smoked has accrued each year,” he says. “In 2010, it was 5% of cases. By 2021, it was 14%.”

Of these non-smoking lung crab cases, 68% were women, compared pinch 43% of those pinch a history of smoking. There was besides a higher proportionality of younger patients: 16% of nan non-smoking patients were aged beneath 50 compared pinch 5% from nan smoking group – and much Black and Asian patients too. White group made up 72% of nan smoking cases, compared pinch conscionable 44% of nan non-smoking.

“We mightiness expect a precocious proportionality of Asian patients, arsenic non-smoking lung crab is very prevalent successful south-east Asia,” says Georgiou. “But nan higher number of achromatic patients is little recognised. They made up 17% of nan non-smoking cases versus 5% from nan group pinch a smoking history.” There were besides clear differences successful shape of position and illness progression. Two-thirds of nan non-smoking patients presented astatine shape four, nan astir precocious stage, and 38% had crab that had dispersed to nan brain. “It’s not only that nan demographics are different,” says Georgiou. “The biology of nan crab is different too.”

These findings bespeak worldwide trends but, arsenic yet, nary of it is afloat understood. According to Cecilia Pompili, a thoracic surgeon and objective elder teacher astatine Hull York Medical School, we are conscionable opening to inquire nan questions. “For truthful long, we didn’t deliberation of lung crab arsenic a illness of young women and often haven’t moreover included them successful objective investigation trials,” she says. (For example, men person made up 65% of participants successful groundbreaking immunotherapy tests for lung cancer.) Pompili is interviewing women pinch lung crab astir their early symptoms and test pathway, for a study funded by nan Roy Castle Lung Cancer Foundation.

Adenocarcinoma is nan astir communal lung crab diagnosed successful non-smokers, and while immoderate women acquisition nan “classic” persistent cough, and besides coughing up blood, for others, symptoms are much vague and non-specific, specified arsenic weight loss, aliases backmost pain. “We want to understand nan denotation trajectory and besides whether women are treated otherwise by their wellness provider,” says Pompili. “We cognize from immoderate patients that a 40-year-old, fresh female pinch a persistent cough is much apt to beryllium diagnosed pinch an allergy, asthma aliases an infection than an older antheral smoker who will beryllium sent for a thorax X-ray.”

Identifying why lung crab is rising successful women requires overmuch much research, says Pompili. Hormones could play a part. Worldwide, indoor aerial contamination caused by wood-burning stoves and biomass fuels utilized for cooking and heating has been identified arsenic a important consequence factor. In nan UK, outdoor aerial contamination is believed to origin astir 1 successful 10 lung cancers. “Air contamination has been demonstrated to beryllium important for some genders, particularly successful younger patients,” says Pompili. It’s imaginable that women’s smaller lungs and narrower airways lead to a higher attraction of pollutants and a greater likelihood of good particulate matter – 2.5 micrometers aliases little successful diameter – becoming trapped.

Rosamund Adoo-Kissi-Debrah, whose nine-year-old girl Ella was nan first personification successful nan world to person aerial contamination listed arsenic a origin of decease connected her decease certificate, is not surprised. “Ella had asthma but location are 700 diseases impacted by aerial pollution,” she says. “When I deliberation of younger women pinch lung cancer, I wonderment astir nan schoolhouse run, nan clip sitting successful cars aliases buses successful dense traffic. When I deliberation astir nan higher number of achromatic and brownish people, I deliberation of economics. Who takes buses, and waits astatine autobus stops, and lives successful societal lodging and cheaper lodging adjacent to main roads?

“London is nan astir congested metropolis successful Europe. Worldwide, we are number five,” continues Adoo-Kissi-Debrah, who campaigns for cleaner aerial done nan Ella Roberta Foundation. “Yet somehow, officially, Ella is still nan only personification who has died because of aerial pollution. We’ve sewage to nan constituent wherever nan load of sick wellness caused by aerial contamination is truthful huge, I’m asking myself: ‘What will it return to make nan nationalist request much action?’”

Also cardinal present – but again, not afloat understood – is nan domiciled of familial mutations, particularly successful younger non-smoking women. Mutations successful nan epidermal maturation facet receptor (EGFR) are nan astir common, believed to origin 10-15% of lung cancers successful nan UK. Recent research has identified really aerial contamination mightiness “wake up” dormant cells successful nan lungs that transportation these cancer-causing mutations, promoting their growth.

Sarah Li, a 42-year-old freelance film-maker, was diagnosed pinch EGFR-positive lung crab past year. A non-smoker and a vegan, Li lives successful London and was signed up for her seventh marathon astatine nan time.

“I’d had a persistent cough but I wasn’t worried,” she says. “I’d had a acold first and nan cough conscionable seemed to travel disconnected nan backmost of it.” Li was besides experiencing symptom successful her correct shoulder. “Looking back, that was different denotation but I didn’t cognize capable to subordinate nan dots.” A physio suggested enarthrosis exercises and a pharmacist sold Li syrup for her cough. After 4 months though, arsenic nan cough worsened, Li saw her GP, expecting antibiotics for a thorax infection. Instead, she was referred for a thorax X-ray, past fast-tracked for a CT scan. In April 2024, Li learned she had inoperable lung cancer, pinch a tumour connected her near lung, and crab besides coming successful nodules successful her correct lung.

“Even now, I find it unusual erstwhile I opportunity I person lung cancer,” says Li. “I tin opportunity I person crab – truthful galore group get crab – but nan thought of lung crab still feels rather foreign. How americium I nan look of lung cancer? When I was first diagnosed, I went done everything, asking: ‘Why? What did I do?’ I deliberation I led a patient lifestyle, but I lived successful India for 4 years, successful Hyderabad, a engaged city. I consciousness unusual blaming immoderate 1 point aliases focusing connected what I mightiness person done wrong. Nobody wants this.”

Sarah Li was diagnosed pinch lung crab past year. Photograph: Linda Nylind/The Guardian

Although Li had only been pinch her partner Robin for 18 months, they had to person difficult conversations astir fertility and early children. “Did I want to frost my eggs earlier treatment? We decided it was amended to support maine live and commencement curen arsenic soon arsenic possible.” In fact, nan effect of lung crab connected fertility has only conscionable go an area of research. The International Pregnancy and Lung Cancer Registry was launched successful December 2023. “Understanding really lung crab and its curen impacts young women successful each ways – their full lives, their fertility, their young family and caring responsibilities, their career, is only conscionable beginning,” says Pompili. “It’s thing we person done for bosom crab – but not lung cancer.”

After years of underfunding (widely attributed to lung cancer’s nexus pinch smoking), pioneering treatments are processing accelerated – particularly for cancers for illustration Li’s, driven by familial mutations. In nan past decade, nan National Institute for Health and Care Excellence has recommended 48 caller treatments for lung crab – six times much than successful nan erstwhile decade.

Li’s first information of chemotherapy, radiotherapy and immunotherapy led to monolithic reductions successful her tumours. However, successful January, a mini lesion was recovered connected her brain. She is now having a targeted therapy – a regular pill – and much chemo. “Life is much aggravated now,” she says. “There’s much vividness to everything. Like today, I’m conscionable truthful happy that I’m emotion good capable to beryllium outside, to person a bully lunch. Those small things you return for granted … you’re conscionable measurement much appreciative of it all. The thought of talking astir ‘two years’ time’ aliases ‘five years’ time’ for illustration my friends do? I can’t. I cognize that yet nan crab will outsmart nan curen I’m on. Hopefully, by then, there’ll beryllium different curen pathway.”

Smith is successful nan aforesaid position. A fewer weeks into her palliative care, nan family were informed by telephone that nan biopsy taken from Smith’s backmost showed a familial mutation, ALK-positive lung cancer, and a curen was available. She began taking 8 tablets a time – targeted crab drugs, ALK inhibitors – pinch monthly humor tests and scans each 3 months. “It went well, location was a large simplification successful cancer,” she says. “After 2 years, I sewage immoderate progression successful my brain, truthful I’m connected nan 2nd statement of curen now.”

Explaining her illness to others is exhausting. “You ever get nan aforesaid reaction,” she says. “‘But you don’t smoke?’ ‘You’re truthful young?’ There’s specified a organization astir bosom crab – much powerfulness to it – but pinch lung cancer, location really isn’t. It feels for illustration it’s conscionable you.” This is contempt nan truth that nan illness kills arsenic galore women arsenic breast, ovarian and cervical cancers combined.

Smith is simply a pilates coach now – this summer, she went connected a yoga retreat successful Bali. Her partner, Sammy, flew retired to subordinate her successful July and, during a locomotion connected nan beach, he proposed. “This is my dream. I’m enjoying my life,” she says. “I’ve gone done truthful much. I mislaid nan yoga studio, I mislaid a batch of money, but nan things you deliberation matter? They really don’t. All I attraction astir is my family and friends, and being happy and healthy.

“I still consciousness sadness and I’m frightened – I’m terrified because I don’t cognize what’s to come,” she continues. “Scans ne'er get easier, but you get amended astatine dealing pinch them. It’s a cliche but I genuinely unrecorded for coming now – and 5 years on, I’ve yet reached a shape wherever I tin beryllium grateful for that.”