Lung cancer in never-smokers is a significant global health issue with distinct characteristics. This patient group often bypasses traditional high-risk screenings, leading to late-stage diagnoses when treatment is primarily palliative.
This form of lung cancer disproportionately affects women and Asian populations. It typically presents as adenocarcinoma, driven by specific gene mutations like EGFR and ALK. While these cancers respond well to targeted therapies, they are less responsive to standard immunotherapies due to a lower overall mutational burden.
The causes are a complex interplay of inherited and acquired factors, including germline variants, DNA repair gene mutations, and environmental exposures such as radon, air pollution, and secondhand smoke. This complexity hinders the development of broad, cost-effective screening programs.
However, targeted low-dose CT screening may benefit carefully selected high-risk groups, such as Asian women with a family history of lung cancer, though more evidence on survival and cost-effectiveness is needed.
Researchers are exploring tailored clinical pathways, including earlier use of targeted therapies, preventive cancer vaccines, and immunotherapy for high-risk individuals. These strategies aim to reduce mortality while managing toxicity and health system costs.
Clinicians are urged to maintain a high index of suspicion for lung cancer in never-smokers presenting with persistent symptoms, as research progresses toward more precise risk stratification, screening, and prevention.