Experts Call for Targeted Screening and Research on Lung Cancer in Never-Smokers

Overview

• As smoking declines, people who have never smoked now make up a growing share of lung cancer diagnoses, with many detected at advanced stages.
• Whether absolute case numbers are rising remains unsettled, though a UK analysis found cases in never-smokers doubled between 2008 and 2014 and some US signals suggest increases.
• These tumors are often adenocarcinomas with targetable drivers such as EGFR mutations or ALK fusions, yet they tend to respond poorly to checkpoint immunotherapy.
• Proposed contributors include air pollution, radon, second-hand smoke, occupational exposures, inherited variants, and clonal hematopoiesis, with disproportionately higher risk reported in women and people of Asian descent.
• Pilot efforts are testing risk-based screening in selected groups, including Taiwan’s program for never-smokers with a family history and a New York study in women of Asian descent, while broader guidelines and funding remain absent.