Other causes are possible

Cancer is still an unfortunate possibility for people who have never smoked or smoked very little (less than 100 cigarettes in their lifetime). Although most people with lung cancer are or were smokers, up to 20% of all lung cancers occur in those who never smoked. How can you get lung cancer if you’ve never smoked?

There are several reasons this can happen. One reason is exposure to secondhand smoke. This is why banning smoking indoors is an important step in improving public health. Another culprit is radon exposure. Many people are unaware of the risks of radon gas exposure. Radon gas naturally occurs from the breakdown of elements in the soil. If a building has cracks in the foundation or walls, radon can become trapped inside and breathed in by those using the facility. Over time, this exposure can lead to lung cancer. Radon detection is fairly simple. You can hire a professional or use a home test kit that is mailed to a laboratory for processing.

A third reason non-smokers can be diagnosed with lung cancer is genetics. In most cases, genetic lung cancer is not inherited. It occurs when gene mutations happen over a person’s lifetime. Genetic mutations are largely out of our control. Compared with men, women are more likely to have lung cancer caused by genetic mutations. Researchers know about some genetic markers for lung cancer but are just beginning to study others; hopefully, more options for detection and targeted treatment will emerge.

The U.S. Preventative Services Task Force recommends that the following people be screened for lung cancer with a low-dose CT scan: all adults who are 50-80 years old and have a 20-pack-year smoking history and either still smoke or quit within the past 15 years. Chest X-rays are inadequate for detecting lung cancer; a CT scan is the best for screening. There are a couple of things to unpack here. First, what is a pack-year? This is the number of years a patient has smoked multiplied by the number of packs they smoke each day. For example, a person who has smoked one pack a day for 40 years has a 40-packyear history of smoking. A person who has smoked two packs a day for 20 years also has a 40-pack-year history of smoking. Second, doesn’t a CT scan expose a person to radiation that can cause cancer? Yes, however, this is a very low dose of radiation, and in people who smoke or have smoked, the risk-cost-benefit ratio is in favor of the low-dose CT for screening. In other words, having a lowdose CT scan poses a much lower risk for lung cancer than current or past smoking. There is currently no recommendation for screening non-smokers for lung cancer because of the risk-cost-benefit ratio.

If you have risk factors for lung cancer beyond smoking, you may qualify for screening even if you have never smoked. Check with your health-care provider. Some examples of people who may be eligible include those with the following: a family history of certain genetic lung cancers in nonsmokers, known exposure to radon for many years, and heavy exposure to second-hand smoke, like bartenders or casino workers. In addition to screening, lung cancer should be considered if any of the following are present, even in those who have never smoked or smoked very little:

• Chronic cough (longer than one month).

• Coughing up blood.

• Unexplained shortness of breath.

• Unexplained weight loss.

• Hoarseness that lasts longer than two weeks.

• Loss of appetite.

• Recurring or non-healing lung infections.

The more symptoms present, the more worrisome for lung cancer.

If you are a smoker or former smoker who smoked more than 100 cigarettes in your lifetime and are 50-80 years old, please see your health-care provider about being screened for lung cancer. If you do not qualify for lung cancer screening, know your family history, history of exposure to second-hand smoke and potential for radon exposure. Familiarize yourself with the possible symptoms commonly seen in patients with lung cancer and see your health-care provider if you are experiencing any of them, particularly if more than one is present. Lung cancer is treatable if detected early, so know your risk and see your health-care provider if you think you need testing.

Rebecca Eskew Clawson, PA-C, MAT, assistant professor of Physician Assistant Program, School of Allied Health Professions at LSU Health Shreveport.