Attributed to Dr. Narjust Florez, Co-Director, Young Lung Cancer Program, Dana-Farber Cancer Institute. This article was featured on UICC.

Lung cancer remains the most diagnosed cancer and the leading cause of cancer-related deaths globally. Despite progress in tobacco control, the disease now claims more lives among women than breast, cervical, and ovarian cancers combined. In 2022 alone, over 600,000 women died of lung cancer—an alarming figure that is forcing health professionals to rethink long-held assumptions.

Dr. Narjust Florez, a thoracic oncologist and Co-Director of the Young Lung Cancer Program at the Dana-Farber Cancer Institute, has been at the forefront of this conversation. Speaking with the Union for International Cancer Control (UICC), Dr. Florez emphasized that the rise in lung cancer cases among young women, many of whom have never smoked, points to overlooked risk factors and systemic gaps in detection and care.

“Lung cancer is still seen as a smoker’s disease,” she says. “But that stereotype is leaving many women out of the conversation, out of screening programmes, and out of timely care.”

Not Just a Smoker’s Disease

In the United States, approximately 10% to 20% of lung cancer cases occur in people who have never smoked, translating to between 20,000 and 40,000 diagnoses annually. This trend is mirrored in countries around the world, with clinicians from Mexico to India reporting rising numbers of young, non-smoking women with advanced lung cancer.

Dr. Florez shares a stark example: “I recently treated a 22-year-old medical student with extensive metastatic lung cancer. She had never touched tobacco. And before that, a 19-year-old tested positive for an EGFR mutation—a targetable genetic driver of lung cancer. This is not anecdotal anymore. The patients are getting younger.”

These cases challenge the belief that tobacco exposure is the sole cause. Genetic factors are increasingly coming into focus. Mutations such as EGFR T790M—more prevalent in women of Asian and Jewish descent—are now recognised as strong risk factors. Family history, inherited syndromes like Li-Fraumeni, and population-specific genomic markers are reshaping the scientific understanding of who is at risk.

Environmental and Gendered Exposures

Dr. Florez also points to environmental triggers, including ambient and indoor air pollution. In many low-income communities, women are disproportionately exposed to toxic smoke from cooking fuels such as wood or coal—often in poorly ventilated spaces. “This exposure,” she notes, “accounts for up to 20% of lung cancer deaths in women globally.”

Radon gas is another invisible threat. It is the second leading cause of lung cancer and the primary one among non-smokers in the US, yet testing remains inconsistent. Hormonal influences are under investigation too, as studies suggest that estrogen may accelerate certain lung cancers.

The Role of Stigma and Delayed Diagnosis

Even with advanced disease, women often struggle to be taken seriously. “Their symptoms are dismissed as asthma, pneumonia, or even anxiety,” says Dr. Florez. “They’re sent for mammograms before anyone checks their lungs.”

This delay in diagnosis has dire consequences. Younger women are typically diagnosed three times later than their male counterparts, even when presenting the same symptoms and risk profiles. These biases extend to treatment too—especially for women of colour, who are significantly less likely to be offered screening or genomic testing.

And the stigma doesn’t end there. Whether they’ve smoked or not, many women feel blamed for their illness. Dr. Florez is clear: “Tobacco use is not a lifestyle choice—it’s an addiction, influenced by social and economic pressures and reinforced by decades of targeted marketing by tobacco companies.”

Addressing Structural Inequities

Globally, lung cancer reflects broader gender and income disparities. In low- and middle-income countries, nearly 72% of female cancer deaths occur before age 70—double the rate in wealthier nations. Often, women lack the agency or resources to seek early care, and when they do, services are under-resourced or inaccessible.

Even within her own family, Dr. Florez experienced these barriers. “My mother, a non-smoker, was misdiagnosed repeatedly. By the time she was properly diagnosed, the cancer had spread. I was already a Harvard professor, and even that couldn’t protect her.”

The Way Forward

To change the trajectory, Dr. Florez calls for bold, equity-focused action. Cancer programmes must listen to women with lived experience. Research should prioritise non-smoking-related lung cancers and invest in understanding gendered exposures. Screening protocols and trial designs must evolve to reflect real-world populations, not outdated assumptions.

At Dana-Farber, her team is working to embed equity into every level—from community outreach and clinician education to inclusive clinical trials. “Equity isn’t a checkbox,” she says. “It must be part of the system.”

But progress is at risk. Recent federal funding cuts to cancer research in the US threaten advancements in early detection and population-specific studies. “We’ve come too far to lose momentum now,” she warns.

In the fight against lung cancer, the evidence is clear: gender matters, history matters, and equity matters. The narrative must change—because lung cancer doesn’t belong to one group. It belongs to all of us.