Non-smoking lung cancer

Smoking is a common risk factor for lung cancer, but 15 per cent of lung cancers are diagnosed in never-smokers, and the rate is increasing¹. In the UK, 6,000 people die of non-smoking lung cancer each year – more than the numbers who die of lymphoma, leukaemia and cervical cancer².

Most never-smokers do not think they are at risk of lung cancer and symptoms can be obscure. As a result, 90 per cent of patients are diagnosed with non-smoking lung cancer at stage 3-4, too late for curative treatment⁴. 

This is especially true for young, fit and active patients, in whom a large proportion of non-smoking lung cancer diagnoses occur. Indeed, more than half of cases occur in people younger than 50, with a large proportion occurring among women³. 

Symptoms include shoulder, spine or chest pain that may present without respiratory or ‘alarm’ features (cough, breathlessness, fatigue and unintentional weight loss). Physiotherapists, including first-contact physiotherapists, could play a pivotal role in identifying patients with lung cancer as symptoms may initially present as musculoskeletal in nature. 

Red flags include pain that is unfamiliar or unexplained and that does not ease with a change in position. In some cases, symptoms may wax and wane. 

The See Through the Symptoms campaign, led by charities ALK Positive UK, EGFR Positive UK, and the Ruth Strauss Foundation, highlights these symptoms and encourages healthcare professionals to act on them, regardless of a person’s smoking status.

Lung cancer should be considered as a differential diagnosis in patients whose symptoms persist for 12 weeks or more. In such cases, patients should be referred back to their GP for a chest x-ray, which can rule out lung cancer, consistent with national guidelines⁵.

In doing so, and in broadening awareness of non-smoking lung cancer, we can strive for earlier diagnoses and, ultimately, save lives.