Before her untimely passing, Susan Wojcicki, the former CEO of YouTube, shared a poignant message highlighting the growing incidence of lung cancer among non-smokers and women. In a posthumously published YouTube blog, she emphasized the need for increased investment in lung cancer research, particularly focusing on women and those who have never smoked.

Wojcicki, a tech industry trailblazer and one of Google's first employees, succumbed to lung cancer in August after a two-year battle, at the age of 56. The blog, penned in the final weeks of her life and published with her family's consent, revealed her own shock at being diagnosed with lung cancer despite leading an active lifestyle and never smoking. Wojcicki's reflections on her diagnosis and the unpredictability of life underscored her desire to cherish the present and advocate for better understanding and treatment of the disease.

The trend of increasing lung cancer diagnoses among young and middle-aged women in the United States, many of whom have never smoked, is a concerning development. It is estimated that approximately two-thirds of lung cancer cases in non-smokers are female. Jhalene Mundin, a 36-year-old nurse from New Jersey, found herself in this group when she was diagnosed with stage IV lung cancer last year, despite having no risk factors and never smoking. The advanced stage meant the disease had spread beyond her lungs, a revelation that left her in tears, thinking of her two children and the life she wanted to live for them.

Mundin's case is not an isolated one. Research indicates that lung cancer diagnoses among women in the U.S. have surged by 84% over the past 42 years, while in men, they have decreased by 36%. Women who have never smoked are more than twice as likely to develop lung cancer compared to their male counterparts who have also never smoked. Dr. Helena Yu, a thoracic medical oncologist, points out that 20% of lung cancers diagnosed today are in never-smokers, equating to around 40,000 cases annually. This demographic also sees a significant increase in lung cancer-related deaths.

The exact reasons behind the rise of lung cancer among young women are not fully understood, but Dr. Yu suggests two potential factors: exposure to environmental hazards such as air pollution, asbestos, secondhand smoke, and radon, and genetic mutations that cause lung cancer, which are increasingly prevalent in women. Mundin's doctor was highly confident that a genetic mutation was the cause of her lung cancer, a revelation that left her frustrated with the lack of awareness and screening for such mutations.

A specific genetic mutation in the epidermal growth factor receptor (EGFR) gene has been linked to an increased risk of lung cancer. This mutation is just one of several that are associated with the disease. The EGFR protein, when mutated, can cause cells to grow excessively, potentially leading to cancer. Kara, a 38-year-old patient of Dr. Yu, was diagnosed with EGFR lung cancer and has been advocating for more research into the condition. Despite her diagnosis, Kara maintains a normal life, running marathons and traveling, thanks to targeted therapies that block the growth and spread of cancer cells by targeting the genetic mutations in tumors.

Research shows that EGFR mutations are more common in tumors from women, appearing in about 59% of female tumors compared to 26% of male tumors. Some studies also indicate that EGFR mutations occur more frequently in tumors from East Asians than in non-Asian individuals. Dr. Alexander Drilon, another thoracic medical oncologist, notes that patients with targeted mutations like EGFR tend to be younger and often female, with many never having smoked.

The mystery surrounding the biological differences in lung cancer has prompted calls for more research into these disparities. The Women and Lung Cancer Research and Preventative Services Act, introduced by U.S. representatives, aims to commission more lung cancer research and requires the U.S. Department of Health and Human Services to review the status of lung cancer in women, including identifying new opportunities for screening, diagnosis, and treatment.

Historically, women were underrepresented in large lung cancer studies, and many clinical trials excluded them before 1993. Despite being the leading cause of cancer death in the U.S., lung cancer appears to be one of the least-funded in terms of research, suggesting that it is underfunded relative to its societal impact. In 2019, only 15% of the National Institutes of Health's $267 million lung cancer budget was allocated to women-focused research, according to the nonprofit Women’s Health Access Matters. Yet, lung cancer claims more lives among U.S. women than breast, ovarian, and cervical cancer combined.

Lung cancer's deadliness is partly due to late diagnosis, which makes treatment more challenging. The only recommended screening test in the U.S. is a low-dose computed tomography (CT) scan, which captures images of the lungs using a low dose of radiation. Current guidelines recommend annual lung cancer screening for current or past smokers starting at age 50. However, many patients, like Mundin, have never smoked and were diagnosed at an advanced stage.

International efforts, such as the TALENT study in Taiwan, have sought to identify never-smokers who may benefit from screening. The study enrolled approximately 12,000 non-smokers and found lung cancers in about 2.5% of participants. Early detection is crucial for improving survival rates across all cancers.

Mundin hopes for increased awareness about the rise in lung cancer among young women, leading to the development of targeted screening, especially for those with genetic mutations. She looks forward to a greater understanding of how to diagnose these cases early, for the sake of her children and future generations.