Lung cancer is no longer limited to smokers.

Around 10–20% of lung cancer cases occur in never-smokers, with even higher rates reported in parts of Asia.

This shift highlights new, under-recognised risk factors beyond tobacco use.

Why Is Non-Smoker lung cancer Increasing?

Environmental Exposure

Outdoor air pollution, especially fine particulate matter and diesel exhaust, is a major contributor.

Indoor risks include radon gas, asbestos, arsenic, and poorly ventilated cooking fumes, particularly from biomass fuels.

Second-Hand Smoke

Passive smoking remains dangerous.

Studies estimate 15–35% of lung cancers in never-smokers may be linked to long-term exposure to others’ tobacco smoke.

Genetics and Tumour Biology

Lung cancer in never-smokers often differs biologically.

These cases are commonly adenocarcinoma and frequently show EGFR mutations or ALK rearrangements, which affect treatment choices.

Changing Demographics

Women and people of east Asian descent are disproportionately affected.

Research shows 15.7% of women with lung cancer had never smoked, compared to 9.6% of men.

What Are We Missing

Low Awareness

Many non-smokers still view lung cancer as a smoker’s disease, delaying medical attention.

Screening Gaps

Current screening guidelines focus on smoking history, excluding high-risk non-smokers.

Unmeasured Risks

Indoor air quality, cooking smoke, radon exposure, and occupational hazards are often poorly assessed.

Prevention Blind Spots

Tobacco control dominates prevention efforts, while environmental and indoor risks receive less focus.

What Needs to Change

Clinical Vigilance

Persistent cough, chest pain, or unexplained symptoms in non-smokers should not be ignored.

Broader Risk Assessment

Clinicians should ask about air pollution, cooking fuels, second-hand smoke, occupation, and family history.

Policy and Environmental Action

Improve ventilation, reduce biomass fuel use, radon test, and control ambient air pollution.

Early Molecular Testing

Genomic profiling is crucial to guide targeted therapy in never-smokers.

Education

Shift public and professional perception from “smoker-only” lung cancer to inclusive risk recognition.

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