Ask the Doctor: Heba Ismail, M.D.

Q. I am a 35-year-old mother of two young children. I lead a healthy, active life and I never smoked. However, I was recently diagnosed with lung cancer. How did I get it and could I have done anything to avoid it?

A. There is a huge misconception that lung cancer is more common in men and affects mainly smokers. This is simply not true. Many women are not aware that lung cancer is common in women and in non-smokers as well. The rate of lung cancer in women has risen 116 percent over the past five years with no discernible cause. In fact, one in five women diagnosed with lung cancer has never smoked.

Because of this misconception, many women dismiss symptoms that could indicate underlying lung issues, including lung cancer, since these symptoms could be easily overlooked. Persistent cough, wheezing, shortness of breath, chest pain, hoarseness, face and neck swelling, loss of appetite, unexplained weight loss, and unusual fatigue are common symptoms that are associated with lung cancer and could indicate late stages of the disease.

Non-tobacco related risk factors for lung cancer in women include:

  • Family history of lung cancer
  • Exposure to air pollution
  • Genetic and molecular susceptibility which are seen almost exclusively in women who do not smoke
  • Certain dietary supplements
  • Arsenic in drinking water
  • Previous radiation therapy to the lungs

While tobacco use remains the principal cause for the vast majority of lung cancers in both men and women, studies suggest that women have an increased susceptibility to the carcinogenic effects of tobacco.

Lung cancer presents differently in women than in men. The most common type of lung cancer in women is adenocarcinoma, a type of non-small cell lung cancer (NSCLC), which develops at the outer regions of the lung, and can grow quite large or spread without early symptoms.

Genetic mutations, such as Epidermal Growth Factor Receptor (EGFR) and Anaplastic Lymphoma Kinase (ALK) mutations, are also commonly associated with developing lung cancer. EGFR is the most common lung cancer mutation and can be found in 60 percent of Asian, non-smoking lung cancer patients.

The good news is that early detection of lung cancer can significantly improve survival rates. This is particularly important as its survival rate is five times lower than other major cancers due in part to its late detection. Women should not ignore early warning signs or symptoms and should consult with their primary care physician or pulmonary specialist to receive the proper screening.

The U.S. Preventive Services Task Force recommends annual CT screening for lung cancer in women ages 55-80 who have a smoking history of 30 pack-years and currently smoke or have quit smoking within the past 15 years. Women who meet this criteria should have a discussion with their pulmonologist regarding the benefits and risks of screening by low-dose CT scan for early detection of lung cancer.

Unfortunately, current lung cancer screening guidelines apply only to heavy smokers or ex-smokers. There are also no genetic or blood tests to screen for lung cancer mutations. However, women who are non-smokers and have one of the above risk factors should be vigilant about their health and should discuss a lung cancer evaluation with their lung specialist.

Once lung cancer is diagnosed, treatment will depend on type and stage of lung cancer, as well as the age and overall health of the patient. Early stages of lung cancer can be treated by surgery, while advanced stages are treated with chemotherapy, radiation and/or targeted therapy.

A comprehensive approach by an interventional pulmonologist, surgeon and oncologist is highly recommended to achieve the best treatment plan for each patient.

Heba Ismail, M.D. is a board-certified interventional pulmonologist at the Pacific Pulmonary Medical Group. She is the only board-certified interventional pulmonologist practicing in Orange County. Her areas of expertise include interventional pulmonology, lung cancer, and pulmonary hypertension, and she has a special interest in lung diseases in women. Her office is located at Hoag Health Center Irvine – Sand Canyon.