GoKawiilLung cancer in people who have never smoked is now recognized as a distinct disease with its own treatments and preventative strategies.
A layer of smog sits over Wazirabad in New Delhi, India.Credit: Sanchit Khanna/Hindustan Times via Getty
In July 2025, Lily Nguyen was arranging a vase of flowers at her home in Los Angeles, California, when she felt a “radiating heat and numbness” sweep down the right side of her body. Moments later, she was wracked by violent muscle convulsions. She went to the emergency department, but the physician dismissed her concerns.
When the convulsions happened again the next day, Nguyen filmed herself. She showed the footage to a different physician, who sent her for a magnetic resonance imaging (MRI) scan. The scan revealed three brain tumours. Five days later, Nguyen underwent surgery to remove them. Biopsies uncovered an unexpected and devastating cause: Nguyen had stage 4 lung cancer. “I was in shock,” she says.
Nature Outlook: Lung cancer
Nguyen is just 41 years old, has never smoked and has no family history of lung cancer. Yet she is one of a growing number of young Asian women who are developing the disease despite the absence of these risk factors.
After decades of viewing lung cancer “almost exclusively as a smoking-related disease”, cases in people who have never smoked are becoming more visible, says Jaclyn LoPiccolo, a thoracic oncologist and researcher at Dana-Farber Cancer Institute in Boston, Massachusetts. Specialists now recognize that this diagnosis is “a biologically distinct entity”, she adds.
Lung cancer in people who have never smoked is now considered to be the fifth most common cause of cancer death globally. As tobacco smoking declines worldwide, lung cancer clinicians are spending more of their time tending to people who have never smoked, says Charles Swanton, a cancer physician-scientist at the Francis Crick Institute in London. But there is more than a proportional rise going on, he says: evidence also suggests “a genuine absolute increase” in cases of lung cancer in people who have never smoked.
It’s not yet clear why, but researchers are beginning to piece things together — with the goal of helping people, such as Nguyen, well before they reach such an advanced stage of disease.
Exposing the exposures
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