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a cce s s H ea l t h N ews . n e t J a n u a ry 2 0 2 6 Volume 11 | Issue No. 103 6 aH Health Care Deferred Makes The Heart Sick Never-smokers at huge risk for fatal, late-stage lung cancer diagnosis F never-smokers, people who have never smoked cigare es or who smoked fewer than 100 cigare es in their lifetime, a lung cancer diagnosis may seem far-fetched. And to their detriment, this misnomer means primary care providers and systems that govern screening eligibility too often negate lung cancer screening tests, which means when the disease is discovered, it's often too late. Lung cancer is one of the most common cancers in the world and the leading cause of cancer-related deaths in men and women in the United States, according to Yale Medicine. While cigare e smoking is by far the most common carcinogen, genetic and environmental factors are also formidable contributors to lung cancer in smokers, nonsmokers, and never-smokers. Like other forms of cancer, lung cancer begins at the cellular level. It is the result of abnormal cells that reproduce rapidly and uncontrollably. The thoracic area, between the neck and the abdomen, houses vital organs like the heart and lungs, and includes the thoracic spine (the T1 to T12 vertebrae) which supports the rib cage and protects the spinal cord. Lung cancer can start in one area and spread or metastasize to other organs and bones. Primary lung cancer starts in the lungs and consists of two types: non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). These two types of lung cancer are named for how the cancer cells look under a microscope, and account for the lion's share of the 230,000 newly diagnosed cases of lung cancer in the U.S. every year. Smokers and nonsmokers (and never-smokers) are generally diagnosed with two different subtypes of NSCLC. More than half of lung cancers diagnosed in smokers are characterized by squamous cells. Under a microscope, squamous cells look like flat, thin, skin-like cells that line the lung's airways. Nonsmokers and never-smokers often present with a different NSCLC known as adenocarcinoma. It starts in the mucus-producing glands in the outer part of the lung, progressing into the inner lung and the small airways called bronchioles. Adenocarcinoma has a different shape than other types of lung cancers, and is also most commonly diagnosed in younger individuals. Daniel Boffa, M.D., a Yale Medicine thoracic surgeon, differentiates squamous and adenocarcinoma in this way: "If you are a smoker, you can think of your lungs as a bag of white marbles, and cancer is like pu ing a black marble in there. The type of cancer a nonsmoker gets is more like pu ing in black sand. Instead of a spot or a lump, it's more like a hazy area. It's more diffuse." For nonsmokers and never-smokers, studies suggest that a type of genetic mutation in the tumor — a somatic mutation –drives cancer development. According to the Cleveland Clinic, somatic mutations don't pass from parents to their children and happen randomly or sporadically. Environmental factors like radon gas, secondhand smoke, air pollution, and cancer-causing agents in the workplace (exposure to asbestos, heavy metals, and diesel exhaust) can also lead to lung cancer. The medical community tends to be more proactive with cancer screenings for smokers. However, screenings for nonsmokers and never-smokers are often overlooked, dismissed, or conducted way too late, leading to a late-stage diagnosis. Common symptoms, like coughing, wheezing, and swelling in the neck, are missed or misa ributed. When race and age are factored in, late-stage diagnoses — or no diagnosis at all — tend to be fatal. By Tonia Wright, Publisher/Editor-in-Chief