Katie Hulan, a 37-year-old tech marketing manager from Toronto, initially sought medical advice due to a persistent cough that worsened over a month and a half. Initially suspected to have asthma, her condition did not improve with the prescribed inhalers. Ultimately, her family doctor ordered an X-ray, revealing a mass on her lung. Following further tests, Hulan received the devastating diagnosis of stage 4 lung cancer.

Reflecting on her diagnosis, Hulan described it as a "death sentence," as she had always been healthy, active, and a non-smoker. Diagnosed in late 2020, she later relocated to Victoria to continue her treatment. Hulan's case is increasingly representative of a growing trend: the number of non-smokers diagnosed with lung cancer is rising. The Canadian Cancer Society estimates that approximately one-quarter of lung cancer cases in Canada occur in non-smokers. Interestingly, this trend appears to affect women more frequently than men, although the exact reasons remain unclear. Jessica Moffatt, vice-president of programs and advocacy at the Lung Health Foundation, suggested that estrogen might have a role in tumor growth, but emphasized that these are still theories.

Environmental factors are significant contributors to lung cancer risk, particularly radon gas. Health Canada identifies radon—an invisible, radioactive gas resulting from the breakdown of uranium in soil and rocks—as the leading cause of lung cancer among non-smokers. The agency recommends that all households undertake radon level tests. Other risk factors include exposure to second-hand smoke, asbestos, and fine particulate matter from air pollution. Current wildfires, which produce significant smoke, further aggravate concerns regarding lung cancer risks, according to Moffatt.

Dr. Rosalyn Juergens, a medical oncologist at McMaster University and Hamilton Health Sciences Centre, noted that she has observed a significant increase in non-smoking lung cancer patients throughout her 20 years of practice. In her experience, non-smokers were relatively uncommon in her early years, but they represent a growing segment of her patient pool today. Juergens revealed that a considerable number of her non-smoking patients are women and highlighted a lack of awareness regarding lung cancer as a women's health issue. She pointed out that by the time they seek help, their cancer is often at an advanced stage.

Juergens emphasized the severity of lung cancer among women, indicating that more women are expected to die from lung cancer than from breast, ovarian, and cervical cancers combined, with one in five being lifelong non-smokers. Screening programs targeting lung cancer have been implemented in British Columbia, Ontario, and Nova Scotia since 2022, but these initiatives primarily focus on smokers, leaving non-smokers without the benefit of early detection.

Moreover, Juergens underscored that lung cancer symptoms are typically subtle, making early detection challenging. Unlike other cancers, the lungs lack nerve endings, meaning patients may not experience pain or noticeable lumps until the disease is advanced. In a positive development, advancements in lung cancer treatments have occurred since the 1990s, when chemotherapy was the primary option. Current strategies involve next-generation sequencing to identify specific types of lung cancer, enabling the selection of appropriate treatments tailored to individual cases.

Hulan's situation reflects these advancements, as her initial prognosis of six months was considerably improved after genetic testing revealed an ALK mutation, which only occurs in about 4% of lung cancer cases. This genetic marker allowed her to access targeted therapies, transforming her outlook to an average life expectancy of five to six years.

Five years following her diagnosis, Hulan continues her treatment with a daily pill, having avoided chemotherapy altogether. She feels "wonderful" and is committed to living a full life. As part of her advocacy work with the Lung Health Foundation, Hulan aims to raise awareness about the need for equal access to targeted cancer therapies across Canada and encourages individuals to seek medical help for persistent coughs lasting two to three weeks. She stresses that lung cancer is not exclusive to smokers, emphasizing, "Anyone with lungs can get lung cancer."