Lung cancer rates in non-smokers like Pope Leo are rising. How can you catch it early?

Pope Leo XIV has announced he underwent surgery for lung cancer, after doctors detected a small growth on his lung during a routine health check.

The Vatican said the pope had lung adenocarcinoma, the most common form of lung cancer. Leo, 71, is a non-smoker.

In Australia, lung cancer is the leading cause of death from cancer, killing more men and women annually than breast and prostate cancer combined, and is the fifth most diagnosed cancer.

Despite this, detection rates remain low. Why? And what can you do to catch it early?

What causes lung cancer?

Globally, cases of lung cancer are increasing, particularly among young women who never smoked, according to research published by The World Health Organisation last year.

The link between smoking and lung cancer is well-established, with coordinated public health campaigns over the past few decades helping rates of smoking drop significantly.

This year, Australian researchers published a review with the strongest evidence yet that vaping is likely to cause lung and oral cancer.

But Fraser Brims, deputy director of the Institute for Respiratory Health and professor at Curtin University, says environmental factors – like air pollution and radon, a natural gas – occupational exposure to dust, asbestos and silica, and genetics and family history can all contribute.

“One of the really important messages is that anybody with lungs can get lung cancer, and it’s certainly not just about smoking,” he says.

Evidence that exposure to incense or candle smoke causes cancer – despite information commonly circulated online – is inconclusive and there is no known risk, says Brims.

Nor is risk merely shaped by individual lifestyle choices.

Aboriginal and Torres Strait Islander peoples disproportionately bear the burden of the disease in terms of diagnosis and mortality, alongside those living in regional and rural areas and from lower socioeconomic backgrounds.

Mark Brooke, Lung Foundation chief executive, says while most lung cancers have no symptoms in the early stages, the four most common signs are coughing up blood, persistent coughing, fatigue and weight loss.

The stigma

Despite plummeting smoking rates in countries like Australia, and rising lung cancer among non-smokers, the disease still carries stigma.

“Australia is one of the worst in terms of this assumption and judging people against that. In no other type of cancer do we judge by a risk factor,” says Brims.

In Australia, 28 per cent of people admit they have less sympathy for someone with lung cancer compared to other forms of cancer, while one-third are unable to name one symptom.

Lingering stigma, Brooke says, influences investment and donations. Compared to breast cancer, which has higher survivorship rates, lung cancer research receives around 30 per cent less funding.

How can you catch lung cancer early?

Oncologists said Leo’s prognosis was “excellent” even before the operation due to early detection, according to the Associated Press.

But this is relatively rare in Australia, with the disease’s vague symptoms meaning it is often diagnosed late after the cancer has spread. Individuals diagnosed with lung cancer have a 27.3 per cent chance of surviving five years after diagnosis (early detection can lift this to 70 per cent).

In July last year, the government announced its National Lung Cancer Screening Program, with the aim of changing this through low-dose CT scans.

Unlike a population-based screening program, where eligibility is based on age, the program is aimed at current and past smokers aged 50 to 70.

But given the rising number of non-smokers affected by lung cancer, should the program’s target be broadened?

Brooke says there is no evidence for making it a population-based screening program.

“We have to weigh up the economic benefit versus the risks of having our population exposed to a CT scan on a frequent basis,” he says, adding non-specific screening also risks returning false positives, exposing individuals to invasive and potentially harmful medical interventions.

Lung nodules – small growths found in lung tissue – can be found in up to half of people screened, but most are not related to cancer, says Brims.

“It’s for us and medical teams to work out which ones we need to be most concerned about … the screening program’s process has so far proven very effective,” he says, adding they are working to identify and effectively target population groups most at risk.

The Lung Foundation is calling on the government to increase eligibility to individuals aged 50 to 75 with a direct family history and those at risk of occupational exposure, alongside greater government research funding and more support for those diagnosed and their carers.

If you are concerned about your lung cancer risk or exhibit any “red flag” symptoms, like a lingering cough, Brooke urges individuals to “talk to your GP, explore your options for a CT scan and don’t delay”.

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