Lung Cancer in Young Adults

Most people think of lung cancer as an older person's disease, but it also affects young people. Lung cancer is less common among young people, and the risk factors and types of lung cancer are different than for older adults. Lung cancer in young adults requires comprehensive and early treatment, and the outcomes are usually good.

Age and Sex

The average age of lung cancer diagnosis is 70. Approximately 53% of cases occur in adults 55 to 74, while 37% occur in those over 75.

Only 10% of lung cancers occur in people under 55, and the rate drops with every decade preceding that age.

Overall, the gender distribution of lung cancer is 57.8% male and 45.9% female. Among young people, the disease affects young women more often than young men.

Cancer Type and Stage

Adenocarcinoma is the most common type of lung cancer overall, and it is the predominant type of lung cancer affecting adults under 35.

Younger people tend to have more advanced lung cancer at the time of diagnosis, with approximately half presenting with stage 4 disease (also known as metastatic cancer).

Metastasis, the spread of cancer from the primary tumor location, is the sign of advanced, incurable disease. In younger people, metastasis will generally affect a single organ, most often the pleura (the lining of the lungs), the lung tissue, bones, liver, and brain.

Delayed diagnosis is thought to be the main reason for the high rate of advanced lung cancers in younger people. Lung cancer is generally not something that doctors think about when a young person presents with respiratory symptoms.

And chest X-rays typically miss lung cancer in the early stages, in part because adenocarcinomas develop in the outer peripheries of the lung rather than in the airways or central lung (like squamous cell carcinomas).

Causes

Lung cancer is usually associated with smoking. In fact—roughly 85% of cases and 90% of lung cancer deaths can be directly attributed to cigarette smoke.

But according to a 2018 review in Translational Lung Cancer Research, young people with lung cancer are far more likely to be non-smokers than smokers.

Genetics is believed to play a more substantial role in lung cancer among young people.

Three gene mutations commonly associated with lung adenocarcinoma are:

• EGFR mutations, the most common gene alteration in people with lung adenocarcinoma
• ROS1 rearrangements, found in 1% to 2% of people with non-small cell lung cancers like adenocarcinoma
• ALK rearrangements, one of the more common mutations seen in never-smokers found in 3% to 13% of people with non-small cell lung cancer

As many as 59% of young people with lung cancer will have these and other genetic mutations. ROS1 mutations and ALK rearrangements are more common in young people with lung cancer and are almost always associated with aggressive disease.

Other less common mutations include HER2 and BRAF2, which are also linked to breast cancer.

Family history is thought to be a major risk factor for lung cancer in young adults. A 2017 review in the journal Oncology Letters concluded that having a parent or sibling with lung cancer increases your risk of the disease by 50% compared to people with no family history.

Still, the findings are far from conclusive. Some studies, in fact, could find no evidence of a familial association in young people with lung cancer, suggesting that delayed diagnoses in tandem with other risk factors (such as secondhand smoke, radon exposure in the home, or air pollution) contribute to the risk. Further research is needed.

Diagnosis and Treatment

The diagnosis of lung cancer in young people is the same as the diagnosis for older adults. It may involve imaging tests like computed tomography (CT) or magnetic resonance imaging (MRI) scans, and investigative procedures like bronchoscopy and sputum cytology. Lung cancer can be definitively diagnosed with a biopsy.

Based on the staging and grading of the disease, treatment would involve many of the same options used in older adults.

Treatments may include:

• Surgery, which is generally used for stage 1, stage 2, and some stage 3 cancers
• Chemotherapy destroys cancer cells
• Radiation therapy is used before or after surgery or chemotherapy to shrink the tumor
• Immunotherapy includes drugs like Opdivo (nivolumab) or Keytruda (pembrolizumab) to stimulate a defensive immune response in people with stage 3 and 4 lung cancer

Targeted Therapies

Targeted therapies are a newer class of drugs that work by attaching to unique receptors on a mutated cancer cell. Because the drug only attaches to these receptors, these treatments cause fewer side effects than chemotherapy.

There are multiple targeted drugs approved for the treatment of lung cancer in the United States.

Some of the more commonly used:

• Tagrisso (osimertinib), used in first-line targeted treatment of EGFR-positive tumors
• Tarceva (erlotinib), used for tumors with certain EGFR mutations
• Vizimpro (dacomitinib), for use in people with certain EGFR mutations
• Xalkori (crizotinib) for people whose tumor has a ROS1 or ALK4-EML rearrangement

Other targeted drugs include:

• Alecensaro (alectinib), used for metastatic ALK-positive tumors
• Alunbrig (brigatinib), used for metastatic ALK-positive tumors
• Zykadia (ceritinib), used for metastatic ALK-positive tumors
• Lorbrena (lorlatinib), used for metastatic ALK-positive tumors
• Rozlytrek (entrectinib), used for metastatic ROS-1 positive tumors and metastatic NTRK-positive tumors
• Trabecta (capmatinib), used for metastatic tumors with mesenchymal-epithelial transition [MET] exon 14 skipping mutation
• Retevmo (selpercatinib), used for metastatic RET-positive tumors
• Tafinlar (dabrafenib)/ Mekinist (trabetinib), used for metastatic tumors with BRAF V600E mutations
• Gilotrif (afatinib), used for metastatic tumors with certain EGFR mutations
• Iressa (gefitinib), used for metastatic tumors with certain EGFR mutations

Because many lung cancers associated with these genetic mutations are treatable with targeted therapies, genetic testing (a.k.a. genetic or molecular profiling) is strongly recommended to see if a young person has a mutation that's associated with lung cancer.

Prognosis

Despite the fact that lung cancers in young people tend to be advanced when first diagnosed, their predicted outcome (prognosis) tends to be better than that of older adults with the same stage and cancer type.

Younger people are generally better able to tolerate cancer therapies. The use of targeted drugs also helps increase the likelihood of sustained progression-free survival in young people.

Resources

Resources are available for young adults with lung cancer, including local and online support groups and non-profit organizations solely dedicated to young people with the disease.

Among them:

• The Bonnie J. Addario Lung Cancer Foundation provides support to people 50 or younger by helping them navigate the healthcare system and the various financial aid programs available to them.
• Stupid Cancer: The Voice of Young Adult Cancer is a support community that meets online and in person to empower young adults with cancer. There is also a "Stupid Cancer" radio show, as well as regional meet-ups and an annual summit.
• The Ulman Cancer Fund for Young Adults provides information, resources, and advice to young adults living with cancer. This includes help related to treatment decisions, housing, college scholarships, jobs, financial assistance, fertility issues, and general health and wellness counseling.

Social media can also be a resource for young people with lung cancer. For example, you can use the hashtag #LCSM (which stands for lung cancer social media) to identify Twitter posts and participate in the conversation.

A Word From Verywell

Lung cancer is not common in young people, but it does occur. It is easily missed in the early stages, so you need to tell your healthcare provider if you have any signs or symptoms of lung cancer, or if you have a family history of the disease. This is true whether you are a smoker, a former smoker, or a never smoker. By catching lung cancer early, you have a far better chance of achieving long-term remission and living a normal, healthy life.