Lung Cancer in Young Adults

The disease differs from diagnoses in older adults in several ways

In This Article

Most people think of lung cancer as an older person's disease, but it also affects young people, albeit less commonly. When lung cancer does occur, it tends to be distinctive, both in the type of cancer involved and the risk factors. More often than not, lung cancer in young adults will advance and require aggressive treatment, but the outcomes are often good.

Age and Sex

Lung cancer is associated with older age, with 70 being the average age of diagnosis. Approximately 53% of cases occur in adults 55 to 74, while 37% occur in those over 75. By contrast, only 10% of lung cancers occur in people under 55, and the rate drops dramatically with every decade preceding that age.

According to a 2019 study in the Journal of Cancer, only around 1.4% of lung cancers occur in people under 35.

One of the ways in which lung cancer differs in young people is that young women are affected more by the disease than young men. In contrast, the ratio seen in the larger population of people with cancer is 57.8% male to 45.9% female.

symptoms of lung cancer
Verywell / Julie Bang

Cancer Type and Stage

The predominant type of lung cancer affecting adults under 35 is adenocarcinoma. This is not an entirely unusual finding given that lung adenocarcinoma is the most common type of lung cancer overall.

A notable difference is the severity in young adults. Younger people tend to have more advanced lung cancer at the time of diagnosis, with most presenting with stage 4 disease (also known as metastatic lung cancer).

Metastasis, the spread of cancer from the primary tumor to disease organs, 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), bones, liver, and brain.

Delayed diagnoses are 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.

Even if cancer is suspected, 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 do).

Causes

Another way that lung cancer differs in young people is its association with smoking. 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.

This stands in complete opposition to the statistics seen in the larger population of people with lung cancer, in which roughly 85% of cases and 90% of deaths can be directly attributed to cigarette smoke.

According to the research published in the Journal of Cancer involving 8,734 adults with lung cancer under the age of 35, 71.6% were non-smokers and roughly half of those had no history of ever smoking.

Genetics is believed to play a central role in this anomaly. Just as BRCA gene mutations are known to increase the risk of breast cancer, researchers have begun to uncover gene mutations that also raise the risk of lung cancer.

Three gene mutations commonly associated with lung adenocarcinoma are:

Of the three, EGFR mutations are the least common in young people with lung cancer and the type associated with less aggressive disease.

ROS1 mutations and ALK rearrangements are not only more common in young people with lung cancer but are almost always associated with aggressive disease.

As many as 59% of young people with lung cancer will have these and other genetic mutations. 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 in 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 doesn't vary from that in 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. These may include:

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, they leave other normal cells untouched and cause fewer side effects.

There are multiple targeted drugs approved for the treatment of lung cancer in the United States. Some of the more commonly used drugs are:

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

More 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

Younger people are more likely to have treatable gene mutations, like ALK4-EML, than older adults and are more likely to be candidates for drugs like Xalkori.

Because many of the risky 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 treatable mutation. All people with advanced cancer are advised to undergo genetic profiling.

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 and, as such, are usually treated more aggressively than their older counterparts. The use of targeted drugs also helps increase the likelihood of sustained progression-free survival in young people.

According to research in the Journal of Oncology, the five-year survival rate of people 18 to 35 with lung cancer is 53.3% for all stages. That's vastly superior to the 16% five-year survival rate seen in the larger population of people with this disease.

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 has also proven to be a powerful resource for young people with lung cancer. Every other Tuesday evening there is a Twitter chat involving people with lung cancer, cancer advocates, family members, and treaters. Use the hashtag #LCSM (which stands for lung cancer social media) to identify posts and participate in the conversation.

A Word From Verywell

As uncommon as lung cancer is in young people, it does occur. Because it is so easily missed in the early stages, speak up if you have signs or symptoms of lung cancer and 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.

Was this page helpful?
Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Cancer Society. Key statistics for lung cancer. Updated October 1, 2019.

  2. De Groot PM, Wu CC, Carter BW, Munden RF. The epidemiology of lung cancer. Transl Lung Cancer Res. 2018;7(3):220-33. doi:10.21037/tlcr.2018.05.06

  3. Liu B, Quan X, Xu C, et al. Lung cancer in young adults aged 35 years or younger: A full-scale analysis and review. J Cancer. 2019;10(15):3553-9. doi:10.7150/jca.27490

  4. American Lung Association. Lung cancer fact sheet. Updated May 27, 2020.

  5. Centers for Disease Control and Prevention. Health effects of cigarettes. Updated April 28, 2020.

  6. Harrison PT, Vyse S, Huang PH. Rare epidermal growth factor receptor (EGFR) mutations in non-small cell lung cancer. Semin Cancer Biol. 2020;61:167-79. doi:10.1016/j.semcancer.2019.09.015

  7. Lin JJ, Shaw AT. Recent advances in targeting ROS1 in lung cancer. J Thorac Oncol. 2017;12(11):1611-25. doi:10.1016/j.jtho.2017.08.002

  8. Du X, Shao Y, Qin HF, Tai YH, Gao HJ. ALK-rearrangement in non-small-cell lung cancer (NSCLC). Thorac Cancer. 2018;9(4):423-30. doi:10.1111/1759-7714.12613

  9. Wang Y, Chen J, Ding W, Yan B, Gao Q, Zhou J. Clinical features and gene mutations of lung cancer patients 30 years of age or younger. PLoS ONE. 2015;10(9):e0136659. doi:10.1371/journal.pone.0136659

  10. Sacher AG, Dahlberg SE, Heng J, Mach S, Jänne PA, Oxnard GR. Association between younger age and targetable genomic alterations and prognosis in non-small-cell lung cancer. JAMA Oncol. 2016;2(3):313-20. doi:10.1001/jamaoncol.2015.4482

  11. Kanwal M, Ding XJ, Cao Y. Familial risk for lung cancerOncol Lett. 2017;13(2):535-42. doi:10.3892/ol.2016.5518

  12. Chen R, Manochakian R, James L, et al. Emerging therapeutic agents for advanced non-small cell lung cancer. J Hematol Oncol. 2020;13(1):58. doi:10.1186/s13045-020-00881-7

  13. Cancer.Net. American Society of Clinical Oncology. Genetic testing for lung cancer risk. Updated August 2018.

  14. Cancer.Net. American Society of Clinical Oncology. Lung cancer non-small cell: Statistics. Updated May 2020.