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A 37-year-old Nurse Got Unusually Short Of Breath On A Hike. She Had Stage 4 Lung Cancer.

Lung cancer is rare in people under 45, but more women who have never smoked are developing the disease.

Tiffany Job was surprised by how out of breath she felt on a hike.

She was young, healthy, and never smoked so was shocked when she was diagnosed with lung cancer.

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On a hike in July 2020, Tiffany Job found herself incredibly short of breath.

"I couldn't go 20 yards without my heart rate shooting up," she told The Patient Story.

This was unusual for Job, 41, from Texas. "I maintained a healthy diet. I exercised constantly. As a Registered Nurse and part‐time pilates instructor, I was more proactive than most when it came to managing my own health and well-being," she wrote on the website of her nonprofit, Ten for Ten Million.

Then, that August she developed a cough that wouldn't go away after antibiotic and steroid treatments, so she went to see a primary care doctor who was a family friend.

Pulmonary function tests showed that Job had the lung capacity of an 80-year-old. The doctor thought she might have COVID, tuberculosis, or a fungus in her lungs.

But months after her symptoms began, Job was diagnosed with stage four lung cancer at age 37, despite being young, fit, and having never smoked.

Job first noticed her lungs weren't working normally while on a hike with her husband and twin sons. Captured by KLC

Lung cancer is rare in people under 45, with most patients diagnosed aged 65 and over, according to the American Cancer Society. Although CDC data suggests rates of cigarette smoking, which is the leading risk factor for lung cancer in the US, have declined significantly over the last few decades, rates of non-smokers getting lung cancer are rising.

Women who have never smoked in particular are more than twice as likely to develop lung cancer than men who have not smoked, and more of the few young people who get lung cancer have never smoked, a study published earlier this year in the journal Nature Reviews Clinical Oncology found.

Researchers don't know why this is, but it could be linked to certain gene mutations, such as EGFR, which can cause cells to grow out of control and lead to cancer.

Job was diagnosed with lung cancer after switching hospitals

In October 2020, Job underwent a series of tests including a bronchoscopy, where a tube is fed down the throat into the lungs so doctors can see inside.

5 Signs Of Lung Cancer Even Nonsmokers Need To Know

IKON Images/Adobe Stock

When 34-year-old Ashley Vassallo came down with a cough and chest pain in the fall of 2021, she assumed she had COVID. But Vassallo kept testing negative, so doctors started to think asthma, acid reflux, or even pneumonia was at play. Her health continued to worsen over a yearlong period, eventually landing her in the ER, where a CT scan and biopsy revealed that Vassallo—an otherwise healthy, young, nonsmoker—had stage 4 lung cancer.

"Although most lung cancer is associated with tobacco abuse, that's just the number-one cause," Sonam Puri, MD, a thoracic oncologist with the Moffitt Cancer Center, tells SELF. There are lots of other things that can play a role, like exposure to some chemicals and having certain genes. You can also get it for seemingly no reason at all. "There's a stigma attached to lung cancer associated with smoking and that's just not true," Dr. Puri says.

Vassallo was considered low-risk for lung cancer and didn't qualify for any screenings. And while *most* cases are tied to smoking, 10–20% of lung cancers happen to folks who've only occasionally, or never, touched a cigarette. That's why it's helpful for all adults to be aware of lung cancer signs and symptoms. Here's what to watch for.

1. Your cough just won't quit.

Early-stage lung cancer typically impacts how your respiratory system—a.K.A. Your nose, mouth, throat, windpipe, and lungs—functions. Veronica Chiang, MD, FAANS, an oncologist with Yale University, says a persistent, hoarse cough was usually the first red flag for most people she treats. "If you see a patient who has a cough, there are lots of different reasons for it," she tells SELF, noting that colds, infections, reflux, pneumonia, or even allergies can be common initial misdiagnoses. "It's much more common to have an infection or even pneumonia than it is to have cancer."

Dr. Chiang says the big thing to pay attention to is how long it lasts—if a cough is from an infection, it'll likely ease eventually. Cancer won't let up. "The patients that I see typically have had a cough that's persistent, that sometimes is treated by antibiotics, and still continues on," she explains. Anything that lingers two weeks or longer usually isn't great. "It's not like the infection your two-year-old gave you. You're just not getting better," Dr. Puri adds.

Dr. Chiang says that some tumors can also cause you to have problems swallowing. "In lung cancer, there's a nerve—a recurrent laryngeal nerve—that feeds your voice box. So sometimes my patients will also have hoarseness that's developed." Bottom line: If the cough lasts more than a few months, get it checked out.

2. You've got unexplained aches or pains.

Vassallo lived with an annoying cough for two months before a sharp, menacing pain settled into her chest. "I was having trouble breathing," she tells SELF, noting that the sensation felt like "a little alien" was trapped inside of her ribcage. Her doctors initially misdiagnosed it as anxiety, and then asthma. Turns out, Vassallo had a tumor behind her heart that doctors kept missing in X-rays. "If your cancer develops, and especially if it goes to places next to a nerve, you might start to have some manifestations of pain," Dr. Chiang explains. "I once had a lung cancer patient who came to the ER with chest pain and he got worked up for the heart, but it really was because he had a large mass compressing different structures and just causing pain in the area."

The chest isn't the only spot that might feel heavy or tight, Dr. Chiang says. "If it goes to the bone, maybe in one of your vertebrae, you can weaken that bone and sometimes you can be more susceptible to a fracture," she notes.

As for how lung cancer pain might differ from, say, anxiety-related chest pressure, again, it can be hard to differentiate, both experts agreed. The main thing to look for? It's new—and not letting up.

3. You're strangely short of breath.

Vassallo was super active before her lung cancer symptoms settled in. So when she started having issues with her breathing, it was particularly noticeable. "I'd go to martial arts classes and lift weights, still in pain and tiring out really quickly," she explains. "I was training for a half-marathon at the time, but I eventually had to stop—I couldn't go longer than a few minutes without wanting to pass out."

In Vassallo's case, her tumor was putting pressure on her lungs, causing her respiratory system to become inflamed and agitated. But people can have a hard time inhaling because the cancer is causing fluid to build up in the lungs, Dr. Chiang says. "You might even have some shortness of breath changing positions because, if you're bending over, that fluid sort of 'goes with gravity' either to the front or the back."

Vassallo was a generally athletic person, so her lung capacity changes were stark. But what if you're not logging miles on a daily basis? "Typically what I hear from my patients is that things have changed over time and you're in a different place than you were before," Dr. Chiang notes. "It might be something like, 'Oh gee, I used to be able to fold all my laundry in one go, and now I have to take several breaks while I'm doing that because I get really tired and short of breath.'"

4. You're dropping weight without trying.

One doc thought acid reflux was to blame for Vassallo's woes, so she was put on a GERD diet (a.K.A. Things that discourage heartburn, like whole grains, vegetables, watery foods like watermelon, and foods with a higher pH, like bananas and melons). When Vassallo went on to lose weight over the course of a few months, she figured her new eating habits were the cause.

According to Dr. Chiang, weight loss is often associated with all types of cancer, not just lung. "That's because cancer cells use a lot of sugar, and sometimes people lose their appetite," she notes. (Cancer cells grow more rapidly than normal cells, Dr. Chiang explains, and suck up a lot of energy.) "So even though they're not trying to lose weight, they may just have a loss of appetite and not be interested in food."

So what's a red flag? If you've dropped 10 pounds, or roughly 5% of your body weight, over several months without trying, bring it up to a doc ASAP.

5. You've developed blood clots.

Roughly 10% of people with any kind of cancer develop blood clots because they tend to have "sticky" blood or a tumor that can compress blood vessels. If you have a clot, you might feel throbbing, cramping, swelling, or redness in the legs or arms, or sudden breathlessness or chest pain. Clots can be particularly prevalent in lung cancer, Dr. Puri says. "I recall one of my patients who was extremely active. He used to bike, had his own company, and just had a blood clot out of nowhere. Blood clots don't happen in healthy young people without risk factors."

She notes that being sedentary for long periods and some forms of birth control with high estrogen can increase the risk of clotting, but cancer can also be a culprit. "In just two to three months, he started developing a mass in his neck. It was lung cancer." Vassallo also developed blood clots, something doctors only thought to scan for when she went to the ER.

How worried should I be about all of this?

Unfortunately, as Dr. Puri reiterates, lung cancer—like all cancers—can happen even when there's not a clear cause. There are a few factors that can come into play, including inherited genes that up your risk and exposure to air pollution (say, from vehicle exhaust or coal-fired power plants). Dr. Puri says that radon, the gas that can naturally accumulate in homes in some parts of the United States, can also be really impactful. "Radon is so under-recognized," she explains. "It's odorless and you can't see it. It usually comes from the soil that's around your house." She says that, while certain tests can help identify if your home is at safe levels, there are no federal regulations around monitoring. "Anyone who knows that their area is high-risk for radon should get their house tested frequently for radon exposure." Learn if your area is considered a "high-radon zone" and here's how to find a radon test kit.

Even if you're situated in a spot with higher-than-average radon levels, Dr. Puri says it's important not to freak out. "Not every person who lives in a high-radon house has lung cancer. Not everybody who smoked all their life has lung cancer, but yes, they're risk factors."

That same logic applies to medical testing, Dr. Puri says: You don't need to be a "strong candidate" for lung cancer to get a screening. "If you feel like your [concerns] are not being addressed, it's always okay to ask your doctor for a CAT scan," she advises. "Just because you've never smoked doesn't mean that you don't get access to one. It's not about smoking or not smoking at all."

Originally Appeared on SELF

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These Early Signs Of Lung Cancer Are Often Missed, Oncologists Say

Lung cancer is the second-leading cause of cancer death in the United States after skin cancer, according to the American Cancer Society. The disease is to blame for about 1 in 5 cancer deaths, and the ACS estimates more than 125,000 people will die from it this year.

These statistics are grim, but there's a reason why lung cancer often progresses past the point where it's treatable: Early signs of lung cancer are often missed (or nonexistent).

"Most patients may not have symptoms unless it has spread or unless there is evidence it is metastatic or there is involvement of major structures," says Dr. Amna Sher, a medical oncologist at Stony Brook Cancer Center.

Early diagnosis can significantly improve a person's chances of survival. For instance, the five-year survival rate for the most common type of lung cancer, non-small cell lung cancer, which includes adenocarcinoma, squamous cell carcinoma and large cell carcinoma, is 65 percent if diagnosed while it's still localized (in other words, it hasn't spread elsewhere in the body).

Those numbers drop to 37 percent if it spreads to structures near the lungs, like the lymph nodes, and just 9 percent if it spreads to more distant areas of the body, such as the brain.

It's a lot to take in. But the bottom line is this: "If lung cancer can be diagnosed at an early stage, the patient will have more treatment options and a better chance of remission," says Dr. Xiuning Le, a V Foundation clinical scholar at the University of Texas' MD Anderson Cancer Center. "It is extremely important to detect lung cancer as early as possible."

But how? Doctors shared commonly missed early signs of lung cancer and what to do if you're concerned.

Commonly missed sign

A persistent or worsening cough is a commonly missed early sign of lung cancer, Sher says.

"It warrants an evaluation if someone has a new or persistent cough … which has been ongoing for several weeks or months, especially in a high-risk patient with a strong history of smoking," she says. "For example, you got a course of antibiotics, but it's been two months, and you're still coughing — seek medical attention."

Sher says doctors often see patients come in with months of a persistent cough, but an abnormal X-ray prompts a deeper dive into the cause of the issue.

Easy to dismiss

Le and another expert agree that a chronic cough is an easy-to-miss sign of lung cancer. Part of the problem: Chronic coughs are often similar to other diseases, including those at a higher risk for lung cancer — primarily smokers — may already have.

"Most — but not all — cases of lung cancer are associated with a prior tobacco smoking history," says Dr. Brett Bade, the director of the Lung Cancer Screening Program at Northwell Lung Insitute in New York. "Tobacco smoking is a risk factor for both lung cancer and lung disease. Chronic obstructive pulmonary disease, for example, can also cause a chronic cough and shortness of breath. People may attribute their symptoms to their lung disease or prior tobacco use."

In other words, patients may be used to coughing and consider it normal.

Even people without a history of smoking or lung disease may chalk a persistent cough up to something else, and usually, something less severe.

"Patients may think it's just an upper respiratory infection or virus," Sher says. "It may be seasonal. Patients have allergies. If you're around patients with kids, you're exposed to all these viruses and may think you just didn't get better."

Other overlooked signs

A persistent cough isn't the only early sign of lung cancer that's easy to overlook.

"Since the lungs don't have many pain receptors, most symptoms of lung cancer are related to the tumor's involvement of a local structure or another organ," Bade says. "For example … shortness of breath may develop if the tumor involves the airway. Similarly, if the tumor spreads to a bone, the involved bone becomes painful."

Bade says that other common signs of lung cancer a patient may not recognize include: fatigue, hoarseness, chest pain, bone pain, reduced appetite and weight loss.

Diagnosis, treatment

Doctors will biopsy the involved site to diagnose lung cancer.

"Frequent biopsy sites include the lungs, lymph nodes in the neck or chest or drainage of fluid from around the lungs," Bade explains. "If other organs are involved, your doctor may recommend a biopsy of those sites; examples might include the liver, the adrenal gland or a bone."

Le says that several factors determine a patient's lung cancer treatment plan, mainly: the type of lung cancer, the cancer's stage, and genetic and immunological features of the specific patient.

"In general, surgery, radiation and systemic therapies are all effective treatments for lung cancer," Le says. "There are many different options within the (therapy) class."

A care team will work with a patient on the best option for their specific case.

If you're concerned about lung cancer, talk to your doctor.

"Early recognition and early treatment is the key to longer lung cancer survival," Le says. "If you have new symptoms or suspect you are eligible for lung cancer screening, you should discuss it with your doctor."

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