Lung cancer is the number one, most common cause of cancer deaths in the United States. Chances are that if you are reading this article, you have either battled lung cancer or know someone who has fought it.

Many of us might think lung cancer is something that affects only older people who have smoked — and there is some truth to that. Only 1 out of every 10 people (10 percent) with lung cancer is younger than 55 years old, and only about 12 percent are nonsmokers. However, although rare, the rate of young adults — including people in their 20s and 30s — with lung cancer has been increasing recently, and scientists do not know why.

In this article, we will explore what doctors think are possible causes of lung cancer in your 20s. We also discuss how lung cancer in this age group is typically discovered and how well young people do once a lung cancer diagnosis has been made.

Types of Lung Cancer

There are different lung cancer types, each with different causes and risk factors, as well as treatment options. Lung cancers are divided broadly into small cell (SCLC) and non-small cell lung cancer (NSCLC). About 85 percent of lung cancers are NSCLC. Within the NSCLC group, there is lung adenocarcinoma, squamous cell carcinoma, large cell carcinoma, neuroendocrine cancer, and other more rare types.

Adenocarcinoma is the most common NSCLC, making up about 40 percent. Younger age groups, however, are typically even more likely to have adenocarcinoma when diagnosed with lung cancer. Unfortunately, young people are also more likely to be diagnosed at a later/advanced stage.

Possible Causes and Risk Factors

Compared to older people living with lung cancer, younger people with lung cancer have cancers that have more genetic mutations. However, unlike other conditions in which there is often a family history, it does not appear that these mutations are passed down in families.

Common gene mutations in younger people include ALK, EGFR, and ROS-1 mutations, as well as several others. ALK (anaplastic lymphoma kinase) and EGFR (epidermal growth factor receptor) are both receptors found in normal lung cells (and many other cells in the body) that are important for proper growth. However, when these receptors are mutated, the cells can grow too much and thus become a cancer risk.

Diagnosis

There are rarely any symptoms of early-stage lung cancer. Often, when people with lung cancer start feeling symptoms, such as problems breathing, chronic cough, and blood in their sputum, cancer has already advanced and spread.

Screening

With any type of cancer, we try to do effective screening. Screening means trying to detect cancer early and in a treatable stage before it starts to cause problems. As an example, breast cancer is screened by regular mammograms. For lung cancer, screening methods are not as effective, except for a subset of older, longtime smokers.

For younger people, especially those who have not smoked or have not been longtime smokers, there are currently no recommendations for screening tests for lung cancer. This might explain why lung cancer in your 20s is often detected very late. Doctors also tend not to suspect lung cancer when diagnosing a young person. In this group of young people, it is usually found as an “incidental finding” when getting a scan for other illnesses, such as an X-ray for pneumonia (lung infection) or a broken rib.

If You Have Symptoms

When symptoms arise, usually an X-ray of the chest will be used to see if there are any obvious masses or tumors. Typically, this is then followed by a CT scan for an even closer look at the lungs and surrounding structures, such as lymph nodes, where cancers often spread.

A biopsy — when surgeons take a tiny piece of the mass to look at under a microscope — may then be done for any masses found on scans. The procedure can be carried out through a tube inserted into the breathing passages (bronchoscopy) or by a biopsy under a CT scan or another type of imaging. The test results will determine what the specific type of lung cancer is, or if it is another type of cancer entirely (e.g., lymphoma or spread from cancer in another part of the body).

Treatment

Treating lung cancer, especially forms of NSCLC, involves a combination of medications (chemotherapy) and radiation (radiotherapy). Occasionally, if there is a single mass, surgery may be considered as well, depending on its location. You will be working with an oncologist, a doctor that specializes in cancer treatment, who can talk to you more about your options depending on your circumstances. Your doctor can also help you overcome the side effects of treatment.

Unfortunately, because of the late stage in which younger people present with lung cancer, these types of cancer tend to be more aggressive, and five-year survival rates are relatively poor. According to JAMA, a premier medical journal, “the survival of young patients with NSCLC is unexpectedly poor compared with other age groups, suggesting more aggressive disease biology.” For people under 40, the average survival is now about 18 months. It is important to know that cancer statistics like these are just average numbers based on thousands of unique people, and individuals with different genetics and risk factors will all have different outcomes and survival rates. You are a person, not a single number or a statistic.

The Future Is Bright

The good news is that rates of new lung cancer cases (incidence rates) overall are going down. People across all age groups are surviving longer thanks to new cutting-edge technology and treatments that are coming out every day. Depending on the types of genetic mutations your particular type of cancer has, there are new targeted therapies that are becoming available, specifically for tumors with those certain genes. New clinical trials are continuously pushing the forefront of cancer care and how we think about and treat lung cancer in younger people. If standard treatments are not successful, ask your doctor about any clinical trials in which you might be eligible to participate.

Talk With Others Who Understand

MyLungCancerTeam is the social network for people with lung cancer and their loved ones. On MyLungCancerTeam, thousands of members come together to ask questions, give advice, and share their stories with others who understand life with lung cancer.

Do you or someone you know have questions about lung cancer? Have you been diagnosed with lung cancer in your 20s? Share your experience in the comments below, or start a conversation by posting on MyLungCancerTeam.