Most doctors and patients alike consider lung cancer to be due to smoking.

Recently, my team and I reported on the increasing frequency of non-smoking lung cancer in the UK, a worrying presentation that has doubled in the last 7 years and now forms a third of our patients undergoing surgery for lung cancer at the Royal Brompton and Harefield NHS Foundation Trust. This represents the early disease spectrum, but trends for increased non-smoking lung cancer has also been reported in the USA for advanced disease. Worldwide, the incidence of non-smoking lung cancer has been recognised to be highest in Asian (usually oriental) non-smoking females, especially in China.

Non-smoking lung cancer has been noted to be different from smoking lung cancer in that mutations for drug targeted treatments tend to be higher as the cell type is usually adenocarcinoma. 

Careful and expert management is required particularly for early stage disease where it tends to present as "ground glass shadowing" in the lungs. I have previously presented to a worldwide audience as part of the International Association for the Study of Lung Cancer (IASLC) on the implications for management of adenocarcinoma. We now recognise that adenocarcinoma represents a spectrum of disease ranging from benign to malignant, so it is critically important to determine the sub-type to guide best management. As the disease can occur in more than one part of the lung(s) or manifests with time, my opinion is always to preserve as much lung tissue as possible. 

Clinical expertise, tissue confirmation and judicious surgery are the key components to the best outcomes for early stage disease.

Do contact me if you are concerned about non-smoking lung cancer or to discuss management options for ground glass shadowing detected on CT.