TORONTO - Katie Hulan, a 37-year-old tech marketing manager, initially thought her worsening cough was due to asthma. After trying inhalers without success, she found herself struggling to speak at work. "At the end of the day, I would be in pain just from the shaking and coughing," Hulan said.

Her doctor ordered an X-ray, which revealed a mass on her lung. After further tests, she was diagnosed with stage 4 lung cancer. "That was one of the most devastating moments of my life," she recalled. "My immediate reaction was, 'I know how this story ends.' And so for me, it just felt completely like a death sentence." Hulan, who had always been healthy and did not smoke, was shocked by the diagnosis.

She is part of a growing trend of non-smokers diagnosed with lung cancer. The Canadian Cancer Society estimates that about 25% of lung cancer cases in Canada occur in non-smokers. Furthermore, a higher proportion of these cases are among women, although the reasons remain unclear. Jessica Moffatt, vice-president of programs and advocacy at the Lung Health Foundation, noted, "One of the theories is that potentially estrogen is doing something to perpetuate tumor growth, but it’s all theories at this point."

Environmental factors, particularly radon gas, are known contributors to lung cancer risk. Health Canada identifies radon, an invisible radioactive gas from uranium decay in soil and rocks, as the leading cause of lung cancer among non-smokers. The agency recommends that all homes be tested for radon levels. Other risk factors include second-hand smoke, asbestos exposure, and fine particulate matter from air pollution. Moffatt expressed concern about the impact of wildfires, stating, "The effects of that smoke is a huge concern for us."

Dr. Rosalyn Juergens, a medical oncologist at McMaster University, has observed an increase in lung cancer cases among non-smokers over her 20 years of practice. "It was uncommon for me, not never, but uncommon for me, to see a never-smoker when I first started in practice. And we are definitely seeing more and more," she said. Many of her non-smoking patients are women, yet lung cancer is often not recognized as a women's health issue.

Juergens pointed out that many non-smokers arrive at her office with advanced cancer. "More women will die of lung cancer than will die of breast cancer, ovarian cancer, and cervical cancer combined," she said. "One in five of them will be people who have never touched a cigarette a day in their lives."

Current lung cancer screening programs in British Columbia, Ontario, and Nova Scotia focus primarily on smokers, leaving non-smokers without early detection options. Juergens noted that lung cancer symptoms are often subtle, making diagnosis challenging. "Your lungs inside don’t have nerve endings. So it’s not like you’re going to get a pain. You’re never going to feel a lump," she explained.

Despite these challenges, advancements in lung cancer treatment have been significant since the 1990s. Juergens highlighted the role of next-generation sequencing in identifying the specific type of lung cancer, which helps tailor treatments. Hulan's initial prognosis of six months has improved to an average of five to six years due to targeted therapies. A biopsy revealed an ALK genetic mutation, which is present in about 4% of lung cancer cases. "When I got that news, it felt like a 180. I had life. I had hope," she said.

Nearly five years post-diagnosis, Hulan continues her treatment with a pill, has avoided chemotherapy, and feels "wonderful." She is now an advocate for the Lung Health Foundation, promoting equal access to targeted cancer medications and encouraging individuals to seek medical attention for persistent coughs. "I think the word on the street is that you have to be a person who has smoked and that’s not at all the case," she said. "Anyone with lungs can get lung cancer."