Did you know that lung cancer is still the leading cause of cancer death in the U.S.?
Knowing your personal risk isn't just useful — it can be lifesaving. From genetics and environmental exposures to the rising popularity of vaping and marijuana, lung cancer risk is broader than many people realize.
"By the time you start showing symptoms, the cancer is likely already advanced," says Dr. Chinemerem Abanonu, an oncologist at Houston Methodist. "That's why we want everyone to understand their personal risk factors and how they can lessen their risk."
Who is at the highest risk of lung cancer?
Cigarette smoking remains the No. 1 cause of lung cancer. Between 80% and 90% of lung cancer cases are linked to cigarette or tobacco use. People who smoke tobacco of any kind — cigarettes, cigars, hookahs and pipes — are 15 to 30 times more likely than nonsmokers to develop lung cancer.
Burning tobacco releases more than 7,000 different chemicals, according to the latest data from the American Cancer Society. Most of these are harmful to the human body, and at least 69 are known to cause cancer.
"There's still a misconception out there that some types of cigarettes are safer than others," Dr. Abanonu says. "The truth is, it, whether it's filtered or unfiltered, menthol or not, it makes no difference. Chewing tobacco is a significant cause of mouth and throat cancer. I tell my patients that tobacco causes cancer from head to toe."
(Related: Why You Shouldn't Brush Off Lung Cancer Screening)
Are other types of smoking linked to lung cancer?
Vaping, often marketed as a safer alternative, presents a complex picture. While there is not yet direct, long-term data to show whether vaping causes lung cancer, growing evidence is concerning.
For one, vaping exposes users to other problematic chemicals, many of which are known carcinogens such as formaldehyde, benzene and heavy metals. These can cause inflammation and potentially damage DNA, setting the stage for cancerous changes.
"There's so much we don't know about vaping," Dr. Abanonu says. "The chemicals are unregulated, and a lot of products use various oils for flavor. Our bodies don't metabolize these oils, and they get deposited in lungs, where they can cause problems over time."
Similarly, marijuana smoke can contain some of the same toxic substances found in tobacco smoke, including tar and carbon monoxide. Holding smoke in the lungs longer may increase exposure to these toxins.
What about environmental risks?
Radon is the leading cause of lung cancer among nonsmokers. This invisible, odorless gas can seep into homes through cracks in foundations, particularly in rural areas or older buildings.
"It's a hard thing to explain to people, and it's not something we talk about often enough," Dr. Abanonu says. "Radon is naturally occurring radioactive gas that doesn't have a smell, there's no taste and you can't see it."
Outdoors, the amount of radon in the air is miniscule, as it dissipates quickly. Inside a home, however, the gas can build up quickly, leading to increased exposure over time. Radon can also be a problem in untreated water, putting those in rural areas who depend on well water at higher risk. Radon testing is available for residential and commercial buildings.
Some people might be exposed to harmful fumes in their work environments as well. Arsenic exposure is a top concern, as is diesel fuel exhaust and heavy air pollution. Asbestos insulation, formerly a leading cause of lung cancer, is now strictly regulated, but it can still be present in older buildings and shipyards.
(Listen: How Does Air Pollution Affect Lung Health?)
Is the risk of lung cancer genetic?
Genetics can play a role in lung cancer risk, though the precise mechanisms are still being studied.
"If you have a first-degree relative who has had lung cancer, you are at increased risk of lung cancer when compared to the general population," says Dr. Abanonu. "Some of this might be due to shared lifestyle or environmental exposure."
Not everyone with a genetic predisposition will develop lung cancer. Talk with a doctor about your family history of the disease, especially if you also have environmental exposures or symptoms that aren't improving.
(Related: Why Knowing Your Family Health History Matters)
What kind of screening is available for lung cancer?
For people at high risk of developing lung cancer, effective screening methods are available. The U.S. Preventive Services Task Force (USPSTF) recommends annual lung cancer screening with low-dose computed tomography (LDCT) scan for adults aged 50 to 80 who are at high risk of lung cancer because they meet either of two criteria:
- Have a 20 pack-year smoking history (such as smoking one pack a day for 20 years or two packs a day for 10 years)
- Currently smoke or quit within the past 15 years
"Unfortunately, not everyone who qualifies is getting screened, because many people don't know this is available," says Dr. Abanonu. "If you fit the criteria or even if you're unsure, talk with a doctor about whether screening is right for you."
(Related: Lung Cancer Screening: Who's Eligible & Why It's Important)
Researchers are continually working to improve early detection and patient care. Physician-scientists at Houston Methodist are pioneering a new type of specialized lung nodule clinics.
"We're monitoring people who have incidental lung nodules found during unrelated scans," Dr. Abanonu explains. "A multidisciplinary team of radiologists, pulmonologists and oncologists reviews each case and the patient's risk factors. This reduces the chance of missed or delayed diagnoses."
If a lung nodule is found, these clinics provide a streamlined pathway to further evaluation and specialist care, such as ongoing surveillance.
Know your risk, speak up about potential symptoms
If you have persistent coughing, shortness of breath, fatigue or frequent lung infections, don't brush off these symptoms — even if you don't smoke. Lung cancer symptoms can mimic common conditions like asthma or bronchitis. If symptoms linger, talk with a primary doctor and, if necessary, request a referral to a pulmonologist.
"Ultimately, lung cancer is most treatable when caught early," says Dr. Abanonu. "That's why knowing your risk and acting on it is one of the most important steps you can take."
