Lung cancer in non-smokers: Oncologist Dr Prriya Eshpuniyani on risk factors and warning signs

A shifting reality in oncology

Lung cancer has long been associated with smoking, but oncologists are now seeing a growing number of patients who have never touched a cigarette. Dr Prriya Eshpuniyani, an oncologist, is among those raising the alarm: lung cancer is not just a smoker's disease.

Recent discussions in medical circles point to a troubling trend. More non-smokers, particularly women and younger adults, are being diagnosed with the disease. The reasons are complex, and experts say the traditional risk model is no longer sufficient.

Beyond the cigarette: hidden risk factors

Dr Eshpuniyani lists several factors that increase lung cancer risk in non-smokers. Exposure to second-hand smoke tops the list, especially in homes and workplaces where smoking is common. But there are others, less obvious: indoor air pollution from cooking fumes, outdoor particulate matter, and occupational hazards like asbestos or diesel exhaust.

Genetic predisposition also plays a role. Some people carry mutations that make them more susceptible, even without any environmental trigger. The oncologist stresses that these cases are not rare anomalies but a significant slice of the patient population.

Warning signs that are easy to miss

The symptoms of lung cancer in non-smokers can be subtle. A persistent cough that doesn't go away, chest pain, shortness of breath, and unexplained weight loss are classic signs. But Dr Eshpuniyani warns of less obvious ones: hoarseness, frequent lung infections, and finger clubbing.

Many patients dismiss these as allergies or the result of stress. By the time they seek help, the cancer has often advanced. This delayed diagnosis is a major concern, particularly in regions where awareness is low and healthcare access is uneven.

The screening gap in India

Screening programmes in India have traditionally focused on smokers, using criteria like pack-years to decide who gets tested. This approach misses a large number of at-risk non-smokers. Experts are now calling for a shift towards risk-based screening that accounts for environmental exposure and family history.

Some are even proposing AI-driven case-finding tools that can identify high-risk individuals from routine health data. Such technologies could help bridge the gap, but they require investment and political will.

What this means for patients

For the average person, the takeaway is simple: do not ignore persistent respiratory symptoms, even if you have never smoked. Early detection can dramatically improve outcomes, and treatment options have advanced significantly in recent years.

Dr Eshpuniyani's message is a call to action for both the public and the medical community. Awareness campaigns need to move beyond the smoking narrative, and doctors should consider lung cancer as a possibility in non-smokers presenting with relevant symptoms.

As the evidence grows, the hope is that screening guidelines will evolve to reflect the true risk profile of India's population. The next few years will likely see renewed debate on this issue, with patient advocacy groups pushing for change.