Over the past couple decades, trends that could be equally alarming in lung cancer diagnoses have surfaced, specifically in young, healthy, non-smoking women. Sarah Li is a 42-year-old, originally from London, now freelance filmmaker based in Toronto, Canada. Recently, she was diagnosed with EGFR-positive lung cancer, a type of cancer normally associated with smokers. Her story is representative of an increasing number of cases that are challenging traditional assumptions about the demographics of the lung cancer population.
In this context, air pollution has increasingly moved to the front burner, especially following the tragic death of nine-year-old Ella Adoo-Kissi-Debrah. Her story has brought unprecedented attention to the issue. Ella’s death was a watershed moment. She was the first individual in the world to have air pollution listed as a cause of death on her death certificate. Her mother, Rosamund Adoo-Kissi-Debrah, has been a vocal advocate for raising awareness about the severe health impacts of air pollution.
In the UK, outdoor air pollution is thought to cause up to one in ten lung cancers. This statistic is particularly troubling given the increasing toll of respiratory disease associated with climate change and environmental harms. Dr. Georgiou, a thoracic oncologist specialized in lung cancer, is particularly interested in analyzing patient data from his own clinic. He noted an annual increase in the prevalence of never-smokers among lung cancer patients, steadily from 2010 to 2021.
Sarah Li’s journey started when she suddenly showed symptoms that were wrongly diagnosed. Despite being a healthy vegan and training for her seventh marathon at the time, she was diagnosed with breast cancer. In late 2019, she found herself confronting the gauntlet of fighting stage IV, or metastatic, lung cancer. Doctors didn’t soften the blow as they delivered the diagnosis: she had inoperable lung cancer. A large tumor was found on her left lung, along with several other cancerous nodules in her right lung.
Li underwent an intensive course of treatment. This regimen featured eight second-line cancer drugs known as ALK inhibitors, in addition to monthly blood tests and quarterly scans. Her resolve to wage war against the disease was fierce. Since her initial round of chemotherapy, radium-223 radiotherapy and immunotherapy, Nicole experienced shrinkage of 90–95% in her tumors.
“It feels strange when I say I have lung cancer,” Li reflected on her diagnosis. For example, I can easily tell people that I have cancer – who doesn’t know someone who’s had or died from cancer? The notion of lung cancer is still very other. How could I be the face of lung cancer?
Becca Smith, another patient currently battling lung cancer, shared her experience of intense pain and misdiagnoses before finally being recognized for her condition. At first, she was treated by her GP, a physiotherapist and a chiropractor, all of whom suspected she had a torn muscle. Over the course of weeks, her symptoms flared up to an unbearable extent, requiring her to seek more urgent medical care.
I went from playing 36 holes a day at my peak, to one day finding myself in bed with an ocular migraine and blurry vision, Smith said. They told me there was absolutely nothing they could do about my situation.
As difficult as it’s been, Smith is today thriving on targeted therapy and customized chemotherapy. In particular, she wants to bring home the message that lung cancer can affect anyone, even those with healthy lifestyle choices.
Rosamund Adoo-Kissi-Debrah has been at the forefront of advocating for greater awareness and action regarding air pollution and its health effects. She noticed a profound inequity in how lung cancer was affecting younger women. Further, she illustrated how socioeconomic factors play a role in this pressing crisis.
When I think of younger women with lung cancer, I wonder about the school run and the time spent sitting in cars or buses in heavy traffic, Adoo-Kissi-Debrah stated. And when I consider the disproportionate impact on black and brown people, I’m considering this through an economic lens. Who rides transit and waits at transit stops. Who lives close to main roads?
The relationship between air pollution and diseases like asthma, heart disease and stroke is well established. In her testimony, Adoo-Kissi-Debrah asserted that Ella had suffered from asthma, and there are more than 700 diseases affected by air pollution.
The growing rate of lung cancer among non-smokers points to a broader array of questions about environmental health policy, practice, and public awareness. Ella’s case starkly illustrates the lethal dangers of air pollution. Too many remain unwilling to acknowledge it as a top-tier public health threat.
“Yet somehow, officially, Ella is still the only person who has died because of air pollution,” Adoo-Kissi-Debrah exclaimed. We’ve reached the point where the costs of poor health due to air pollution are immeasurable. I’m asking myself: ‘What will it take to make the public demand more action?’”
Today, as Sarah Li fights her cancer, she views the world, like all those who survive cancer, with a different lens. “There’s more vividness to everything,” she shared. Just as in today’s post, I’m just so grateful that I’m feeling well enough to be outside, to have a beautiful outdoor lunch. Those small things you kind of had before and maybe didn’t think much about … you’re just so much more grateful for everything.