Key Takeaways
- Prevalence and impact: Lung cancer is the leading cause of cancer deaths in the U.S., with over 229,000 new cases expected to be diagnosed in 2026.
- Common symptoms: Early warning signs of lung cancer include a persistent cough, shortness of breath, chest or back pain, fatigue, and unexplained weight loss.
- Primary causes: While cigarette smoking remains the number one risk factor, 15% to 20% of lung cancer cases occur in lifelong nonsmokers due to radon, environmental carcinogens or genetic mutations.
- Screening criteria: Annual low-dose chest CT scans are recommended for high-risk individuals aged 50 to 80 who have a 20-pack-year smoking history. Early detection significantly improves survival rates.
- Treatment options: Lung cancer treatments are determined by the stage and type (NSCLC or SCLC) and typically involve surgery, chemotherapy, radiation, immunotherapy or gene-targeted precision medicine.
According to the American Cancer Society, 229,410 new cases of lung cancer (110,910 in men and 118,500 in women) are expected to be diagnosed in 2026, making it the second most common cancer in both men and women (not counting skin cancer).
Lung cancer is also the deadliest type of cancer: The ACS estimates that 124,990 people will die of the disease (63,040 men and 61,950 women) in 2026.
These are significant statistics, but detection and treatment advances in recent years have improved quality of life and overall life expectancy for those living with the disease.
Here, we’ll unpack everything you need to know about lung cancer, how it’s diagnosed, how it’s treated and what lifestyle changes you can make to reduce your risk.
What Are Lung Cancer Symptoms?
Lung cancer typically does not offer many signs of its presence early on, which makes detecting it in its early, most treatable stages a difficult undertaking. Among those who do have symptoms, the most common ones, according to the American Cancer Society, are:
- A cough that does not go away or gets worse
- Coughing up blood or rust-colored sputum (spit or phlegm)
- Chest pain that is often worse with deep breathing, coughing or laughing
- Hoarseness of the voice or throat
- Weight loss and loss of appetite
- Shortness of breath
- Feeling tired or weak
- Infections such as bronchitis and pneumonia that don’t go away or keep coming back
- New onset of wheezing
Lung cancer does not discriminate based on sex or race, but the primary risk factor for developing the disease is a history of smoking.
The Centers for Disease Control and Prevention reports that about 80% of lung cancer deaths are directly linked to cigarette smoking, and people who smoke have a 15 to 30 times greater risk of developing or dying from the disease than nonsmokers.
What Causes Lung Cancer?
While smoking is the No. 1 driver of lung cancer, not all people who smoke will develop lung cancer, and not all lung cancer patients previously smoked. In fact, the CDC reports that 15% to 20% of all lung cancer cases occur in people who never smoked.
Factors that can contribute to the development of cancer in these cases include:
- Environmental exposure to inhaled carcinogens such as asbestos or air pollution
- Exposure to radon, a naturally occurring, invisible and odorless radioactive gas
- Other types of radiation exposure
- Genetic mutations
In recent years, researchers have identified a host of genetic mutations on various growth pathways and cellular receptors that can increase the likelihood of developing lung cancer, transforming the understanding and treatment of the disease.
As researchers have learned more about the complex cellular changes that can turn into lung cancer, the field has moved from treating lung cancer as a single disease to breaking it down into subtypes of disease that begin in the lungs. This specificity has led to the development of precision treatments that are more effective than previous approaches.
“Precision medicine based on the genetic makeup of the tumor is part of our standard of care,” no matter where you live and what stage of disease you’re diagnosed with, says Dr. Christine Lovly, division chief of thoracic medical oncology with City of Hope’s national system. She is based at City of Hope Comprehensive Cancer Center in Duarte, California.
This is important because it’s not merely a theoretical or academic concept. “Whether you’re in Los Angeles or New York or rural North Dakota, that is part of your care for lung cancer,” she says.
Who Qualifies for Lung Cancer Screening?
Regular screening for lung cancer is not yet available to everyone, although people who currently or formerly smoked heavily are encouraged to monitor the health of their lungs, especially if they won’t or can’t quit smoking.
Dr. Mia Kazanjian, a board-certified radiologist specializing in breast and body imaging with Stamford Health in Stamford, Connecticut, says that the current gold standard screening for lung cancer in high-risk individuals is a low-dose chest CT.
“I tend to follow the NCCN,” Kazanjian says, which defines high risk as age 50 and over with a 20 pack-year history of smoking cigarettes or more than 20 years of smoking cigarettes. These high-risk individuals should get an annual low-dose CT scan of the chest.
The current USPSTF recommendation calls for annual low-dose CT screening in adults aged 50 to 80 who have at least a 20 pack-year smoking history and currently smoke or have quit within the past 15 years. This represents an expansion from the prior 2013 guidelines, which required a 30 pack-year history and set the eligibility window at ages 55 to 80, aiming to screen a larger population of high-risk individuals.
However, be aware that screening can cause false-positives, which can lead to unnecessary surgery and potential harm to the patient.
Therefore, it’s best to discuss with your provider whether screening makes sense for you based on your specific situation. And be sure to advocate for yourself, say Dr. Rohit Gosain, medical oncologist and hematologist at the Roswell Park Care Network, and Dr. Rahul Gosain, medical director of the University of Rochester Medicine’s Wilmot Cancer Institute at Webster in New York – the two doctors and brothers behind the popular podcast and educational platform The Oncology Brothers.
“Too many eligible patients still aren’t being screened, and too many primary care physicians aren’t flagging who qualifies. Closing that gap is one of the most impactful things we can do right now for lung cancer outcomes at the population level,” the Gosains note.
How do I calculate pack years?
To calculate your pack-year figure, multiply the number of packs of cigarettes you smoke or smoked daily by the number of years you have smoked.
For example, if you smoked a pack a day for 30 years, your pack-year rate would be 30. The higher the number, the higher your risk of developing lung cancer, and the more you need annual screening with a low-dose CT scan.
Example: 30 pack years = 1 pack of cigarettes daily x 30 years of smoking
How Is Lung Cancer Diagnosed?
To diagnose lung cancer, your doctor will use X-ray or CT imaging to get a better look at your lungs. If a suspicious mass or tumor is found, your doctor may recommend additional imaging such as a PET (or positron emission tomography) scan or lung endoscopy, in which your doctor will use a scope to get a look inside your airways.
A biopsy will remove a tissue sample which can then be tested to determine whether the mass is cancerous, and if so, what type and stage of cancer you have.
Kazanjian says that the Lung Imaging Reporting and Data System, or Lung-RADS, classification system from the American College of Radiology is commonly used to make assessments of nodules seen on a chest CT. “As a radiologist, I describe nodules and use the Lung-RADS to categorize them as benign, probably benign or suspicious, among others, and make recommendations for their management.”
Features that make a nodule suspicious include:
- Size. Large nodules – those 8 millimeters or larger – should be investigated further.
- Shape. Irregularly shaped nodules need to be investigated.
- Growth rate. Nodules that have appeared suddenly or are growing quickly need to be checked out.
Samples of your tumor will be sent to the lab for additional analysis to determine the specific genetic mutations that may be driving the growth of the cancer. This information is important for helping your oncologist develop the right treatment plan for your individual case.
How liquid biopsies and AI could improve early lung cancer detection
An innovative way of determining whether cancer may be in the body is liquid biopsy. While it’s not being used to initially diagnose cancer, it’s been useful in helping detect recurrence and helping pinpoint genetic mutations that could affect treatment decisions. This approach uses a simple blood sample to look for fragments of tumor DNA or other signs of cancer circulating in the blood.
The hope is that as the accuracy of these analyses improve, liquid biopsy could eventually replace CT imaging as a routine screening method, as it’s less invasive, has very few side effects, may be less expensive to make available to a wider swath of the population and returns results in about seven to 10 days versus two to three weeks for a conventional tissue biopsy.
“That faster turnaround time helps me get answers for patients faster during a very vulnerable time,” Lovly says. It also enables doctors to make informed decisions about treatment approaches more quickly.
Artificial intelligence is also playing an increasing role in the detection of lung cancer. This “significant innovation” uses “deep learning to detect and categorize nodules with high sensitivity and specificity,” Kazanjian says.
AI detection software can produce these results with ultra-low-dose CT. “There is also a program, Sybil, that can predict the future risk of lung cancer based on the low-dose chest CT,” she notes.
A combination of liquid biopsies and AI-assisted image analysis could significantly increase the chances of earlier detection in the future, which in turn could lead to more successful treatment.
What Are the Types of Lung Cancer?
A lung cancer diagnosis varies across patients, but there are two main types of lung cancer: non-small cell lung cancer, or NSCLC, and small cell lung cancer, or SCLC.
Type of Lung Cancer
How Common Is It?
Key Characteristics
How It’s Classified
Non-small cell lung cancer (NSCLC)
Accounts for about 77% of lung cancer cases
- The most common type of lung cancer
- Generally grows more slowly than SCLC
- Often diagnosed after it has spread
- Includes several subtypes
Stage 0 through 4 based on tumor size and location
Small cell lung cancer (SCLC)
Accounts for about 13% of lung cancer cases
- Less common but tends to be more aggressive
- More likely to spread to distant organs quickly
- Also sometimes called oat cell cancer
Staged as limited or extensive depending on the size and location of the tumors
What Are Lung Cancer Stages?
As part of a lung cancer diagnosis, your doctor will stage the disease, meaning they will find out:
- Where the cancer cells are located
- The size of the nodule or nodules
- Whether cancer has spread to other parts of the body
This process helps your team determine the best way to treat the cancer, and it can provide some information about prognosis, or how long you might live with the disease.
Doctors use the TNM classification system to assign a score for:
- T: tumor size and location
- N: regional lymph node involvement
- M: metastasis in distant organs
NSCLC stages
NSCLC has five stages and numerous sub-stages to pinpoint the severity of disease.
- Stage 0: This very early-stage lung cancer is only in the top lining of the lung or bronchus and has not spread. It’s also sometimes called carcinoma or tumor in-situ.
- Stage 1: This early stage is divided into two sub-stages, 1A and 1B, based on the size of the tumor. These cancers have not spread to the lymph nodes or other parts of the body.
- Stage 2: This mid-stage disease is also divided into sub-stages, 2A and 2B, with further sub-stages that depend on the size and location of the tumors. These tumors are larger than Stage 1 tumors and/or have begun spreading to nearby lymph nodes.
- Stage 3: Stage 3 tumors are classified into 3A, 3B or 3C, depending on the size and location of the tumor and how far it has spread. Stage 3 tumors are typically in the lymph nodes and the mediastinum – the area between the lungs.
- Stage 4: This is the most advanced form of NSCLC and means the cancer has spread to the lining of the lung or other areas of the body such as the brain or bones.
SCLC stages
SCLC has just two primary stages:
- Limited stage. This earlier-stage cancer is detected in only one lung with or without spread to the lymph nodes in the mediastinum.
- Extensive stage. This advanced-stage cancer has spread to tissue outside the originally affected lung, such as the opposite lung or distant organs.
How Is Lung Cancer Treated?
Although lung cancer is the leading cause of cancer death in the United States, there are ways to treat the disease that can prolong a patient’s life.
The very first thing you should do upon receiving a lung cancer diagnosis is quit smoking if you haven’t already done so. Although never smoking is best, quitting as soon as possible is always better than continuing to smoke.
Even if you’ve smoked for a long time, quitting smoking is the best way to help improve your survival timeline and prognosis.
Treatment for NSCLC typically starts with surgery. There are a few different options depending on the stage of cancer:
- A wedge resection removes the tumor and a wedge-shaped perimeter of healthy cells around it. This may be enough if the cancer hasn’t spread beyond the lung.
- A lobectomy removes a lobe or section of the lung in some more invasive or later-stage cases of NSCLC.
- A pneumonectomy, or removal of the entire lung, may be recommended in some later-stage cases. It’s possible to still lead a relatively normal life with just one lung.
- A sleeve resection surgery removes part of the bronchus if the tumor is located in those tubes that connect the windpipe to the lungs.
Depending on the stage and type of cancer you have, your doctors may also recommend that you undergo:
- Radiation therapy
- Chemotherapy
- Immunotherapy
- Targeted genetic therapies
Advanced lung cancer treatment options
Recent treatment advances have improved the outlook for lung cancer patients. “Lung cancer treatment has been transformed by our ability to identify specific genetic mutations driving tumor growth,” the Gosain brothers explain.
“What we call next-generation sequencing – a comprehensive molecular fingerprint of someone’s cancer – is now standard of care. It tells us which mutations are present and which targeted therapies have a shot at working against them.”
A number of newer therapies now can use this genetic sequencing information so your provider can select a more effective, precision treatment to target:
- EGFR mutations
- ALK fusions
- ROS1 fusions
- KRAS G12C
- MET exon 14-skipping
- RET fusions
- HER2 mutations
- NTRK fusions
“What’s exciting is each has a corresponding drug or drug class designed to attack that specific vulnerability,” the Gosain brothers say. This means that now “lung cancer has become the field’s leading example of what precision medicine looks like in practice, with more actionable mutations than perhaps any other cancer types.”
Nevertheless, for someone diagnosed with EGFR or ALK-positive lung cancer today, “the conversation with their oncologist should be fundamentally different than it would have been in 2010 or even 2015.”
However, the Gosains note that these therapies do have some side effects and need to be managed carefully. Your provider can help you figure out if the potential risks are worth the benefits for any specific treatment.
Health Care Providers That Treat Lung Cancer
Lung Cancer Survival Rate by Stage
The National Cancer Institute’s SEER database, which stands for Surveillance, Epidemiology and End Results, provides estimates of survival rates for different types and stages of lung cancer. The combined five-year survival rate for all types of lung and bronchus cancer is 29.5%.
But there’s a lot of variation to that rate depending on the type of cancer and when it’s detected. Here’s a look at how those factors alter the expected survival rates.
Stage at Diagnosis
NSCLC five-year survival rate
SCLC five-year survival rate
Clinical Meaning
Localized
67%
34%
The cancer has not spread beyond the lung.
Regional
40%
20%
The cancer has spread outside the lung to nearby structures or lymph nodes.
Distant
12%
4%
The cancer has spread to distant parts of the body, such as the brain, bones, liver or other lung.
All SEER stages combined
32%
9%
Combined five-year survival rate for all types and stages of lung and bronchus cancer is 29.5%.
These rates only apply to the stage of the cancer when it is first diagnosed, not later if the cancer grows, spreads or returns after treatment.
Other factors that can influence your prognosis include:
- Subtype of NSCLC
- Gene mutations in the cancer cells
- Your age
- Your overall health
- How well the cancer responds to treatment
- Quality of care you receive
Survival rates can be useful for predicting how long someone with a particular type or stage of lung cancer might expect to live, but even so, they don’t paint the whole picture, and each case of cancer is different.
Generally speaking, the healthier you are overall and the earlier the cancer is caught, the better the outlook. But even for the direst cases, new treatment breakthroughs are extending life expectancy significantly.
One of the most impactful of these breakthroughs has been the introduction of immunotherapies – especially immune checkpoint inhibitors, Lovly says. Examples include pembrolizumab (Keytruda) and nivolumab (Opdivo).
These drugs are “harnessing the power of the immune system to help fight cancer. Not every patient benefits from those, but they have been transformative,” she notes.
The introduction of targeted therapies, which are drugs deployed based on the genetic composition of the tumor, have also been revolutionary. “Those two classes of agents have transformed lung cancer care,” Lovly says.
That coupled with recent expansions of screening guidelines have helped reach more high-risk people. This means more cases of lung cancer are being caught early when they’re most treatable, and that means better survival outcomes.
“We have a long, long way to go in terms of improving our uptake of lung cancer screening,” Lovly says. But each improvement is a step forward.
How Can I Prevent Lung Cancer?
While you can’t control your genetic makeup, there are a few things you can do to reduce your risk of developing lung cancer.
- Don’t smoke, or quit smoking now. Because lung cancer is so closely associated with smoking, the biggest way to prevent developing the disease is to not smoke. If you smoke, quitting now will greatly reduce your chances of developing the disease later. If you already have lung cancer, quitting smoking will improve your prognosis and your survival outlook.
- Avoid e-cigarettes and smokeless tobacco. You should also avoid using smokeless tobacco products and electronic e-cigarettes that have claimed to be safer alternatives to smoking conventional tobacco cigarettes. “There is evolving research into e-cigarettes that show they are addictive, carry carcinogens and increase risk of lung cancer,” Kazanjian says. Therefore, the ACS and other experts advise avoiding e-cigarettes all together, especially for young people. “This is crucial because e-cigarette use is on the rise, and they are being marketed as flavorful and safer than cigarettes, but they can be very dangerous,” she adds.
- Avoid environmental exposures. Avoiding exposure to known inhalable carcinogens, such as asbestos, silica dust and air pollution, and reducing exposure to radiation can all lower your risk.
- Test for radon. The Gosains note that radon testing “deserves more attention than it typically gets,” as it’s the second leading cause of lung cancer deaths in the U.S., responsible for an estimated 21,000 deaths per year.
- Take care of yourself. General good health advice applies here as it would for any chronic disease. This means you need to exercise regularly, eat right, get plenty of sleep, manage your weight and manage your stress levels.
Nonsmokers are still at risk
While smoking is the No. 1 risk factor for developing lung cancer, a growing number of people who don’t or never smoked are being diagnosed.
“There’s been a stigma around lung cancer that it’s only a smoker’s disease, but that is absolutely not true,” Lovly says.
A concerning rise in the rates of lung cancer among never-smokers underscores this fact. Lovly says it’s not clear exactly what’s going on, but some risk factors include radon, air pollution and other environmental exposures, such as particulate matter in the air from wildfires. “They set up inflammatory states in the lungs,” she says, which over time can accumulate and lead to the development of lung cancer.
The bottom line is: Smoking is not the only risk factor for lung cancer, Lovly says, and you should ask your provider about whether lung cancer screening makes sense for you given the many risk factors that can contribute to it.
Emerging Field: Lung Cancer Survivorship
Lovly says she loves being a lung cancer doctor in part because it’s an exciting time to be a lung cancer specialist – there are so many new treatments that are significantly improving quality of life and life expectancy for patients. But these improvements bring about the question of what these individuals need to know or do to maximize their experience while living with or beyond lung cancer.
Even just a few years ago, lung cancer survivorship wasn’t common. But now, she says, “patients are living with advanced disease for more time then they used to do.” These individuals are living through and beyond treatment, and creating support systems and developing survivorship care guidelines is an important focus going forward, she says.
This is an active area of research that will continue to evolve and impact how people live with and after lung cancer, Lovly says.
FAQs
Can you get lung cancer if you never smoked?
Yes. While smoking is still the leading cause of developing lung cancer, about 15% to 20% of cases occur in people who never smoked. Risk factors include radon exposure, air pollution and inherited genetic mutations.
Who qualifies for lung cancer screening?
Current screening guidelines target adults ages 50 to 80 who have a 20 pack-year smoking history and who currently smoke or quit within the past 15 years. Talk with your health care provider about whether you’re at high risk of lung cancer and should begin annual screening with low-dose CT chest scans.
How do I calculate pack years?
Multiply the number of packs of cigarettes you smoked per day by the number of years you smoked. For example, if you smoked one pack a day for 20 years, your pack-years equals 20.
What is precision medicine for lung cancer?
Precision medicine uses genetic testing of a tumor to identify which mutations are driving the cancer’s growth. This information helps your doctor choose the right targeted therapy that may provide better outcomes with fewer side effects. Molecular testing of tumors is now considered standard of care for all lung cancers.
How can I lower my risk of lung cancer?
The best thing you can do is never smoke or quit smoking now. Taking care of your overall health and well-being and limiting exposure to known carcinogens can also help lower risk.
