Why Are More Nonsmoking Women Getting Lung Cancer?

At upcoming annual symposium, a Johns Hopkins oncologist will describe her quest for answers.

Published in Dome - September/October 2018 Dome

Oncologist Julie Brahmer is trying to understand why more women who have never smoked are developing lung cancer. (Nonsmoking men are, too, but to a lesser extent.) Toxins in the environment, genetic predisposition and interactions with hormones may hold clues to why this is occurring. 

This topic—and dozens more health concerns—will be addressed at A Woman’s Journey, the annual Johns Hopkins Medicine conference that offers insights on women’s physical and emotional health.

This year’s event takes place Saturday, Nov. 10, at the Hilton Baltimore. Some 750 women from 18 states are expected to attend. Each attendee chooses four of 32 presentations. The sessions highlight such diverse topics as brain health, hair loss, insect bites, pain relief and heart disease. 

In the 24 years since it began, A Woman’s Journey (AWJ) has enlightened participants about scores of medical discoveries, such as the mind-gut connection and skin diseases that can reveal the health of the entire body. Speakers have often described research that yields surprising—even counterintuitive—results.

That’s how Brahmer views her studies on women and lung cancer. In recent years, Brahmer, director of the Thoracic Oncology Program at Johns Hopkins and an international leader in lung cancer clinical trials, has witnessed rising rates of lung cancer in her female patients who’ve neither smoked nor had regular exposure to tobacco smoke.

Brahmer will share her clinical experiences, research and success with new immunotherapies—cancer treatments that boost the body’s natural ability to fight cancer—at the conference.

Brahmer’s session on lung cancer in women who have never smoked will likely draw strong interest, says Yasmine Sursock-Khouri, a marketing project manager for the event, because the news is so alarming.

But for nonsmokers between the ages of 40 and 79, more women than men are at risk for developing lung cancer. The latest data show an incidence rate in nonsmoking women ranging from 14.4 to 20.8 percent. For nonsmoking men, the rate is between 4.8 and 13.7 percent.

Brahmer says, “Patients who have never smoked are shocked and ask, ‘Why me?’” It’s not clear whether the causes are environmental, hormonal or genetic, she adds, “but we’re looking at this carefully and pressing the government to do the same.”

Brahmer acknowledges that exposure to secondhand smoke and high radon levels, as well as family history, can also raise risks. “We haven’t been able to find a particular gene,” she says, “but having a sibling or parent with lung cancer also increases your risk.”

She also wants women to be aware of symptoms that can alert a patient and physician to lung cancer before the spread of disease. Red flags include shortness of breath, an incessant cough and overwhelming fatigue.

Brahmer chose to study lung cancer in the 1990s because treatment for the disease was then in its infancy. Her interest was also personal: Several of her family members died from lung cancer. All were men, but in her practice, Brahmer began noticing that more women who had no exposure to tobacco smoke were developing lung cancer.

From the outset of her career, she’s been working on lung cancer treatments. For the past dozen years, she’s been helping to develop immunotherapies to treat patients with lung cancer. Brahmer’s clinical trial results led to the approval of immunotherapy to treat non-small cell lung cancer.  

The side effects of immunotherapy differ drastically from those of chemotherapy, notorious for causing extreme nausea, Brahmer explains. Immunotherapy can cause inflammation of organs, including lungs, colon and skin. But the number of Brahmer’s female patients who require treatment for these side effects, she says, is only 15 percent. And those symptoms can be relieved by steroids.

Spending time with patients inspires Brahmer to press harder for more clinical research dollars. “To see people respond to therapy—and for these women to be able to see their kids graduate from high school or have grandchildren—has been gratifying,” she says. With more funding, she adds, “we can have an impact on how well patients do, and, over the next 10 years, we think it will be possible to cure more patients with this disease.”

Brahmer has been a featured speaker at AWJ in Palm Beach as well as Baltimore. “It’s been a great experience to see so many women vested in their health,” she says. “People need to keep lung cancer on their radar; it’s not just ovarian or breast cancer that can strike women.”

AWJ has taken place in nine locations, including Palm Beach and Naples, Florida, where the topic of rising rates of lung cancer in nonsmoking women will also be covered. In recent years, in partnership with Johns Hopkins Medicine International, the program has expanded to Bermuda and Saudi Arabia. Employees receive a 10 percent discount for registration. Continuing education units also are offered by professional groups.

Learn more about A Woman’s Journey.