Objective

Lung cancer in never-smokers is recognised as a distinct entity. Many are expected to present late. As there are no established aetiological factors, identification of patients at risk is challenging. The aim of the study is to define the incidence and clinical features of never-smokers presenting sufficiently early for surgery to determine if it is possible to identify patients at risk.

Methods

We retrospectively analysed data from a prospectively collected database of patients who underwent surgery at our institution. The incidence was defined as number of never-smokers versus current and ex-smokers by year. Clinical features at presentation were obtained and collated as frequency (percentage).

Results

A total of 2170 patients underwent surgery for lung cancer from March 2008 to November 2014. The annual incidence of developing lung cancer in never-smokers increased from 13 to 28 percent, attributable to an absolute increase in number and not a change in the ratio of never smokers to current and ex-smokers. 436 (20%) patients were never smokers. The mean age at presentation was 60 (16 SD) years and 295 (67%) were female. Good lung function was observed

Conclusion

We observed more than double the annual incidence of never smokers in the last 7 years, and hypothesise that this is representative of the UK, as we are one of the highest surgical volume centres in our country. Patients present with non-specific symptoms and the majority were detected on incidental imaging. Imaging is likely to play an important role and further efforts need to be expended on early detection in this increasing cohort without any observable risk factors.