As lung cancer screening improves in smokers, and as smoking rates continue to decline, we’re seeing a shift in those who are being diagnosed. It’s estimated that up to a quarter of lung cancer cases in Canada are now in non-smokers and in that population of non-smokers, a disproportionately large number are women. In fact, it has been estimated that more women will die of lung cancer than of breast cancer, ovarian cancer, and cervical cancer combined.

There are a number of causes. Second-hand smoke is still an issue, as is exposure to asbestos, but an even greater contributor is air pollution and fine particles in it. The wildfires burning throughout Canada have caused significant deterioration in air quality, but even without their contribution air pollution in general, and especially small particles in the air, do serious damage. These nanoparticles descend deep into the lungs and pass into the circulation, triggering inflammation. Studies have shown that people living in areas with higher levels of air pollution are at an increased risk for lung cancer and cardiovascular disease.

Another cause is radon. This colourless, odourless, radioactive breakdown product of the uranium naturally occurring in rocks and soil can only be detected using special equipment. Houses may have dangerous radon levels without anyone being aware, which is why testing is so important. According to Health Canada, long-term exposure to radon is the number one cause of lung cancer among non-smokers.

There are lung cancer screening programs in British Columbia, Ontario, and Nova Scotia (none in Quebec), but these programs only target smokers. One of the difficulties in making the early diagnosis of lung cancer is that the symptoms at that stage of the disease can be minimal or non-existent. The good news is that lung cancer survival rates and treatments have improved. Five-year survival rates for people with lung cancer have doubled since the 1990s, but it’s still responsible for almost one quarter of all cancer deaths in Canada.

The best situation would be for lung cancer rates to continue to decline and for our diagnostic capabilities to improve so that we can make the diagnosis earlier. Hopefully we’ll get there soon. In the meantime, you should consider having your house checked for radon; limit your exposure to polluted air; check that there’s no asbestos in your workplace; and avoid places where there’s second-hand smoke.

The latest COVID vaccination recommendations

Moderna and Pfizer have updated their COVID-19 vaccines to target the LP.8.1 variant that’s circulating. The current recommendations from the Canadian National Advisory Committee on Immunization is that two doses of the vaccine over the course of a year should be provided to: 1) anyone 80 years of age or older; 2) those with moderately to severely affected immune systems; or 3) those living in long-term care facilities. A single booster dose should be offered to those: 1) 65 to 79 years of age; or 2) at higher risk (for example: pregnant; health care workers; people with serious underlying health conditions; members of equity-denied communities).

The SARS-CoV-2 virus has not disappeared. Infection with it causes serious illness with increased hospitalization and death rates in the elderly and those with underlying health issues, but it still will make even relatively healthy people miserably unwell. The vaccine may not protect 100 per cent, but it will lessen the risk of: 1) serious complications; 2) hospitalization; 3) death; and 4) the risk of developing “long-COVID”.

To me the benefit outweighs the risk, but I leave that decision up to you.

Dr. Mitch Shulman is an Associate Professor in the Department of Emergency Medicine at McGill Medical School as well as an Attending Physician in the Emergency Department of the McGill University Health Centre. He’s also the CJAD AM 800 Medical Consultant.