Lung cancer now kills more American women each year than breast, pancreatic, and ovarian cancers combined, yet a growing share of new cases strikes women who have never touched a cigarette, and current screening rules do almost nothing for them.
Former YouTube CEO Susan Wojcicki never smoked. She died of lung cancer at 56. Her sister, Anne Wojcicki, started the Susan Wojcicki Foundation with their family to push early detection and prevention of a disease that, by the time most patients feel symptoms, has already spread too far to treat. Roughly 20 percent of all lung cancer cases occur in nonsmokers, and women who have never smoked account for two-thirds of that group, a ratio that makes the current screening framework look like a policy built for a different era.
The American Lung Cancer Association recommends low-dose CT scans only for people over 50 who have a 20-pack-year smoking history, the equivalent of a pack a day for 20 years. That guideline, by definition, excludes every nonsmoker. And the survival gap between early and late detection is enormous: patients caught at stage I or II have an 81 percent survival rate, according to a 2023 study in The Journal of Radiology. Patients diagnosed at a late stage face a 10 percent survival rate, CBS News reported.
Shira Kupperman Boehler, a friend of Anne Wojcicki, was diagnosed with stage 1B lung cancer at 44. She had never smoked. Under current guidelines, she would not have qualified for a screening scan for at least six more years, and even then, only if she had a two-decade smoking history she did not have.
Boehler put the problem in plain terms:
"The problem is we don't feel our lungs until it's too late, until the cancer has spread to our bones, to our brain, and then it is the number one cancer killer."
She said she wants lung cancer screening to begin at age 40, the same age many women start routine mammograms. That proposal would represent a sharp departure from the current guidelines, which tie eligibility almost entirely to smoking history rather than sex or age alone.
Dr. Kim Sandler, director of the Vanderbilt Lung Screening Program, appeared alongside Wojcicki and Boehler on Norah O'Donnell's health podcast "Healthful." Sandler did not mince words about the scale of the problem.
"This is a women's health crisis, but we don't talk about it."
Sandler also flagged a risk that breast cancer survivors in particular need to hear. Lung cancer, she said, is the most common cancer to develop after breast cancer, a connection that most patients and even some physicians do not emphasize enough.
"We think about cancer as lightning striking. 'I've had this disease. I should never have to deal with this again. I'm so fortunate that I've come out on the other side.' And the truth is that once we have cancer once, we're actually at an increased risk of developing cancer again, and lung cancer is the most common cancer to develop after breast cancer."
That statement reframes the risk for millions of women who finished breast cancer treatment and assumed the worst was behind them. Under current guidelines, none of them would qualify for a lung screening unless they also happened to be longtime smokers.
The core tension is straightforward. Medical guidelines gate access to the one proven early-detection tool, low-dose CT scans, behind a smoking threshold that automatically excludes the fastest-growing group of lung cancer patients. Twenty percent of cases are nonsmokers. Two-thirds of those nonsmokers are women. The survival difference between early and late detection is 81 percent versus 10 percent. And yet the system waits for symptoms that, by the time they arrive, often mean the disease has already metastasized.
Anne Wojcicki watched her sister die from a disease that might have been caught earlier with broader screening. The Susan Wojcicki Foundation now focuses on early detection and prevention, though the foundation's specific policy proposals and programs beyond that stated mission are not yet public.
O'Donnell, who said she knew Susan Wojcicki personally, had interviewed her, and had hosted her at her home, used the "Healthful" episode to press the case that the medical establishment's screening criteria have not kept pace with the changing profile of lung cancer patients.
Several questions remain unanswered. No one in the episode identified why nonsmoking women are developing lung cancer at rising rates. The source of the 20 percent nonsmoker statistic was not cited. And whether any formal push exists to change the American Lung Cancer Association's screening age or eligibility criteria, from advocacy groups, Congress, or the medical community, was not addressed.
When the government builds a screening system around yesterday's risk profile, the people who fall outside the old categories pay with their lives. Women who never smoked deserve better than a set of guidelines that assumes they are not at risk.
