In early 2018, Abigail C. Marean, then 38, developed a “violent” cough. She was treated for pneumonia but she never improved. She followed up with a pulmonologist who eventually diagnosed her with stage 4 lung cancer. She couldn’t believe it — she had never smoked.
“When you receive a cancer diagnosis, your mind immediately goes to the worst possible place,” Marean, 41, a private investigator in a risk consulting firm, who lives in Brooklyn, told TODAY. “I had no idea that lung cancer occurs outside of smoking before my own diagnosis.”
She’s sharing her story so that people understand that lung cancer can happen to young nonsmokers and to help them understand what the early symptoms are.
"Only when I got my own diagnosis did I realize and learn about how lung cancer can take place among people who haven’t smoked,” she said. “That’s something people need to be aware of.”
‘Violent’ cough leads to diagnosis
In early 2018, Marean noticed she struggled to breathe if she walked a city block or up the stairs. Then the coughing started.
“It was just a very severe cough, very disruptive, very violent,” she said. “I would be at work or anywhere and erupt into these coughing fits.”
She visited urgent care and received an x-ray. They noticed something in her lungs but thought it was pneumonia and prescribed her an antibiotic. But the coughing continued. She made an appointment with a pulmonologist, who also believed it was pneumonia and prescribed another round of antibiotics.
“That also had no effect,” she said. “That’s when the pulmonologist started thinking more broadly.”
Marean underwent more x-rays, a CT scan and then a procedure where they take tissue from the lung to send it for a biopsy. Then she started experiencing “sharp pain.”
“We went to my pulmonologist’s office but I was keeled over. And he’s like, ‘Abby, I think you might have a collapsed lung,’” she explained.
She was in the hospital when she learned the results of the biopsy — lung cancer. Negative thoughts flooded her mind.
“It is like I’m not going to be able to do anything," she recalled thinking. "I am not going to be able to have any sort of normalcy. I’m going to be lying flat out, dying in a hospital bed. I’m going to lose my hair.”
Marean learned she had anaplastic lymphoma kinase (ALK), a non-small cell type of lung cancer. ALK lung cancer impacts younger people without a history of smoking. Anywhere from 10% to 20% of lung cancers occur in nonsmokers, said Dr. Jorge Gomez, medical director of the solid tumor oncology inpatient unit at The Mount Sinai Hospital.
“It is actually much more common than people realize,” Gomez said. “It’s a fairly significant proportion.”
Nonsmokers and lung cancer
Lung cancers can develop that are not related to using tobacco. But why people who have never smoked develop lung cancer remains murky.
“There are multiple risk factors that are likely to contribute. It’s much harder to pin that down than to attribute the majority of lung cancers to smoking — that relationship is much more clear,” Gomez said.
Risk factors for nonsmokers developing lung cancer:
- Exposure to second hand smoke.
- Exposure to radon gas.
- Environmental exposures, such as air pollution or asbestos.
“So which one has the biggest contribution? We don’t know that. Again because there is no clear link between any of these and the lung cancer,” Gomez said. “What we do know is there are, for example, many studies done in areas where there is a high radon exposure and the incidence of lung cancer is significantly higher, both in smokers and never smokers.”
The same is true for asbestos, he added. But when it comes to things like air pollution or asbestos exposure few people know if they’ve been exposed to it. That means they don’t know their risk factors for developing never-smoker lung cancers. In many cases people are like Marean and receive a diagnosis in stage 4.
“If you take a look at all of the patients with lung cancer about half are diagnosed with already advanced, incurable disease and that’s because often lung cancer doesn’t produce symptoms until it leaves the lungs,” Gomez said. “The first symptoms are usually respiratory so things like cough, difficulty breathing. But by the time these tumors cause symptoms they’ve usually grown enough that they’ve already spread.”
Prior to the COVID-19 pandemic, many people would think little of a cough and not even seek treatment for it. That could also delay diagnosis. And never smokers don’t undergo routine screening for lung cancer — though researchers are investigating better lung cancer screenings.
“There are many efforts to modify screenings, to make screenings less invasive,” Gomez said. “There are efforts to do, for example, blood tests to look at the genetic makeup potential or to look for tumor DNA in the blood.”
Life with incurable cancer
Immediately, Marean started taking a medication “that targets the specific genes that are reproducing in a negative way.” There are at least three generations of the treatment.
“Within a few weeks, honestly, of being on that treatment my breathing improves, my coughing reduced and my symptoms were diminished,” she said. “It shrunk my tumors. It stopped the reproduction of the cells.”
Eventually, she became resistant to the first treatment and for the past two years she’s been taking the second generation of the targeted treatment. She feels good.
“I have a little bit of shortness of breath and some coughing but nearly what I had before,” she said. “The tumors are kept to this reduced size.”
While there’s cancer in her hip joint and liver, she doesn’t qualify for surgery because the cancer has already metastasized. But she’s back at work, able to walk up the stairs without stopping and enjoying life.
“It’s remarkable, the efficacy of this treatment,” she said.
At first, she was told her lifespan would be about three years. She’s already three and a half years into treatment and knows she has another treatment she can try. But she hopes more will emerge.
“The cancer will ultimately grow resistant to the treatment I’m on now,” Marean said. “The medical world is actively researching and developing these treatments."
While she originally felt depressed when she was first diagnosed, she feels like she’s reached some acceptance.
“I’m in a better place having had some time to sit with it and do the work myself of processing it,” she said.
Marean hopes to raise awareness of lung cancer in nonsmokers and the symptoms of it.
“Telling people that lung cancer can very much exist outside of a habit of smoking and for people who are under 40 years old, it can happen, (is important),” she said.