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No risk factors, no symptoms: How early lung cancer was discovered in a non-smoker
A 60-year-old’s routine health screening revealed Stage 1 lung cancer – a reminder that the disease can strike anyone, and early detection can be life-saving
A low-dose CT scan can detect lung nodules as small as 4mm to 5mm, enabling early intervention when treatment is most effective.
PHOTO: GETTY IMAGES
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John (not his real name) is a model of healthy living. The former general counsel regularly plays sports and also ensures he eats a balanced diet. He also has never smoked in his life, with no family history of lung disease.
An X-ray ordered during a routine health screening in Oct 2024 revealed an unexpected shadow.
Says the 60-year-old: “The X-ray revealed a dark spot in the right cavity of my chest, and the doctor advised me to follow up with a low-dose CT (computed tomography) scan for further investigations.”
The patient was referred to Dr Su Jang Wen, a cardiothoracic surgeon at Gleneagles Hospital, who confirmed the presence of a 2cm tumour at the upper part (lobe) of his right lung.
“It took a while for the news to sink in,” recalls John.
After consulting with Dr Su, John underwent a single-incision video-assisted thoracoscopic surgery (VATS). The tumour was first extracted through a 2.5cm incision, and an on-site pathologist immediately tested the tissue, confirming it was cancerous.
The surgical team then removed the entire upper lobe – one-third of John’s right lung – along with the lymph nodes on the right side of his chest to ensure all cancerous tissue was excised.
Following the surgery, John was discharged within a week, and he was able to resume his daily activities within a month.
Early detection is key
“Every year, almost 2 million people worldwide die from lung cancer. While it may not be the most common cancer, it is the leading cause of cancer-related deaths worldwide
He also observes that there has been an increasing number of lung cancer diagnoses in non-smokers, particularly in Asia. “Environmental factors, genetic predisposition, air pollution and second-hand smoke exposure can all contribute to the development of lung cancer.”
“However, there is a significant group of patients with no risk factors found, such as in John’s case,” says Dr Su.
Dr Su Jang Wen emphasises that early detection through low-dose CT screening can significantly improve cancer patients’ survival rates.
PHOTO: GLENEAGLES HOSPITAL
Adds Dr Chin Tan Min, a medical oncologist at Gleneagles Hospital: “Although smoking is a definite risk factor for lung cancer, it has been increasingly recognised that lung cancer can occur in non-smokers.
“A local study of two groups of lung cancer patients1 found that the proportion of never-smokers diagnosed with lung cancer increased from 31 per cent in the 1999-2002 cohort to 48 per cent in the 2008-2011 group.”
According to the Singapore Cancer Registry Annual Report 2022
Nipping this cancer in the bud is critical. “The survival rate drops by 30 to 40 per cent between Stages 1 and 2,” says Dr Su, explaining: “While Stage 1 lung cancer has a five-year survival rate of at least 65 per cent, the early form (Stage 1A1) can be cured in more than 92 per cent of cases, according to the American Cancer Society.
“In contrast, survival rates for Stage 4 disease remain in the single digits despite medical advances.”
Dr Chin Tan Min notes that lung cancer is increasingly being diagnosed in non-smokers, with nearly half of the cases in a Singapore study occurring in people who have never smoked.
PHOTO: GLENEAGLES HOSPITAL
In John’s case, his Stage 1 lung cancer offered the best prognosis, as the tumour was still small and had not spread to lymph nodes or other organs, notes Dr Su.
Dr Chin adds: “Depending on the size of the nodule, generally, suspicious-looking nodules that are of a significant size will need to be biopsied to rule out cancer. For very small nodules that are less than a centimetre, doctors may choose to monitor them over time with regular check-ups.
“This can be a grey area, and the healthcare team should make this decision together with each patient based on their specific situation.”
She continues: “If cancer is found, the treatment depends on how advanced it is. Early-stage cancer might be treated with surgery or radiation therapy. More advanced cases may need a combination of treatments, including chemotherapy, immunotherapy, and/or targeted treatment to treat the cancer. The goal is to give patients the best chance of full recovery.”
Dr Su says that early identification of potential malignant tumours and taking definitive action at the earliest possible timing are important. In his practice, he has been removing lesions less than 1cm when clinically appropriate, to help clarify the diagnosis and guide subsequent care should the lesion turn out to be cancerous.
A ‘silent’ disease
However, one of the key challenges with lung cancer is that it often develops silently, prompting the need for screening of those at high risk to facilitate early detection.
Symptoms such as persistent cough, chest pain, or breathlessness typically emerge only in more advanced stages, notes Dr Su.
Busting common lung cancer myths
According to Dr Su Jang Wen, cardiothoracic surgeon at Gleneagles Hospital:
Coughing out blood to depict lung cancer as seen in television shows is not the usual presentation of lung cancer.
Contrary to popular belief, most patients who undergo lung cancer treatment do not go bald.
You can continue your fitness goals: Through structured exercise and physiotherapy programmes, the initial lung function loss after surgery can be much improved or recovered.
A low-dose CT scan, which provides detailed cross-sectional images of the lungs, uses only about 20 per cent of the radiation dose of a standard chest CT while still producing clear images, he explains.
He adds: “It is sensitive and capable of detecting nodules as small as 4mm or 5mm – sometimes even smaller – making it far more effective than a standard chest X-ray.”
In early 2026, Gleneagles Hospital will offer an ultra low-dose CT option for eligible high-risk patients within clinical screening guidelines.
“Ultra low-dose CT lung screening has been shown to detect lung cancer more effectively than chest X-ray,” says Dr John Wan Mun Chin, a diagnostic and interventional radiologist at Gleneagles Hospital.
“The radiation exposure is comparable to natural background radiation over a short period of time, or roughly one round-trip flight between Tokyo and New York. The scan is fast and painless, does not require any injection, and image interpretation is supported by Health Sciences Authority-approved AI software as part of the clinical assessment process.”
Currently, guidelines by Academy of Medicine Singapore
Dr Chin notes that researchers both globally and locally are studying whether lung cancer screening should be extended to non-smokers in Asia, particularly those with a strong family history of cancers. “Mature results are not definitive at the moment, and as such, there is currently no standardised lung cancer screening programme for non-smokers in Singapore.”
Check your eligibility and speak to your doctor about low-dose CT screening if you are 50 to 80 years old with a ≥20 pack-year smoking history and currently smoke, or have quit smoking within the last 15 years. Find out more about lung cancer screening here.
Footnote
1Toh CK, Ong WS, Lim WT, et al. A Decade of Never-smokers Among Lung Cancer Patients-Increasing Trend and Improved Survival. Sept 2018.
