Lung cancer is commonly believed to exclusively affect older adults with a history of smoking, but teens can and do develop the disease, though it is exceptionally rare. When lung cancer manifests in adolescents, it is biologically distinct from the tobacco-related cancer typically seen in older populations. This distinction means the causes, types, and symptoms are often unique, presenting a diagnostic challenge for young patients.
The Reality of Adolescent Lung Cancer
Lung cancer is one of the rarest malignancies diagnosed during adolescence (ages 15 to 19). The incidence of primary lung cancer in the entire pediatric population is estimated to be approximately 1 in 2 million, accounting for only about 0.2% of all childhood cancers. For comparison, lung cancer is the leading cause of cancer death in adults.
Statistics show that from 2000 to 2019, only 301 cases of primary lung cancer were reported in individuals aged 19 and younger in the United States. This extreme rarity means adolescents are not routinely screened for the disease. The peak incidence in the pediatric population occurs in two age groups: very young children (0 to 4) and older teens (15 to 19).
Distinct Causes and Risk Factors in Youth
The vast majority of lung cancer cases in adolescents are not caused by personal tobacco use, which is the primary factor in adult diagnoses. Instead, the disease in young patients is driven by genetics or specific environmental exposures earlier in life. Many young patients diagnosed with non-small cell lung cancer, the most common type, are never-smokers.
One significant factor is the presence of specific genetic mutations, known as driver mutations, which cause cells to grow too quickly. While lung cancer is not generally considered hereditary, inherited traits or DNA-repair variations can make lung cells more susceptible to cancerous changes. Individuals with a family history of lung cancer may have a two- to threefold higher risk, suggesting a genetic contribution.
Environmental toxins are also recognized as potential causes for lung cancer in non-smokers. Exposure to radon, a radioactive gas that seeps into homes, is the second leading cause of lung cancer overall and poses a risk to youth. Early or prolonged exposure to high levels of secondhand smoke, air pollution, or industrial carcinogens like asbestos can damage lung tissue. Furthermore, a history of prior radiation therapy for a different childhood cancer can increase the risk of developing a secondary malignancy, including lung cancer, years later.
Recognizing Symptoms in Young Patients
Diagnosing lung cancer in adolescents is often challenging because initial symptoms are subtle and easily mistaken for common, less serious ailments. Physicians may initially attribute a cough or wheezing to persistent allergies, asthma, or a routine respiratory infection, potentially delaying diagnosis. Vigilance is necessary, particularly when symptoms are persistent or do not respond to standard treatments.
Key symptoms that warrant further investigation include a persistent cough that does not clear up, especially if accompanied by coughing up blood. Unexplained shortness of breath or wheezing should raise concern if it is unusual or progressive, as it may be mistaken for asthma. Other general signs, such as unexplained weight loss, chronic fatigue, and chest or shoulder pain, can also indicate a developing tumor. Recurrent respiratory infections, such as pneumonia that keeps returning to the same area of the lung, should prompt a doctor to look for an underlying obstruction or abnormality.
Specific Types of Lung Cancer Affecting Teens
The types of lung cancer seen in adolescents are distinct from those commonly found in older adult smokers, influencing both prognosis and treatment. The most frequently diagnosed primary lung tumors in teens are carcinoid tumors, a type of neuroendocrine tumor. Carcinoid tumors often grow slowly and are considered less aggressive than other forms of lung cancer, leading to better outcomes.
Other types that may affect this age group include:
- Pleuropulmonary blastoma, an aggressive tumor primarily affecting infants and younger children.
- Mucoepidermoid carcinoma, which originates in the mucus glands of the airways.
- Various forms of non-small cell lung cancer, such as adenocarcinoma and squamous cell carcinoma.
Because these cancers often have different biological drivers, such as specific gene rearrangements, treatment protocols may rely more heavily on surgery and targeted therapies than on the chemotherapy and radiation typically used for adult smoking-related cancers.