Lung Cancer in Never-Smoker Women: The Emerging Urban Indian Reality
Published On: February 4, 2026
Lung Cancer in Never-Smoker Women: The Emerging Urban Indian Reality
By Dr. Rajendra T. Nanavare, Pulmonologist & Chest Physician (Mumbai)
Lung cancer has long been wrongly branded as a “smoker’s disease.” However, India is now witnessing an epidemiologic shift where a growing number of lung cancer patients—especially women—report no active smoking history. In clinical practice, the appearance of multiple consecutive cases in never-smoker women is no longer unusual. Recent registry-linked analyses and Mumbai-specific reporting also support this trend.
National registry-based estimates report that India recorded approximately 1.56 million new cancer cases and 8.74 lakh cancer deaths in 2024. Within this burden, cancers of the trachea, bronchus and lung contributed substantially: about 74,763 cases in men and 30,446 cases in women, with high mortality (56,818 deaths in men and 24,055 deaths in women).
Why are never-smoker women increasingly represented?
Evidence from Indian and regional reviews indicates that a large proportion of lung cancer in our region occurs in never-smokers, often quoted around 40–50% in Indian series, and the dominant histology is frequently adenocarcinoma.
Mumbai reporting, based on Tata Memorial Centre epidemiology commentary, highlights a striking pattern: adenocarcinoma forms about 56% of lung cancer cases in Mumbai, surpassing squamous cell carcinoma and small-cell carcinoma. Since adenocarcinoma is commonly seen in never-smokers, this histologic shift strengthens the link to non-tobacco risk factors.
Key drivers beyond tobacco
Urban India has multiple exposures that can raise lung cancer risk even without smoking:
Outdoor air pollution (PM2.5) from traffic, construction, and industrial sources
Indoor air pollution from biomass/poor ventilation and chronic smoke exposure in households
Occupational hazards including diesel exhaust and dust/chemical exposures
Genetic and tumour biology factors, with never-smoker adenocarcinoma often showing actionable molecular alterations (which can guide targeted therapy)
A crucial clinical warning: lung cancer can mimic TB
India continues to see delayed lung cancer diagnosis because symptoms overlap with tuberculosis and chronic respiratory disease. A recent Government of India response referencing NCRP findings acknowledges this diagnostic challenge and stresses referral when cancer is suspected.
For general practitioners, the message is simple: a never-smoker woman with persistent cough/breathlessness, weight loss, hemoptysis, chest pain, recurrent pleural effusion, or a non-resolving “pneumonia/TB-like” picture needs early imaging—preferably CT chest—and tissue diagnosis.
This emerging pattern demands a shift in how society and healthcare systems think about lung cancer. Clean-air action becomes cancer prevention; occupational exposure control becomes cancer prevention; and public awareness must clearly state that lung cancer can occur in never-smokers, particularly women in polluted urban environments.
Conclusion
clinic experience aligns with India’s evolving lung cancer epidemiology: more never-smoker women, more adenocarcinoma, and more emphasis on air pollution/indoor exposure/occupational risk and genetics. The most effective immediate step is earlier suspicion, earlier CT imaging, and prompt tissue and molecular diagnosis—because in lung cancer, time lost is life lost.
