She Was 39, Never Smoked and Diagnosed with Lung Cancer

The day after Thanksgiving two years ago, Emily Walthall woke up feeling pressure in her chest. Then she started coughing.

“I went to the doctor and got a COVID test, but it was negative,” says Walthall, a lawyer in Brevard, North Carolina. “They thought it might be pneumonia, so they put me on antibiotics.”

Walthall was 39 years old and had never smoked. No one suspected lung cancer, and she had no family history of the disease. But in February, she was diagnosed with stage 4 lung cancer, meaning it had spread beyond her lungs—in her case to her brain and spine.

“It was devastating and totally shocking news to receive,” she says. “Like most people, I thought if you didn’t smoke, you didn’t get lung cancer.”

But, says UNC Health oncologist Jared Weiss, MD, “if you have lungs, you can get lung cancer.”

Lung Cancer Is Common and Deadly

In the United States, lung cancer is the second most common type of cancer in both men and women, and the leading cause of cancer deaths, accounting for almost 25 percent of cancer deaths. Most of the people diagnosed with lung cancer are age 65 or older, but there’s evidence that a growing number of young nonsmokers, like Walthall, are being diagnosed.

Between 10 and 20 percent of lung cancer cases in the United States are in nonsmokers—people who never smoked or smoked fewer than 100 cigarettes over their lifetime. Some have been exposed to secondhand smoke or radon or have a family history of lung cancer.

Making matters worse for people with lung cancer, research into treating the disease is underfunded, says Walthall, who has become an advocate.

“Lung cancer claims more lives each year than breast, pancreatic and prostate cancer combined, but those cancers receive an average of three times more federal research funding per life lost than lung cancer,” Walthall says.

Targeted Therapy for Lung Cancer

Once she was diagnosed with non-small cell lung cancer, Walthall’s doctors started treating her with targeted therapy through six pills a day aimed at her specific gene mutation. Targeted therapy works for people whose cancer can be traced to a specific gene mutation that causes cancer cells to grow out of control.

“Lung cancer is not the only cancer caused by actionable oncogenic mutations, but it is the most common,” Dr. Weiss says.

Doctors can test cancerous cells for biomarkers, which are genes, proteins and other substances that give information about a particular cancer. Testing for biomarkers can be critical for patient survival because it can help doctors identify effective targeted therapies that can be more effective and less harsh than chemotherapy.

Doctors found a fusion in Walthall’s RET gene, a DNA rearrangement that appears in about 2 percent of patients with lung cancer. These patients tend to be younger and have little or no smoking history. The fusion causes production of an abnormal form of protein that helps cancer cells grow.

The side effects of her RET inhibitor are minimal, Walthall says, and her doctors started seeing improvement after three months of treatment. Now, more than nine months after her first pill, much of the cancer in her lungs and spine has cleared, and there is no sign of cancer in her brain.

Finding Support as a Lung Cancer Patient

Support from her husband, Elliott, and other family members and friends has been critical, Walthall says. Some members of her medical care team shared stories about their own health challenges, encouraging her to have hope. And she is part of an online support group of people with her type of cancer; many of them are on the same medication.

“The RET support group offers their own specific type of support because they’ve been through it,” she says. “It’s important to have a group where you can ask questions and share feelings with people who know what you’re dealing with.”

She didn’t join a support group right away.

“I was hesitant,” she says. “What if someone on my treatment had a bad experience? Would it scare me? What if someone takes a different approach to grief that doesn’t help me? But from the beginning, this was a loving, nurturing group. Sometimes, just talking with someone else your age with the same fears can be really important.”

Now that she is feeling stronger, she is advocating for others with cancer and for increased funding for research.

“It feels good to channel some of my energy into helping others in the lung cancer community,” she says. She wants to help erase the stigma often associated with lung cancer that patients caused their illness by smoking.

Eventually, her cancer may develop resistance to her RET inhibitor drug and she will need new treatments. That’s why research is so critical, she says. Dr. Weiss is part of clinical trials at UNC that are testing a next-generation RET inhibitor.

“Grief is a daily process,” says Walthall, who is 40 and focused on enjoying life with her husband and their three dogs, two English setters and an English springer spaniel. “But I’m doing really well, and I can finally get excited again about looking ahead.”

Get to the Bottom of Chronic Cough or Trouble Breathing

If you have a chronic cough, difficulty breathing or any symptom that isn’t clearing up with time or treatment, keep asking questions, Dr. Weiss says.

“A lung cancer diagnosis is often delayed because the main symptoms—cough and trouble breathing—are far more likely to be something else,” Dr. Weiss says. “When a person starts to cough, especially a nonsmoker, lung cancer is not the first thing you think of.”

The symptoms are usually due to an infection that will resolve, but, if your prescribed treatment isn’t working, ask your doctor what else could be going on and if further tests are needed.

If you or a loved one has cancer, ask your doctor or hospital about support groups, or use online resources to find help.

To find out more about lung cancer symptoms, risks and how to get screened, talk to your doctor, or find one near you.