Lung Cancer and Women: A Q&A with Narjust Florez, MD

To honor Women’s Health Month, we sat down with Narjust Florez, MD, to discuss how lung cancer uniquely affects women. Research shows that women often face different—and sometimes more severe—experiences with lung cancer than men. These differences happen because of biology and because women haven’t been included in clinical trials as much in the past, which affects how new treatments are created and prescribed to patients. 

Women are also more likely to be diagnosed at younger ages and with less extensive tobacco use histories, raising concerns about whether current U.S. screening guidelines identify enough women at risk. In this discussion, Dr. Florez sheds light on these disparities and what they mean for the future of lung cancer care for women. 

What are some of the biggest misconceptions about women and lung cancer? 

A big misconception is that lung cancer only affects older men who use tobacco, but that is outdated. More women, especially those who have no history of tobacco use, are being diagnosed with lung cancer. In fact, among individuals who don’t consume tobacco, women are more likely to get lung cancer than men. 

The problem is the assumption that tobacco use is the only reason someone can get lung cancer. This can be harmful and potentially lead to delays in diagnosis and treatment for women, as their symptoms can be overlooked. That’s part of why we started the #HearHer campaign, to ensure that women’s voices and experiences with lung cancer get the attention they deserve. There is a popular hashtag on X (formerly Twitter), #AnyoneWithLungsCanGetLungCancer, and it’s true! 

How does lung cancer present differently in women? 

Lung cancer can show up differently in women, with vague symptoms that do not raise alarm, such as feeling tired, back pain, or shortness of breath. Unfortunately, these symptoms, especially in women, can easily be brushed off as stress or anxiety. Plus, when examining the biological presentation of lung cancer, women are more likely to get a type of lung cancer called adenocarcinoma non-small cell lung cancer, which does not always present with clear signs, such as coughing early on. Sometimes the cancer is missed or caught at later stages. On top of that, certain genetic mutations, like EGFR, ALK, and ROS1, are more common in women – especially younger women and those who do not use tobacco. Genetic mutations can often open the door to more treatment options, like targeted therapy. 

I believe that in the medical community, we need to shift our perspective and recognize that a lung cancer diagnosis does not always fit into the same mold. Anyone can be diagnosed with lung cancer, but we need to improve our understanding of women’s unique circumstances and experiences to improve their care.  

What unique challenges do women face when navigating a lung cancer diagnosis and outcomes? 

Women deal with a complete set of challenges when it comes to lung cancer. For starters, as previously mentioned, their symptoms are often brushed off or blamed on unrelated symptoms such as anxiety or acid reflux, which can delay the right diagnosis and treatment. Once women are diagnosed, they experience added challenges, and it’s not just about managing their disease. They’re often still expected to keep up with caregiving, work, and everything else. On top of that, things like body image, sexual health, and fertility, which matter a lot, aren’t talked about enough in lung cancer care. All of this can leave women feeling alone in what they’re going through.  

Why do you think that we are seeing Asian American women who have no smoking history being diagnosed at alarming rates? 

We’re likely seeing more Asian American women who have never smoked being diagnosed with lung cancer due to several environmental and genetic factors. Many women in these communities are exposed to kitchen fumes from cooking with high-heat oils, secondhand smoke, air pollution, and even radon, often due to traditional caregiving and cooking roles. Additionally, certain genetic mutations like EGFR and KRAS, which can increase lung cancer risk, are more common in Asian populations, especially among women who do not use tobacco. The frustrating part is that public health messaging still focuses primarily on smoking, so the risks for non-tobacco users are often overlooked, leading to delays in diagnosis. 

Why are women, especially women of color, underrepresented in lung cancer research or clinical trials? 

Women of color face a double burden in lung cancer research. They are often left out—not just because they are women, but also because they are part of racial or ethnic minority groups. This is a layered problem due to the unfair nature of our healthcare system, practical issues like time off work and transportation, and a deep-rooted mistrust of the medical system.  

Clinical trials often leave women out because of strict criteria, or rules, about age and smoking history. More women under age 50 are getting lung cancer, but many don’t meet the requirements for screening. This means their cancer may not be found early, and they miss the chance to join a clinical trial. 

There’s also a false belief that women don’t want to join trials or are harder to work with. Because of this, they’re invited to join less often. As a result, new treatments are tested on fewer women—especially women of color—so we may not fully understand how well those treatments work for them. 

Tell me about how you are addressing the gaps in research regarding lung cancer in women, particularly the Sexual Health Assessment in Women with Lung Cancer (SHAWL) study conducted through GO2’s Lung Cancer Registry that explored the impact of lung cancer treatments on women’s sexual health. 

The SHAWL study is an excellent example of our combined efforts to explore gaps in research for lung cancer in women. It was the first and largest effort to examine how lung cancer and its treatments impact women’s sexual health and intimacy. Out of 249 women studied, 77% reported moderate to severe sexual dysfunction, nearly half, around 49%, said they had not experienced any sexual health issues prior to their diagnosis. Among 128 women who reported recent sexual activity, 72% reported little to no satisfaction.  

Some common reasons for limited sexual activity included lack of interest (68%) and vaginal dryness or pain (30%). We also observed differences based on disease stage and treatment type. Women with stage 4 (IV) lung cancer had lower levels of sexual interest and desire compared to those with early-stage disease. Interestingly, women who were no longer on active treatment reported similarly low levels of sexual interest as those still in treatment. However, women receiving targeted therapies experienced sexual dysfunction at rates similar to women on other treatments.  

Our efforts and findings highlight the need to include sexual health in routine lung cancer care. Further, studies like SHAWL have been especially important in addressing research gaps, especially in women’s health, focusing on unexplored topics, such as sexual health, symptom burden, psychosocial impacts, and disparities in diagnosis and treatment. 

What do you wish more healthcare providers knew about women and lung cancer? 

I really wish more healthcare providers knew that lung cancer is not just a “man’s disease” or only related to tobacco use, and that women’s experience with lung cancer is very different than their male counterparts. Treating lung cancer in women means paying attention to the whole picture, their emotional well-being, sexual health, and all the responsibilities they’re having to deal with outside of the diagnosis. These factors all contribute to their overall quality of life.  

What is the message you want women diagnosed with lung cancer to know? 

I want women with lung cancer to know: your voice matters, and you are not alone. It can be easy to feel overwhelmed and invisible with a diagnosis that is often misunderstood, but you deserve to be heard. Do not be afraid to speak up, ask questions, or get a second opinion if something does not feel right. Trust how you feel because you know your body better than anyone else. Also, know that you do not need to face this alone. In addition to your family and friends, there is a huge support network within the lung cancer community filled with people who understand what you are going through and are eager to offer support, advice, and resources. Lastly, I want to reiterate that your diagnosis does not define you. It is a part of your story. It matters, and so do you.