9th April 2006

It's not just nicotine-stained old men who die of lung cancer - increasing numbers of young women are succumbing, too. What's more, many of them have never even smoked. Julia Llewellyn Smith investigates.

Rosemary Allison couldn't believe it. For the past couple of months the 44-year-old working mother of two from Stirling had had a slight cough that bothered her in the morning. 'But I felt good, it was just a mild irritant,' she recalls. 'I was a keen swimmer and gym-goer. I thought healthwise I was doing everything right.' But one morning she was making the family's beds and had some heart palpitations. Although she was tempted to ignore them, something niggled at her to call her GP.

Within a few hours she was sitting in Stirling Royal Infirmary listening to words such as 'white spot' and 'just a precaution'. She was told some of her lung tissue would have to be sent for a biopsy. The doctor gave her a bronchoscopy and frowned at the image on the screen. He was almost certain he could see cancer. 'You mean lung cancer?' she asked. Suddenly Rosemary was hit with the realisation that she might not live to see her daughters grow up.

Here is Rosemary's smoking history: the odd cigarette at parties when she was a student at the University of Glasgow in her late twenties. 'I gave them a try but, to be honest, I didn't like them,' she says. In her life she'd smoked a total of perhaps 20 cigarettes.

She thought lung cancer was one of the few killers she didn't have to worry about. But, in fact, fortysomething women like Rosemary are the new face of lung cancer. Today it is the leading cause of cancer death among women, and studies show that a woman who smokes 20 cigarettes a day is twice as likely to develop lung cancer as a man who smokes the same amount. 'Because women are smoking in their teens and twenties, I am diagnosing more and more of them in their forties,' says Siow Ming Lee, a consultant medical oncologist at the Middlesex and UCL hospitals, London.

Yet Rosemary assumed her virtually smoke-free history protected her. To a large extent, she was right to feel safe. According to the charity Cancer Research UK, of the 38,000 Britons who will be diagnosed with lung cancer this year (of whom 15,000 will be women), 80 to 85 per cent will be smokers or ex-smokers.

But that still leaves 4,000 people diagnosed with lung cancer who have never smoked. And women non-smokers are two and a half times more at risk than men. Last year Dana Reeve, the widow of Christopher 'Superman' Reeve, and a non-smoker, was diagnosed with lung cancer at the age of 44. She died last month. Yet it still remains far below most women's radar. 'It's the Cinderella cancer,' says Dr Lee. ' It mainly affects the working classes, so there is far less lobbying for research than for, say, breast cancer.' With film stars reluctant to put their faces to a disease seen as self-inflicted, lung cancer has no coloured ribbons, no awareness day. It is the second most commonly diagnosed cancer in Britain - breast is the first - and causes more than a fifth of all cancer deaths. Yet research into the disease receives just four per cent of British research funding, compared with 18 per cent for breast and 12 per cent for bowel. Rosemary was shocked by people's reaction when they learnt she was a non-smoker. 'They acted differently. There was a lot of, "Oh, well, that's all right then," as if somehow, had I been a smoker, I would have deserved it. That angered me.'

Because, historically, women took up smoking later than men - after the Second World War instead of the First - it was a while before doctors realised their greater susceptibility to the disease. Now they are trying to work out why. One theory is that women metabolise carcinogens (such as second-hand smoke or radon, a poisonous gas found in soil ) differently to men, so poisons stay in their systems longer. Women's lungs are also usually smaller, meaning that carcinogens concentrate in a smaller amount of tissue. Another possibility is that women are less capable of repairing DNA damage from carcinogens.

Then there is the oestrogen theory: a study published in 2000 discovered that lung-cancer tumours may grow in response to oestrogen, making lung cancer as much of a 'female' disease as breast, endometrial or ovarian cancer.he cancer's image is not helped by the fact it is so lethal, leaving few survivors to lobby for more research. 'The average life expectancy after diagnosis is six months. It's not a happy message,' confirms Dr Jesme Baird, the director of patient care at the Roy Castle Lung Cancer Foundation. 'If we pick up the disease early, surgeons can take it out, but by the time we discover a shadow on the lungs there isn't much of a chance.' One of the reasons for this is that, as with ovarian cancer, it is not often discovered until it has already spread. 'It's not like breast cancer where you feel a lump,' says Dr Baird. 'People say so often, "I had that niggly thing going on for years."' Smokers should be frightened, but even ex-smokers cannot afford to be complacent.

Received wisdom is that an ex-smoker quickly reaches the same level of health as someone who has never smoked; in fact, the risk of developing lung cancer remains for 20 years after quitting. Then it drops by half. And studies seem to show that girls who start smoking in their teens are particularly vulnerable. Last year Deborah Hutton, the former health editor of Vogue, died at 49 of the disease. She had smoked throughout her teens, but had given up at 23 and since then had 'done all the right things' in terms of health. 'It is really frightening,' she said shortly before she died. 'I had my first cigarette at 12 behind a farm building. You smoke in your teens, stop in your twenties and think you're safe. Wrong.' Five days after being diagnosed with inoperable lung cancer, Rosemary Allison was receiving chemotherapy. She and her husband, Mark, had to explain the situation to her daughters, Laura and Amy, aged five and three. 'We didn't want to talk about death and dying, but we didn't want them to have a terrible shock, so we explained that lungs were hard to mend but that the doctors were trying to help Mummy.' In the end Rosemary was one of the rare lucky ones. Three years on she is still alive, something she attributes to Iressa, a new drug known as an epidermal growth factor receptor (EGFR) inhibitor, that blocks the production of malignant cells. It shrank her tumour considerably. 'It was unbelievable,' she tells me. 'A miracle.'

Yet she cannot raise her hopes too high. 'Iressa's such a new drug the doctors don't know how long the effects last,' she says. She has left her job as a social worker to concentrate on getting better. Doctors confirm that while Iressa and another new drug, Tarceva, are effective in treating young women who are not smokers, they have been less successful among the general lung-cancer population. 'We still need to do a massive amount of work to turn lung cancer into a disease people live with, rather than one that always kills,' Dr Baird warns For now, the best policy (after not smoking) is awareness. Anyone with shortness of breath, wheezing or a cough lasting more than six weeks should see their GP, advice that applies to non-smokers as much as smokers. And there should be no delaying. 'If it had been the girls or my husband with a cough, I'd have sent them to the doctors long before,' Rosemary says. 'But as a mum you're so busy, you put yourself last. But if I'd been diagnosed earlier, today I could be fully cured.'