Lung cancer in women: what ASCO 2026 and a new Nature review tell us

6 Jun

A woman leads an outdoor wellness session at sunset, her back to the camera, facing two women who are smiling. An image representing the lives of women living with and beyond lung cancer.

Last week, two things happened at the same time. The world's largest oncology conference, ASCO 2026, brought together thousands of researchers and clinicians in Chicago. And Nature published an Outlook supplement including an article titled: "Lung cancer in women emerges as a distinct disease."

The convergence was not a coincidence. It reflected where the science is heading.

A disease that is changing

For decades, lung cancer was understood primarily through the lens of men who smoked. That picture is no longer accurate.

Lung cancer diagnoses in women under 50 increased by 50% globally between 1990 and 2023. In the United States, the gap in incidence between young men and young women has nearly disappeared. Between 30 and 43% of young women's lung cancer deaths now have no identified risk factor.

These are not marginal shifts. They point to a population that current systems were not designed to find.

Women who have never smoked are more than twice as likely to develop lung cancer as men who have never smoked. The reasons are not fully understood, but biological differences are increasingly documented. Women with lung cancer show different DNA repair patterns to men. They are more likely to carry driver mutations in the EGFR and KRAS genes. Endogenous oestrogen may play a role in tumour development, though research on this remains complex and sometimes contradictory. Environmental exposures including secondhand smoke and indoor air pollution from cooking fumes disproportionately affect women, linked in part to domestic roles that remain unequally distributed.

Nature Outlook: Lung cancer in women emerges as a distinct disease, 27 May 2026

Abstract 8603, ASCO Annual Meeting 2026

Florez et al. Lung Cancer in Women: The Past, Present, and Future. Clinical Lung Cancer, 2024

Who gets it?

Research presented at ASCO 2026 confirms that young-onset lung cancer has a distinct profile. People diagnosed under 50 are more likely to be female, more likely to have never smoked, and more likely to carry targetable driver mutations including EGFR and ALK. They are also more likely to be diagnosed at stage 4.

The median age for ALK-positive lung cancer is 34. For ROS1 it is 36. These are people of working age, many with caring responsibilities, some considering or in the middle of starting a family.

This profile is not new to many people living with lung cancer or to the organisations that support them. It is, however, increasingly visible in the clinical literature.

Source: SPARK-Lung study, abstract 8070, ASCO Annual Meeting 2026

A screening system built on incomplete data

Current lung cancer screening criteria are based primarily on smoking history. They were developed using data drawn predominantly from male populations. The NELSON trial, the largest European lung cancer screening study, enrolled only 16% women.

New research from a cohort of nearly one million people shows that smoking history-based criteria systematically exclude women who are at genuine risk, including those who have never smoked. Switching from pack-year based criteria to smoking duration criteria would expand screening eligibility for women from 55% to 83.7% in that cohort. The structural problem exists in European screening programmes too, even if the specific figures are from a US population.

Source: Abstract 8004, ASCO Annual Meeting 2026

The trial representation gap

One of the most significant lung cancer results at ASCO 2026 came from the HARMONi-6 trial, presented in the plenary session. Of its 532 participants, 494 were male. Seven per cent were female. This was a headline result from one of oncology's biggest stages.

This is not an isolated example. Analysis of NSCLC clinical trials between 2010 and 2020 found that only 38.7% of participants were women. Treatment guidelines are therefore based largely on evidence generated in men. Women are 25% more likely to experience severe adverse events from targeted therapy than men, and significantly more likely not to report them. The story with immunotherapy is different again, with data suggesting men derive greater benefit from checkpoint inhibitors than women, and pre-menopausal women at higher risk of immune-related toxicities.

These differences are clinically significant. They are not yet routinely reflected in how treatment decisions are made.

Source: HARMONi-6, abstract LBA4, ASCO Annual Meeting 2026

Living with lung cancer as a woman

The challenges do not end at diagnosis. Lung Cancer Europe’s own 10th Annual Report, the largest ever global survey on mental health and lung cancer, documents this in European data. Women living with lung cancer reported significantly worse mental health than men: nearly 30% reported poor to moderate mental health compared to 20% of men. Women were significantly more likely to have been diagnosed with an anxiety disorder (23% versus 13% of men) and felt less capable of managing the emotional impact of their diagnosis. Women were also more likely to experience a greater negative impact on their finances and working lives, and less likely to have someone they could rely on for support.

Women are more likely to delay seeking care, in part because of caring responsibilities. They are more likely to experience financial consequences from a diagnosis. Sexual health is among the most commonly reported sources of distress for women with lung cancer, yet it is rarely discussed in clinical settings.

For younger women, the intersection of lung cancer with fertility and family planning raises questions that the clinical literature is only beginning to address. The incidence of lung cancer diagnosed during pregnancy is increasing. There are currently fewer than 100 confirmed cases in the published global literature. A European registry is being established to capture this data, but it remains early.

What we are still learning

The Nature Outlook published this week describes lung cancer in women as a malignancy where "marked disparities in research, detection and treatment remain." The article spans risk factors, biology, screening, treatment response and survivorship. It identifies where differences accumulate across the pathway and where women are still being missed.

We are at an early stage of understanding why lung cancer affects women differently and what the specific challenges for this group require in terms of research, clinical practice and policy. That understanding needs to develop, and it needs European data to inform it.