Lung Cancer: The Leading Cause of Cancer Death, Never-Smokers and Stigma

Lung cancer is the most commonly diagnosed cancer in the world and the leading cause of cancer death, with about 2.6 million new cases and 1.9 million deaths estimated for 2024. It is not only a disease of people who smoked: in one US population-based registry, the share of lung cancers in people who had never smoked ranged from 9% in White men to 83% in Chinese women. Most cases are still found late, survival is improving from a low base, and the stigma attached to the disease is linked to measurable harm.

Anyone with lungs can get lung cancer. Yet the first question many people are asked after diagnosis is whether they smoked, and the answer, whatever it is, can shape how they are treated by others and how they feel about seeking help. This study, part of our cancer research library, sets out the global figures, what is known about lung cancer in people who have never smoked, how late the disease is usually found, how survival has changed and what research says about stigma. Screening trials and programmes are covered in depth in our companion study on the evidence on lung cancer screening.

The most common cancer and the leading cause of cancer death worldwide

The latest global estimates, GLOBOCAN 2024 from the International Agency for Research on Cancer (IARC) and the American Cancer Society, put lung cancer at almost 2.6 million new cases in 2024, 12.8% of all cancers diagnosed, and an estimated 1.9 million deaths, 19.1% of all cancer deaths^[1]. Put simply, lung cancer accounts for about one in eight cancer diagnoses but nearly one in five cancer deaths. That gap reflects how often it is found after it has spread, and how hard it has been to treat at that point.

The pattern holds in individual countries with strong registries. In the United States, the American Cancer Society projects that lung cancer will cause more deaths in 2026 than the second- and third-ranking cancers, colorectal and pancreatic, combined^[3].

The World Health Organization (WHO) names tobacco as the primary risk factor, alongside outdoor and household air pollution, radon, and occupational exposures such as asbestos, silica and diesel exhaust^[4]. These are population-level associations, and many of them are exposures people did not choose: the air in a city, the gas in a home, the dust at work. Smoking itself is shaped by addiction, marketing, price and where someone grew up. None of this tells us why any one person developed lung cancer.

Lung cancer in people who have never smoked: from 9% to 83% of cases, depending on who you look at

There is no single global figure for the share of lung cancers in people who never smoked, because most cancer registries do not record smoking history. What exists are careful studies of particular populations, and they show how much the answer depends on sex, ancestry and place.

The clearest population-based figures come from Florida's cancer registry. Using individual-level data on microscopically confirmed lung cancers diagnosed from 2014 to 2018, adjusted with national smoking survey data, researchers estimated that the proportion of lung cancers in never smokers ranged from 9% among White men to 83% among Chinese women. Among Asian/Pacific Islander women in the state, lung cancer in never smokers was the second leading cause of cancer death, after only breast cancer^[2].

The share also appears to be growing in some settings. In the registries of three US institutions in Texas and Tennessee, covering 10,593 people with non-small cell lung cancer from 1990 to 2013, the proportion who had never smoked rose from 8.0% in 1990 to 1995 to 14.9% in 2011 to 2013^[5]. The study's authors argued that because the rise was similar across sex, stage and race/ethnicity, and was also seen in a county hospital, it points to a real increase in incidence among never smokers^[5]. A rising share is also what you would expect as fewer people smoke, and the Florida registry study found never-smoker incidence rates stable over 2014 to 2018^[2]. The share and the rate are different measures.

Outside the United States, the picture is starker in some populations. In the Korean National Lung Cancer Registry, a sample of about 10% of the country's lung cancer cases diagnosed in 2014, 643 of 735 women (87.5%) had never smoked^[6]. In a cohort from three tertiary hospitals in Saudi Arabia, covering people diagnosed from 2020 to 2024, more than one in three lung cancers (92 of 253) occurred in never smokers^[7]. These are hospital and registry samples, not national estimates, and should not be compared directly with the Florida figures.

Lung cancer in never smokers is more often adenocarcinoma: in the Korean registry, adenocarcinoma was significantly more common among women who had never smoked^[6]. Adenocarcinoma is also the most common subtype worldwide. A 2025 analysis built on IARC's GLOBOCAN 2022 estimates found that adenocarcinoma made up 541,971 (59.7%) of about 909,000 lung cancers in women and 717,211 (45.6%) of the 1,572,045 in men; the highest adenocarcinoma rates for both sexes were in east Asia. The same study estimated that 114,486 adenocarcinoma cases in men and 80,378 in women in 2022 were attributable to ambient particulate air pollution^[8]. That is a modelled estimate of what cleaner air could prevent across populations, not a count of individual cases with a known cause, and the abstract does not break it down by smoking history. It does underline that lung cancer prevention is also about air quality, a matter for governments, not individuals.

Half of lung cancers in the US are found after they have spread to distant organs

WHO notes that early symptoms can be mistaken for common respiratory problems and that lung cancer is often diagnosed at advanced stages when treatment options are limited^[4]. In the United States, where population-based stage data are detailed, 51% of lung and bronchus cancers recorded in the SEER 21 registries from 2016 to 2022 were diagnosed at a distant stage, and only 24% while still localised to the lung^[9].

Stage matters enormously for outcomes. In the same US data, five-year relative survival was 65.5% for localised disease, 38.2% for regional disease and 10.5% for distant disease^[9]. England's official statistics show the same gradient: for men diagnosed from 2018 to 2022, age-standardised five-year net survival for lung cancer was 59.6% at stage 1 and 4.2% at stage 4. For non-small cell lung cancer, 42.7% of people in England were diagnosed at stage 4^[10]. Why diagnosis comes late, and what can shorten the route, is covered in our study on stage at diagnosis.

Survival is improving, but from a low base

Survival has begun to improve. In the United States, five-year relative survival for regional lung cancer rose from 20% for people diagnosed in the mid-1990s to 37% for those diagnosed in 2015 to 2021, and for metastatic lung cancer from 2% to 10%. The American Cancer Society notes that people with high-mortality cancers and advanced diagnoses had the largest gains over this period^[3]. Overall five-year relative survival in the SEER registries for 2016 to 2022 was 29.5%^[9].

Death rates tell the same story from a different angle. Age-adjusted US lung cancer death rates fell on average by 4.1% a year from 2015 to 2024^[9]. The American Cancer Society attributes the continuing fall in US cancer death rates overall mainly to reductions in smoking, earlier detection and improved treatment^[3]. Survival and mortality measure different things and should not be read as one trend. Survival can also rise when more cancers are found early through scanning, partly because the clock starts sooner (lead-time bias), so gains in stage-specific survival are the more telling figure.

Internationally, progress is uneven. The CONCORD-3 programme, which analysed records for 37.5 million people diagnosed with cancer in 71 countries between 2000 and 2014, reported that in some countries survival had increased by up to 5% for cancers of the liver, pancreas and lung^[11]. How survival compares between countries, and why, is covered in our study of international cancer survival.

Stigma is common, is linked to poorer wellbeing, and affects people who never smoked too

Lung cancer carries a particular stigma, rooted in its link with smoking. A 2026 systematic review of 24 studies found that stigma was prevalent among people with lung cancer and consistently associated with depression, anxiety, distress and poorer quality of life. Smoking history graded how intense the stigma was (current more than former, former more than never), but did not determine it: clinically significant stigma also affected people who had never smoked^[12].

Stigma matters for diagnosis as well as for wellbeing. A 2024 systematic review of interventions to reduce stigma noted that many people with lung cancer or chronic obstructive pulmonary disease (COPD) experience high levels of stigma, which is associated with psychological distress and delayed help-seeking; it found only 11 eligible intervention studies, most at pilot stage, though most reduced at least one measure of stigma^[13]. A 2012 review of 15 studies linked stigma to poorer quality of life and higher psychological distress, while noting that the quantitative studies were generally of low quality^[14], and a 2026 review of 34 studies examined the factors associated with lung cancer stigma and its serious negative effects on psychological wellbeing^[15].

Language is part of the problem, including in research. A 2026 review of 28 scales used to measure stigma in smoking, COPD and lung cancer found that none were free of language that could worsen stigma, and called for person-first, bias-free measures^[16]. At the 2022 World Conference on Lung Cancer, a year after the International Association for the Study of Lung Cancer (IASLC) published a language guide, 177 of 522 slide presentations discussed smoking status; 77 used non-stigmatising language and 100 used the word "smoker"^[17].

Stigma may also shape how charitable funding is distributed. A study of 119 US cancer nonprofits with annual revenue above $5 million, about $6 billion in total in 2015, found that breast cancer drew the largest share ($460 million, 33.2%), while lung cancer was poorly funded relative to its incidence, its mortality and the years of life it costs^[18]. The authors read this as stigma depressing funding; the data themselves show a mismatch, not its cause.

What the evidence asks of us

The figures point to a handful of things that services, funders and governments can act on.

• Stop treating lung cancer as a smoking-only disease. In some populations most people with lung cancer have never smoked^[2][6]. Public information, clinical suspicion and research priorities should reflect that, and registries should record smoking history so the share in never smokers can be measured rather than guessed.
• Act on the causes people cannot control. WHO's priority actions include reducing exposure to environmental and occupational carcinogens, among which its fact sheet lists outdoor and household air pollution, alongside implementing the Framework Convention on Tobacco Control^[4]. The estimate of nearly 195,000 adenocarcinomas in 2022 attributable to particulate pollution^[8] makes clean air a cancer issue.
• Find it earlier. With half of US cases found at a distant stage^[9], WHO points to early diagnosis programmes that reduce delays after symptoms begin^[4]. Screening for people at high risk is part of this, and is covered in our companion study on screening, linked above.
• Make treatment gains reach everyone. Survival for advanced lung cancer has improved^[3], which makes equitable access to quality treatment and essential medicines, a WHO aim^[4], more pressing, not less.
• Take stigma seriously as a barrier. Stigma is linked to distress and delayed help-seeking^[13]. Clinicians, researchers and campaigns can adopt person-first, non-judgemental language^[16][17], and funders can check whether lung cancer gets a share of charitable funding that matches its toll^[18].

Language: this piece says "people with cancer" and "people living with and after cancer", and describes the illness and its treatment plainly, without combat metaphors. Clinical terms such as "stage", "incidence" and "net survival" are used in the sense the cited source defines them.

Why we're publishing this

Lung cancer causes more cancer deaths than any other, yet the people affected by it often meet judgement where they should meet support. Lung cancer charities and support groups make the case every day for earlier diagnosis, fairer treatment, more research and an end to blame. We want them to have the core figures in one place, sourced and stated carefully, including exactly what the share in people who never smoked does and does not measure. The case is theirs.

How to read this data

• Incidence, mortality and survival are different measures. GLOBOCAN figures are modelled estimates of new cases and deaths for 2024. US survival figures are relative survival; England's are age-standardised net survival. They cover different periods and are not directly comparable.
• Never-smoker shares depend on the population. The Florida figures come from one state registry, 2014 to 2018, adjusted with national smoking survey data. The US institutional, Korean and Saudi figures come from hospital or registry samples and use different definitions. None is a global estimate, and a rising share among people with lung cancer can reflect falling smoking rather than a rising rate in never smokers.
• Attributable cases are modelled. The air pollution estimates describe how many cases might be prevented across populations if exposure were removed. They do not identify the cause of any individual's cancer.
• Survival trends. Survival can rise when cancers are found earlier through scanning, even without any change in the date of death (lead-time bias). Stage-specific survival and mortality rates help to separate real gains from this effect.
• Stigma research. Most studies are cross-sectional and many come from high-income countries; associations with distress and delayed help-seeking do not prove that stigma alone caused them. Earlier reviews rated much of the quantitative evidence as low quality.
• What we could not include. We could not verify country-by-country five-year lung cancer survival from the CONCORD-3 full text, so this study gives only its overall finding on lung cancer.

Use this data

Free to cite with attribution to Better Health For Everyone. Charities, campaigners and journalists are welcome to reuse these figures and charts. For the underlying figures as a spreadsheet, get in touch.

Important: This article summarises published research for general information. It is not medical advice and cannot be used to diagnose, treat or predict anything about an individual. If you have concerns about your own or someone else's health, please speak to a qualified health professional.

Sources

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