Can a 20-year-old non-smoker have lung cancer?

Question

Hello doctor,

My younger sister is 20 and found a lump near her collarbone about three weeks ago. She went to her GP, who ordered a chest X-ray and referred her to a respiratory specialist. The X-ray showed a hilar mass, and her specialist has now requested a PET CT and bronchoscopy.

There is no smoking history; she has never smoked, but our father had lung cancer at 52, which was caught at stage 3. I am terrified this could be something serious.

Can lung cancer actually present in someone as young as 20 with no smoking history?
If it is lung cancer, does catching it at this stage, before full imaging results, with the lump being the first sign, count as early enough for curative treatment?
I know we do not have all the results yet, but I cannot stop thinking about what happened to our dad and whether my sister has inherited some kind of genetic risk. Is there a genetic testing pathway that should be considered here, given the family history?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query.

I understand why this is worrying you, especially given what your family has already been through. Anyone in your position would feel concerned.

At your sister’s age, lung cancer is quite uncommon, particularly in someone who has never smoked. When we see findings like a hilar mass along with a lump near the collarbone in a 20-year-old, we more often consider conditions such as:

Tuberculosis (a contagious, airborne infection primarily caused by Mycobacterium tuberculosis bacteria).
Lymphoma (a cancer of the lymphatic system, arising from lymphocytes (white blood cells) that grow uncontrollably).
Sarcoidosis (an inflammatory disease characterized by the growth of tiny, abnormal lumps of immune cells called granulomas in organs, most commonly the lungs and lymph nodes).

These are far more likely in this age group than lung cancer.

The tests that have been advised, PET CT (positron emission tomography - computed tomography scan) and bronchoscopy, are the right next steps. Imaging can suggest possibilities, but it cannot give a definite answer. A tissue sample will be needed to confirm the diagnosis. In practice, many young patients with similar findings are eventually diagnosed with conditions that are treatable, so it is important not to assume the worst at this stage.

Lung cancer can occur in non-smokers, but at this age, it is rare. Regarding your father’s history, it is understandable that it adds to your concern. However, a single family member diagnosed at 52 does not usually suggest a strong inherited cancer risk. Genetic causes are usually considered only in specific patterns, and there is nothing here right now that clearly points in that direction.

As for timing, it is a good sign that this has been identified and is being evaluated without delay. Whether something is early or curable depends on the exact diagnosis and staging after the PET CT and biopsy. At this point, we simply do not have enough information to label it either way.

For now, the best approach is to complete the planned tests and wait for a confirmed diagnosis. Once that clarity is available, the next steps can be guided in a much more precise and meaningful way.

I hope this answers your query.

Please let me know if I can assist you further.

Thank you.