Lung cancer in women statistics: never-smokers, younger-age crossover, and screening gaps

She was 52, never smoked a cigarette, and she came in for a persistent cough she blamed on seasonal allergies. A chest film ordered for something else showed a nodule. The CT that followed made the diagnosis hard to ignore. When she asked how this was possible without a smoking history, I had the same answer I give more often now than I did a decade ago: lung cancer in women who never smoked is not rare enough to treat as an anecdote, and our screening rules were never written for her.

That case sits against a set of numbers that have quietly rearranged the map of lung cancer in the United States. More new diagnoses are now projected in women than in men. Incidence among people younger than 65 has already crossed over. Never-smokers make up a larger share of lung cancer patients among women than among men. Screening still reaches only about one in five people who qualify under federal guidelines. It does not reach never-smokers at all.

This article pulls the figures a reporter on deadline or a clinician at the desk can lift with a primary source named next to each one: 2025 incidence and deaths, the never-smoker share, the younger-age crossover, screening uptake, and stage-specific survival.

Measure	Women	Men	Both sexes
New cases	115,970	110,680	226,650
Deaths	60,540	64,190	124,730
Under-65 incidence, 2021 (per 100,000)	15.7	15.4	-
Incidence decline, 2012-2021 (per year)	1.4%	3.0%	-
Death-rate decline from peak	38% since 2002	61% since 1990	-

Source: Siegel et al., Cancer Statistics, 2025 (CA Cancer J Clin); under-65 crossover and incidence APCs from the same report. Death-rate peak declines also reported in ACS Cancer Facts & Figures 2025.

Year	Death rate per 100,000
2015	41.18
2016	39.09
2017	37.35
2018	35.51
2019	34.15
2020	32.51
2021	31.56
2022	30.17
2023	29.30
2024	27.90

Source: NCI SEER Cancer Stat Facts: Lung and Bronchus Cancer; U.S. mortality rates, all races, both sexes, age-adjusted (observed rates shown).

Incidence and mortality in women

Start with the national projections that journalists and clinicians cite most often. According to Siegel and colleagues in Cancer Statistics, 2025, the American Cancer Society estimates 226,650 new cases of lung and bronchus cancer in the United States in 2025: 115,970 in women and 110,680 in men. On absolute case counts, women are now expected to outnumber men. The same report projects 124,730 lung cancer deaths: 60,540 in women and 64,190 in men. Lung cancer remains the leading cause of cancer death in both sexes; SEER notes it accounts for about 20% of all cancer deaths while representing roughly 11% of new cases.

Rates still favor men when you age-adjust the population. NCI SEER puts new-case rates at 52.0 per 100,000 men and 43.6 per 100,000 women (2019-2023). Death rates for 2020-2024 are 35.4 per 100,000 in men and 26.2 per 100,000 in women. Combined incidence is 47.2 per 100,000 and the combined death rate 30.2. Lifetime risk of diagnosis is about 5.2% overall (SEER, 2021-2023); ACS DevCan tables put women's lifetime probability at roughly 5.6% (about 1 in 18).

The direction of travel differs by sex. ACS reports incidence declined from 2012 through 2021 by 3% per year in men but only 1.4% per year in women. Later uptake of smoking among women, slower cessation, and upticks in some post-1965 birth cohorts help explain the gap. Mortality has improved faster than incidence. ACS Cancer Facts & Figures 2025 states the lung cancer death rate has fallen 61% from its 1990 peak in men and 38% from its 2002 peak in women; from 2013 to 2022 the death rate decreased 4.8% per year in men and 3.7% per year in women. CDC U.S. Cancer Statistics reported 228,058 new lung cancers in 2023 and 128,663 deaths in 2024. Median age at diagnosis in SEER is 71.

For context on other women's cancers, see our reviews of breast cancer screening statistics, ovarian and endometrial cancer statistics, and cervical cancer and HPV screening. Lung cancer kills more U.S. women than any of those sites, with far less of a population screening safety net.

The rise among never-smokers

The CDC states that about 10% to 20% of lung cancers in the United States (roughly 20,000 to 40,000 cases each year) occur in people who never smoked or who smoked fewer than 100 cigarettes in their lifetime. Researchers estimate secondhand smoke contributes to about 7,300 of those cases and radon to about 2,900. About 50% to 60% of lung cancers in never-smokers are adenocarcinomas; roughly 10% to 20% are squamous cell carcinomas.

Sex-specific data sharpen the picture for women. In a CDC analysis of 129,309 lung cancer patients with known cigarette-use status in seven U.S. states (2011-2016), published in JAMA Oncology in 2021, 12.5% of patients overall had never smoked. The proportion was 15.7% among women and 9.6% among men (prevalence ratio 1.63) across age, race and ethnicity, and histology. When a woman is diagnosed with lung cancer, the chance she has never smoked is substantially higher than for a man with the same diagnosis.

That does not mean never-smoking women have higher absolute risk than heavy smokers. Absolute risk is still dominated by cumulative tobacco exposure. What it does mean is that a non-trivial minority of the female caseload will never trigger smoking-based screening criteria. The CDC is explicit that the USPSTF does not recommend lung cancer screening for people who have never smoked, because harms are judged to outweigh benefits in that group with current evidence. Other exposures that matter include secondhand smoke, residential radon, asbestos, and occupational carcinogens. Certain molecular patterns (including EGFR mutations) also cluster more often in never-smoker adenocarcinoma.

One sentence for a lede: according to CDC estimates, as many as 1 in 5 U.S. lung cancers occurs in people who never smoked, and registry data show never-smokers make up a larger share of female than male cases.

When rates in younger women exceed men

Among people younger than 65 years, lung cancer incidence was higher in women than in men in 2021 for the first time: 15.7 versus 15.4 per 100,000 (p = 0.03), according to ACS Cancer Statistics 2025. The absolute gap is small. The direction of the crossover is the news. Incidence still declines overall, but twice as fast in men as in women, so rates have been converging for years and have now crossed in the under-65 band.

That result sits on earlier work. Jemal and colleagues reported in the New England Journal of Medicine in 2018 that among non-Hispanic White adults, female-to-male incidence rate ratios had risen above 1.0 in the 30-34, 35-39, 40-44, and 45-49 age groups by 2010-2014. In Whites ages 40-44, the ratio moved from 0.88 (95% CI, 0.84-0.92) in 1995-1999 to 1.17 (95% CI, 1.11-1.23) in 2010-2014. The crossover tracked birth cohorts born since about 1965. Smoking prevalence in those cohorts approached parity but generally did not reverse enough to fully explain higher female rates, leaving room for susceptibility differences, histology mix, and other exposures.

Two cautions keep this honest. Most lung cancer is still diagnosed after age 65; SEER shows 36.4% of new cases at ages 65-74 alone, and the median age is 71. And a difference of 0.3 cases per 100,000 is real without being a large individual absolute risk. For a woman in her forties or fifties with a persistent cough, chest pain, or unexplained weight loss (smoker or not), the historic reflex that lung cancer is a man's smoking disease is out of date under age 65.

Screening eligibility gaps

The U.S. Preventive Services Task Force updated its lung cancer screening recommendation in March 2021 (Grade B). It recommends annual low-dose computed tomography (LDCT) for adults ages 50 to 80 who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years. Screening should stop once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery. Compared with 2013 criteria, the 2021 update lowered the starting age from 55 to 50 and the pack-year threshold from 30 to 20. Those changes were meant in part to include more women and more Black adults, who on average accumulate fewer pack-years for a given risk level.

Eligibility is not the same as uptake. In an ACS analysis of 2024 National Health Interview Survey data (reported November 2025, published in JAMA), an estimated 12.76 million U.S. adults met USPSTF criteria. Only 18.7% reported being up to date with screening, roughly 1 in 5. The eligible population was 55% male, 66.4% aged 60 or older, and 82.4% non-Hispanic White. Full uptake could prevent an estimated 62,110 lung cancer deaths over five years; at current uptake, only about a quarter of those gains are realized (about 14,970 deaths prevented).

Two structural gaps matter for women. Never-smokers are outside USPSTF criteria by design; the CDC states screening is not recommended for people who never smoked. Given that 15.7% of women with lung cancer in the seven-state registry analysis had never smoked, a meaningful share of female cases will never be interceptable by pack-year-only LDCT programs. That is a deliberate tradeoff against false positives and procedure harms, not a clerical oversight. It is still a coverage hole in the female caseload. Separately, the "quit within 15 years" rule drops long-term former smokers even after heavy decades of use. ACS has argued for expanding eligibility irrespective of years since quitting; women who quit successfully in midlife can age out of eligibility while residual risk remains elevated.

Implementation is the weaker link even for people who qualify. Shared decision-making, access to high-quality LDCT, insurance navigation, and smoking-history stigma all suppress uptake. A screening rate under 20% for a Grade B service is unfinished public health work. Mammography reaches a far larger share of age-eligible women. We detail that contrast in our breast cancer screening statistics. Smoking also multiplies cardiovascular risk; see our overview of heart disease risk factors in women. Cycle-tracking tools such as our period calculator or cycle length calculator do not screen for lung cancer, but they help women document symptom patterns while navigating broader midlife preventive care.

Survival differences and stage at diagnosis

Stage still dominates prognosis. SEER data for diagnoses in 2016-2022 show overall five-year relative survival for lung and bronchus cancer at 29.5%. About 24% of cases are localized at diagnosis, 21% regional, 51% distant, and 4% unstaged. Five-year relative survival is 65.5% for localized disease, 38.2% for regional disease, and 10.5% for distant disease. That is more than fifty percentage points between the earliest and latest stages.

ACS Cancer Statistics 2025, using slightly earlier diagnosis years, reports 27% five-year relative survival for 2014-2020 diagnoses overall (27% among White patients and 24% among Black patients in the long-term survival table by race). Do not over-read that three-point race gap. Histology mix, smoking status, stage at diagnosis, and comorbidity all confound unadjusted comparisons. Gains have been faster for non-small cell lung cancer: three-year relative survival for NSCLC rose from 26% in 2004 to 43% in 2018, versus 9% to 12% for small cell disease. Immunotherapy and targeted therapies explain much of the NSCLC improvement; small cell disease has seen far less progress. The durable population message is that survival remains poor overall because half of patients still present with distant disease.

Racial patterns cut across sex. SEER female death rates (2020-2024) are highest in non-Hispanic White women (29.5 per 100,000) and non-Hispanic American Indian/Alaska Native women (29.3), lower in non-Hispanic Black women (24.4), and lower still in non-Hispanic Asian/Pacific Islander (14.4) and Hispanic women (10.8). Female incidence is highest in non-Hispanic White women (50.9) and AIAN women (48.6). Research and trial enrollment gaps shape how quickly molecular advances reach all patients; see our review of women's underrepresentation in clinical trials.

What clinicians and reporters should use

If you need one number for a lede, use the under-65 crossover: in 2021, lung cancer incidence in women younger than 65 exceeded that in men (15.7 vs. 15.4 per 100,000), per ACS Cancer Statistics 2025. For absolute burden, use the 2025 case projection: 115,970 new cases in women, more than in men. For the never-smoker story, use either the CDC's 10%-20% of all U.S. lung cancers or the JAMA Oncology finding that 15.7% of women with lung cancer (versus 9.6% of men) had never smoked.

For screening, pair eligibility with uptake. USPSTF 2021 criteria (ages 50-80, 20 pack-years, current or quit within 15 years) define who should be offered annual LDCT. ACS's 2024 NHIS analysis puts the uptake figure at 18.7% up to date among about 12.8 million eligible adults. Never-smoker ineligibility is a feature of the evidence threshold, not a clerical omission. For survival, quote SEER with years: 65.5% five-year relative survival for localized disease versus 10.5% for distant disease (2016-2022).

Clinically: do not dismiss persistent respiratory symptoms in never-smoking women; document pack-years so eligible patients are not missed; offer guideline-concordant LDCT to people who meet criteria; and be honest with never-smokers that population screening is not currently recommended for them. Smoking cessation still prevents more lung cancer deaths than screening finds. ACS attributes about 85% of 2025 lung cancer deaths to cigarette smoking directly. Women already in midlife or reproductive care can raise lung-risk questions in the same visit as other preventive counseling. Tools such as our ovulation calculator and late period calculator help with cycle timing; they are not lung-cancer tools, but the patients who use them are often the same midlife cohort now carrying a rising share of female incidence under 65.

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