Read Time: 5 minutes
It’s a mystery that has been baffling researchers: Why do some people develop lung cancer in their 20s or 30s? While we used to think lung cancer was only caused by exposure to tobacco and environmental factors like radon, researchers are starting to learn that the development of lung cancer, particularly in younger adults, could have a hereditary component.
LUNGevity partnered with the Lung Cancer Initiative, a leading nonprofit in North Carolina, to support research into this space by awarding one of our 2023 Career Development Awards to Jaclyn LoPiccolo, PhD, MD, attending physician at the Lowe Center for Thoracic Oncology at Dana-Farber Cancer Institute. We interviewed Dr. LoPiccolo to understand the demographics of these younger patients and how her research aims to shed light on the hereditary genetics of lung cancer development.
LUNGevity Foundation: What can you tell us about young people who develop lung cancer?
Dr. Jaclyn LoPiccolo: We are still working to understand who these patients are and the key factors in the development of lung cancer. Although the average age at lung cancer diagnosis is 70, approximately 2,000 to 4,000 cases of new lung cancers in the US are diagnosed each year in patients under 45 years old, most of whom don’t have significant tobacco exposure. And we have seen that early-onset lung cancer seems to be more common in women than in men. Patients with early-onset lung cancer very often have their tumors test positive for driver oncogenes (genetic changes known to drive tumor growth)—most commonly ALK, EGFR, RET, and ROS1.
LF: What drew your interest to studying the genetics of lung cancer development?
JLP: When I was in high school, I had a family member who was diagnosed with lung cancer at a young age. That definitely raised my awareness of the disease. I was interested in science, so I studied genetics in college and have always maintained an interest. After college, before medical school, I worked in a translational lung cancer research lab, which had a big impact on me. I was able to see early on in my career how basic science ideas could be translated into real-world patient care.
As we started to learn more about lung cancer, I saw how there were patient populations who were younger and didn’t have environmental exposures that could explain why they developed the disease, and wondered whether genetics could help us answer this question.
LF: Tell us about the research funded by the Lung Cancer Initiative and LUNGevity.
JLP: We have assembled a group of more than 350 people diagnosed with lung cancer at age 45 or younger to study their genetics and are trying to determine if there are inherited genetic variations that could explain why they developed lung cancer at a young age. Of course, there are many factors, particularly environmental factors, that could also be very relevant, so we’ve tried to take that into account. Our initial studies suggest that there may be a genetic component that is inherited and may lead to a predisposition, or an increased likelihood, of developing early-onset lung cancer.
With the support of the research award from Lung Cancer Initiative and LUNGevity, our team plans to continue this work to understand the role of inherited genetic variation and to determine if this affects tumor evolution or treatment outcomes.
LF: Tell us about the work you do in your clinic and how it relates to your research.
JLP: I’m currently a new faculty member at Dana-Farber Cancer Institute. During my fellowship, I was mentored by Dr. Pasi Jänne, one of the co-discoverers of EGFR mutations in lung cancer. Together, we saw a lot of these young adults with lung cancer in our practice. Now, having this study open has drawn the attention of a lot of younger patients. So, now a fair amount of my practice is dedicated to younger adults diagnosed with lung cancer, and that will continue to be a focus of my practice going forward.
Most of the time, younger adults are diagnosed with lung cancer at very advanced stages because the disease is mistaken for something else that's more common in that age group. It’s understandable. In a patient who is 20 or 30 years old with a cough, it is more likely they have a cold, or even pneumonia, or something like that. You wouldn’t consider checking for lung cancer right away, and so the diagnosis is often delayed.
That’s why this research is so important. If we can find genetic markers that can predict whether certain people might be at risk of developing lung cancer at a younger age, we can think about using lung cancer screening to catch it early enough to be cured with surgery. We also hope that some of these findings can be translated into developing better treatments.
LF: If this work is successful, what does it mean for the lung cancer community?
JLP: We are aiming to identify valuable opportunities for screening and early detection in the lung cancer community. I also hope that some new therapeutic opportunities will develop from this work.
If we identify inherited genetic markers that put certain young adults at risk for lung or other cancers, this can directly impact their parents, siblings, and children. The families can be aware of the genetic predisposition, pursue genetic testing, and receive medical recommendations for cancer screening and prevention. These people may not have common risk factors for developing lung cancer, such as tobacco exposure. For this reason, we may be able to start screening for lung cancer in people who wouldn't otherwise be on our radar. This would allow us to catch the cancer at its earliest stages when it is most curable.
LF: Why is it important to fund lung cancer research?
JLP: As we learn more about lung cancer, we’re seeing that it’s not just one disease, but a set of diseases with different subtypes, with each subtype requiring its own treatment approach. Lung cancer is probably one of the best examples of a cancer where personalized medicine is applied to treat the disease. So, it’s important that we fund research looking at many different areas of lung cancer biology because they come together to help us address the disease from many angles—including early detection and prevention. Compared to some other cancer types, we still have work to do to improve early detection of lung cancer. I’m hoping our research may be able to help with that.
LF: How did the research award impact your career?
JLP: The Career Development Award, with its communication training and networking opportunities, is one of the most helpful career enhancement opportunities that I’ve encountered. With the low levels of funding available to lung cancer researchers, particularly those of us who are just establishing our research programs, the grant from Lung Cancer Initiative and LUNGevity is so important. I’m so grateful for this support. Without it, this work to understand the genetics behind lung cancer development might never be conducted.
More LUNGevity-supported research projects: