Small Cell Lung Cancer in a Never-Smoking Patient: A Case Highlighting Diagnostic and Screening Gaps in Primary Care
Abstract
Small cell lung cancer (SCLC) is best known in relation to tobacco exposure and tends to be seen in advanced disease. Contemporary guidelines in lung cancer screening demonstrate a strong emphasis on smoking exposure, which may serve as a barrier to recognition in never-smokers who lack conventional risk factors. As a result, SCLC in never-smokers remains an important but underrecognized consideration in general and primary care settings. The current case involves a 65-year-old African American man who has never been a smoker but who presented with progressive thoracic pain, shortness of breath, and unintended weight loss, leading to the discovery of a mass on the right lung. Work-up confirmed extensive SCLC. The patient had a very rapid progression despite surgery, chemotherapy, and radiation. This case highlights potential gaps in current screening and risk assessment frameworks for lung cancer. It underscores the importance of diagnostic vigilance in never-smokers, particularly those with occupational exposures or barriers to healthcare access. For primary care clinicians, there may be a need to reconsider the presence of symptoms, social circumstances, and atypical risk factors for lung cancer to help reduce diagnostic delays and promote more equitable lung cancer care.
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