Lung cancer in non-smoking identical twin sisters: highlighting the need for reassessing screening strategies
Introduction: Lung cancer screening primarily targets smokers, yet non-smokers can develop lung cancer, often diagnosed late because of the lack of screening. This case presents identical twin sisters, lifelong non-smokers, diagnosed within a year: one with squamous cell carcinoma (SCC), who subsequ...
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| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-07-01
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| Series: | Clinical Medicine |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1470211825001496 |
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| Summary: | Introduction: Lung cancer screening primarily targets smokers, yet non-smokers can develop lung cancer, often diagnosed late because of the lack of screening. This case presents identical twin sisters, lifelong non-smokers, diagnosed within a year: one with squamous cell carcinoma (SCC), who subsequently passed away, and the other with synchronous bilateral lung adenocarcinomas and brain metastases. Both worked in retail with no known asbestos exposure. This case underscores familial risk, the need for early detection and the potential expansion of screening criteria for high-risk non-smokers. Case description: The first twin, in her 70s and a lifelong non-smoker, developed a cough and weight loss and was diagnosed with metastatic SCC (T4 N2 M1c) involving the lung, thigh and erector spinae muscles. Despite chemotherapy and radiotherapy, she passed away about a year later (Fig 1).Her identical twin, also a non-smoker with minimal passive exposure, developed a cough and shortness of breath a few months after her sister’s diagnosis. A chest X-ray revealed left upper lobe opacification, with computed tomography (CT) confirming a 25-mm spiculated solid nodule and a right upper lobe subsolid lesion. Follow-up imaging showed interval growth of the left-sided lesion. A CT-guided biopsy confirmed left upper lobe adenocarcinoma, while subsequent wedge resection of the right upper lobe identified a second, minimally invasive adenocarcinoma. Staging investigations detected a solitary 1-cm brain metastasis (T2a N0 M1b). She underwent stereotactic radiosurgery (SRS) and started tepotinib for a MET exon 14 skipping mutation. Conclusion and learning points: • Genetic predisposition in never-smokers: this case highlights a potential hereditary risk for lung cancer, reinforcing the role of genetic factors; • Limitations of current screening criteria: UK lung cancer screening primarily targets smokers, potentially missing high-risk individuals with familial predisposition; • Early detection and clinical impact: earlier screening of the second twin could have enabled curative intervention, underscoring the need to refine screening for at-risk non-smokers; • Future screening considerations: previous research noted that most twin cases occurred in smokers. This rare instance in never-smoking identical twins underscores the need for genetic studies to guide screening expansion. |
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| ISSN: | 1470-2118 |