Why lung cancer belongs in the women’s health conversation

By Joanna Nathan, co-founder & CEO, Prana Surgical

In the lead up to International Women’s Day 2026, women’s health leaders, experts and insiders explore the critical challenges shaping the future of women’s health

Cancer mortality in the United States has steadily declined for more than three decades, with millions of lives saved through smoking cessation, earlier detection, and improved treatment. But the epidemiology of lung cancer is shifting in ways we can no longer ignore. Beginning in 2021, lung cancer incidence in women under 65 surpassed that of men for the first time. The progress we are making in this disease is real, but it doesn’t tell the whole story.

Lung cancer remains the leading cause of cancer death in the United States. For women, it claims more lives each year than breast and ovarian cancers combined. And yet, it is rarely centred in conversations about women’s health. Nearly 20 per cent of new lung cancer diagnoses now occur in people who have never smoked, and the majority of those patients are women. The traditional image of lung cancer as a disease of older male smokers no longer reflects what clinicians are seeing. The face of lung cancer is shifting toward younger patients, toward non-smokers, and increasingly toward women.

Smoking remains the leading cause of lung cancer, but it doesn’t explain everything. Radon, an invisible and naturally occurring gas that can accumulate in homes, is the second leading cause of lung cancer in the United States. Environmental exposures such as air pollution may contribute. Researchers continue to investigate whether biological differences influence how women metabolise carcinogens. What is clear is that lung cancer in never-smokers is not rare. If you separated lung cancer in smokers from lung cancer in never-smokers, each would still represent a major public health crisis on its own. Lung cancer among people who smoke would rank as the number one cancer killer, and lung cancer among those who have never smoked would still rank seventh among cancer deaths.

Screening remains one of the most powerful tools available to us. Annual low-dose CT scans for eligible individuals have been proven to reduce lung cancer mortality by detecting disease earlier. In 2021, screening recommendations were broadened to include approximately 14 million Americans, and most insurance plans now cover it. Yet fewer than a quarter of eligible individuals undergo screening. Stigma, fear, access barriers, and bias in who is offered testing all contribute. Because screening eligibility is tied to smoking history, it doesn’t capture never-smokers at risk, which makes symptom recognition even more critical. A cough lasting more than six weeks, persistent chest discomfort, shortness of breath, unexplained fatigue, upper back or shoulder pain, or weight loss should not be dismissed. Too often, early warning signs in women are attributed to less serious causes, and diagnosis comes later than it should.

Earlier detection is reshaping the clinical landscape. We are identifying smaller nodules, often incidentally or through screening, at stages when a cure is possible. But our surgical paradigm was built for a different era, when lung cancers were typically larger and diagnosed later. Today, many patients with early-stage lung cancer still undergo removal of an entire lobe or segment of the lung. That can mean losing up to 20 per cent of total lung capacity for a lesion that may measure only a centimeter. For a 40-year-old woman who has never smoked, that consequence influences exercise tolerance, pulmonary reserve, and quality of life for decades.

This mismatch between detection and intervention is what led me to co-found Prana Surgical alongside thoracic surgeons Ed Boyle and Rick Fischel. If we can identify a one-centimeter nodule with precision, we should be able to remove it with equal precision while preserving as much healthy lung tissue as possible. Our broader vision is to advance image-guided, tissue-sparing approaches that prioritize oncologic control and long-term quality of life. As the burden of disease shifts toward younger women and never-smokers, the imperative to conserve lung function becomes even clearer.

Building a medical device company around this mission has meant operating in a sector that remains heavily male at the leadership and capital levels. The global medical device market is projected to exceed one trillion dollars within the next decade. These technologies shape how medicine is practiced worldwide. Yet women remain underrepresented among the founders, engineers, and investors determining which problems are prioritised and how solutions are designed. Navigating medtech requires technical fluency, regulatory depth, and persistence. Raising capital for a capital-intensive device company in today’s market is not for the faint of heart. As a female founder, over time, I have learned that credibility is built through execution: know the data, anticipate the risks, deliver the milestones, and keep moving forward.

Representation in this space is not just symbolic. It influences whose health problems receive attention and how outcomes are defined. When women represent a growing share of lung cancer diagnoses, it matters that women are shaping the technologies used to treat them. As we approach Women’s Health Day, lung cancer must be part of the conversation. It is the leading cancer killer of women. It increasingly affects those who have never smoked. Screening can save lives. Radon testing can reduce risk. Early recognition of symptoms can change the course of a diagnosis.

We have made significant progress in reducing cancer mortality. Now we must align our research priorities, screening strategies, surgical approaches, and innovation leadership with the realities of who is being diagnosed today. The face of lung cancer has changed. Our systems should change with it.

About Joanna Nathan

Joanna Nathan is an investor turned entrepreneur on a mission to make surgical oncology more precise as the CEO & Co-Founder of Prana Surgical.

The Prana System has been meticulously designed to enable image-guided, minimally invasive surgery, conserving healthy tissue and driving personalised treatment plans in a range of conditions, including lung cancer.

She is an Adjunct Professor at Texas A&M’s School of Engineering Medicine and Rice University’s Jones School of Business.

Learn more at pranasurgical.com.