Ashley Rivas was 26 when she saw that she was getting tired earlier than usual on her runs. In the coming years, the X-ray technician from Albuquerque, New Mexico, developed a persistent cough and wheezing, which her doctors attributed to exercise-induced asthma. She had other symptoms: weight loss, fever, and a number of attacks of pneumonia. Still, when Rivas finally decided to take a chest x-ray on herself, cancer was the last thing on her mind.
The image showed a mass on her right lung that turned out to be a malignant tumor. Rivas was 32 and had never smoked a cigarette in her life. “I want people to know that lung cancer can happen to anyone,” she says.
Rivas has joined the American Lung Association’s Lung Force campaign, to spread the word that her illness is not only a smoker’s disease. “It is true that the majority of people with lung cancer have a history of tobacco use,” said Lung Association spokesman Andrea McKee, MD, chairman of radiation oncology at Lahey Hospital and Medical Center in Burlington, Massachusetts. “That said, 15% of the patients diagnosed with lung cancer have no history of tobacco use, and they can be very young.”
Other known risk factors besides smoking, a family history of the disease, as well as exposure to certain air pollutants, such as asbestos, arsenic, radon, even diesel fumes, says Dr. McKee. Lung cancer is the most common cancer worldwide; and each year kills more women than breast, ovarian and uterine cancer combined.
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If diagnosed early, the disease is actually very healing, Dr. McKee says. Fortunately this was the case for Rivas. She had her tumor removed in 2013, and is now well. (She ran a half marathon last year!)
But only about 16% of the cases are caught in stage 1. “Usually it’s like a 7 – to 8-millimeter nodule is in the middle of a lung that no symptoms associated with it,” says Dr. McKee. Most patients are diagnosed later, when the tumor has grown large enough that the “press of the respiratory tract, with the result that there is difficulty breathing,” she explains.
That is what Marlo Palacio experienced just before the holidays in 2013, when she developed a cough in contrast to a cough that she had ever had. “I would feel like I was out of breath or suffocate,” she says. First, the social worker from Pasadena, California, assumed she’d picked up a bug from her baby son. But six weeks later, the cough had not been in the way. Doctors diagnose Palacio—an otherwise healthy, 39-year-old non-smoker with stage 4 lung cancer.
In phase 4, the lungs symptoms such as Palacio had (and others, such as pneumonia, and the coughing up of blood) may be associated with problems elsewhere in the body, such as back pain, pain in the bones, headaches, weight loss, and confusion, says Dr. McKee. That is because “if the disease has spread, [it is], usually with an effect on a system outside of the lungs,” she explains.
After several treatments, Palacio has developed a new, isolated tumor in September. But she says that she is doing well, physically and emotionally. “I feel quite positive that this will be something that we can simply eliminate it and maintain it,” she says. “I just accept that this is a life long fight for the maintenance and tracking of my cancer.”
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Dr. McKee is hopeful that the increasing awareness of lung cancer, and the progress of the screening will mean that there are fewer late-stage diagnoses in the future—because catching the disease early can make all the difference.
Frida Orozco know that fact first hand. She was diagnosed with stage 2 in her late twenties, a few months after she developed a dry cough. “I felt a pain every time I cough on the lower side of my ribs, and also on the left side of my chest, near the collarbone,” she says. When Orozco came down with a fever, headache, and dizziness, she went to an urgent care; an x-ray of the chest showed the mass in her lungs.
But today, the 30-year-old student at the Borough of Manhattan Community College, happy to report she is in remission for a year and a half. “You can’t even say I am by all of this,” she says, “except for the scars.”
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So if you have a persistent cough checked out? “To be safe, I would say that a cough that you are worried about the continued than a few weeks, you should talk with your doctor,” says Dr. McKee. “A cough should not linger after two or three weeks.”
If you suspect that something is not right with your health, follow-up, urges Rivas. “You know your body better than anyone,” she says. “Pressure, because you’re probably right. My pulmonologist told me that if I had not caught [the cancer] when I did that, I would have died. And it was because of my perseverance. I knew that something was wrong, I kept pushing.”
To learn more about lung cancer, check out the American Lung Association’s Lung Force campaign.
This article originally appeared on Health.com.