Woman’s unexpected lung cancer diagnosis in Birmingham a reminder on importance of testing for nonsmokers

BIRMINGHAM, Ala. ( WIAT ) — A woman who went to a local emergency room in Birmingham said she was never told everything she needed to know about her visit. Months later, she found out that she had lung cancer.

On October 20, 2022, Fran Johns was rushed by her daughter to the Brookwood Baptist Freestanding ED on Cahaba Valley Road.

“Being an older woman, the doctors scare us about symptoms of heart attack in women versus men and how they can be very different and often back pain is a symptom,” Johns said. “So, I said to my daughter ‘I really think we should go someplace and look at this.”

After several tests, her discharge paperwork shows that her diagnosis was a right trapezius muscle strain. It wasn’t until four months later — while in an emergency room in Chicago for what she thought was a stroke — she was diagnosed with lung cancer.

Johns was stunned by the news, as she hadn’t smoked a cigarette in over 50 years.

“When I was telling my daughter about this, she said ‘Mom, they did a chest X-ray also when you were in Birmingham in October,” she said.

That’s when Johns said she went back into her patient portal to check for the results.

“[The radiologist] saw a nodule in my upper right lung that he said maybe a granuloma, should be followed up with a CT Scan,” Johns said. “They never told me.”

Dr. Aakash Desai studies Johns’ type of lung cancer at UAB.

“A lot of times, patients come into the ED with a different problem and then we find out that they end up having some kind of cancer, including lung cancer,” Desai said.

As a nonsmoker, Johns had a mutation in her epidermal growth factor receptor gene for her cancer. Desai said this cancer is similar to a typo in a series of words that it keeps producing. He said it’s not something that you get from your parents or can pass on to your children.

“We’re not talking about every cell in your body – it’s just the cancer cells that are existing in your body that have mutations and those are actually the reason why the cancer developed,” he said. “It’s sort of an internally driven process and it’s not something that you are doing, or you can be avoiding for it.”

Nicolle Mannion, director of lung cancer education at the American Lung Association, said because EGFR is more common in people without a history of tobacco use, that limits cancer screening eligibility. She encourages people to talk to their doctor if they’re worried they might have cancer.

“There’s lots of lymph nodes right next to your lungs and that’s why we tend to see lung cancer jump around and it’s often times caught at later stages once it has already progressed,” Mannion said.

Mannion and Desai said biomarker testing helps doctors better target the necessary treatment. Desai said testing rates are not where they need to be in the south and that he and other doctors are working to improve the process here in Alabama and beyond to help people get the exact cancer treatment they need.

“What we need to do is to make sure that if you have a diagnosis of lung cancer that you do get tested for these biomarkers or these mutations for which we have different treatments in this day and age,” Desai said.

Desai said doctors are seeing more cases of EGFR in young patients who are female, nonsmoking and of Asian descent.

Johns said it’s important to be your own advocate in the ER.

“This is what happens when you’re in an emergency situation – you’re not thinking clearly, you’re not thinking about things you’re not there for,” she said. “The finding of the chest X-ray had nothing to do with what I went to the hospital for or that diagnosis, which is absolutely fine.”

A Brookwood Baptist spokesperson sent this statement related to Johns’ case:

“Brookwood Baptist Health is committed to providing a high-quality healthcare experience for every patient that visits our facilities. Due to HIPAA regulations, we cannot comment on individual cases.”

You can learn more about EGFR cancer here . You can find more resources from the American Lung Association here .

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