It ‘Took 15 ER & Urgent Care Visits’ for Doctors to Diagnose This 34-Year-Old Nonsmoker’s Lung Cancer — These Were Her First Symptoms

Pushing for Answers

• 34-year-old Ashley Vassallo, a nonsmoker, developed a “subtle” lingering cough and “heaviness” in her chest in 2021 that were dismissed as COVID symptoms, but she was actually in an early stage of lung cancer.
• The hospice social worker, a mom of two young boys, had to advocate for herself for over a year to get some answers, and finally received her advanced lung cancer diagnosis that should never have progressed.
• Smoking is, of course, the primary cause of lung cancer, making up roughly 70 percent of cases, but nonsmokers can, and do, develop this disease. According to the American Cancer Society, around 20 percent of people who die from lung cancer in the U.S. “have never smoked or used any other form of tobacco.”
• Whether you are currently battling cancer or worried that you might have it — or something equally as serious — it’s always important to advocate for your health. Cancer is an incredibly serious disease, and you have every right to insist that your doctors investigate any possible signs of it.

34-year-old Ashley Vassallo , a nonsmoker, developed a "subtle" lingering cough and "heaviness" in her chest in 2021 that were dismissed as COVID symptoms, but she was actually in an early stage of lung cancer. The hospice social worker had to advocate for herself for over a year to get some answers, and finally received her advanced lung cancer diagnosis that should never have progressed. "I was in shock and denial, but also in survival mode. A part of me was relieved I had an answer to a problem that took 15 ER and urgent care visits over 366 days to solve," Vassallo wrote in a personal essay on Wednesday for SELF . "I was also relieved that people were finally taking me seriously and that I wasn't losing my mind." "But I was also angry," she continued. "Because I am a younger woman with an athletic background who appears health, and can 'push' through the pain, I feel I was dismissed. I advocated so hard for myself, but no one took me seriously."

When her symptoms initially took a turn, it was right before Christmas. "I was lying in bed and felt a sharp pain near my lung. I was having trouble breathing," Vassallo recalled. "I knew something was wrong, so I made an emergency telehealth appointment." The nurse practitioner assessed her symptoms as anxiety and suggested talking to a therapist. Admittedly stressed at the time — Vassallo said she was coming out and planning on leaving her husband — but despite the difficult transition, she knew this was "not anxiety."

A Multitude of Misdiagnoses

During in-person evaluations, Vassallo, who thought maybe she had acid reflux, mentioned she had had asthma as a kid, so they leaned toward that and "sent me off with an inhaler." Vassallo was told she probably wasn't using it correctly when symptoms persisted. Meanwhile, she tried a less acidic diet to see if that would help. It didn't. "All the while, my cough was getting worse — it's really embarrassing to have to go into patients visits in hospice while coughing." RELATED : Doc Missed a Young Mom’s Breast Cancer Recurrence in Her Lungs They Gave Her Antibiotics for Cough Instead As an "extreme optimist," Vassallo continued trying to live normally and pursue her healthy lifestyle, and tried to train for a half marathon. She wound up back in the ER with "extreme vertigo and dizziness." An X-Ray determined she had pneumonia and she was put on antibiotics.

The Journey to Diagnosis

Still, the cough lingered on, and Vassallo, who at this point had developed swollen feet, finally found some accurate answers after a doctor checked for blood clots in her body. They were all over, including one in her lung. Her health situation was described as "dire," and after a CT scan, they confirmed the news. "In October of 2022, I was diagnosed with stage 4 lung cancer, as there was a small lesion on my spine. The cancer had spread."

Ironically, Vassallo was falling in love with someone at the time, Erin, who she credits to helping save her life. "This beautiful thing was happening to me — while I was dealing with cancer." "It's been a wild ride," she added.

Treatment for Stage 4 Lung Cancer

Vassallo underwent four rounds of chemo and five radiation treatments near her spine, along with immunotherapy. The doctors didn't know at this point if the cancer was still active. Regardless, Vassallo decided that she wanted her lung removed. Explaining that doctors "don't typically remove the lung when it's stage 4 cancer," which made her surgeon "hesitant." "But I wanted this out of me, I wanted a chance at life." Dr. Raja Flores explains lung cancer surgery options. Scans had revealed that there was still evidence of disease. Vassallo went along with the surgery. Now at 34, she has learned to work on her breathing capacity. She can no longer run and has problems in heat and altitude, but still stays moderately active with yoga and weightlifting. "What's harder to manage are unknowns," she said, noting that she no longer wants chemo because it took a "huge toll" on her body. "I'm not cancer-free and am still going in for radiation," she continued, sharing that her current plan with her team is to continue getting scanned, "and if small spots pop up, we'll treat them." Vassallo is staying hopeful for newer treatments and clinical trials in the coming years.

Raising Awareness

With her story, she hopes to raise awareness that non-smokers and young people can get this disease. "The dialogue needs to shift. Yes, smoking is bad, but there's something else going on here." RELATED : Doctors Stumped As Mom And Dad Nonsmokers Are BOTH Diagnosed With Lung Cancer Within Months: The Community’s Rallying Around Them As for her new day to day, Vassallo is prioritizing her health and trying to eliminate as much stress as possible. "If I am giving too much to everyone around me and their feelings, my health will suffer." On June 10 via her TikTok page, Vassallo, who goes by the handle @onelunglady, went through some of the ways she helps put herself first. https://www.tiktok.com/@onelunglady/video/7378999808561810719 A GoFundMe page for Vassallo set up by her younger sister Carly gave an update last month on her progress in pursuing further health treatments: "We are in Boston today, heading to NY, Baltimore and Houston over the coming days to interview with clinical trials and assess a path forward for Ashleys treatments." "She is staying busy with constant appointments, labs, meetings with physicians and of course chasing around her 2 little boys Maddy and Sonny," Carly added.

"If you get a diagnosis like this, it's important to have a say in your treatment, who you want to see, and how often you want to see them," Vassallo continued in her article for Self . Above all else, "Trust your body."

Lung Cancer in Nonsmokers

Smoking is, of course, the primary cause of lung cancer, making up roughly 70 percent of cases, but nonsmokers can, and do, develop this disease. According to the American Cancer Society , around 20% of people who die from lung cancer in the U.S. "have never smoked or used any other form of tobacco." The CDC reports that there are 20,000 to 40,000 of these cases each year, around 10 to 20%. In recent years, researchers have made progress in understanding the differences between lung cancer in smokers versus nonsmokers, says Dr. Ronald Natale , a medical oncologist at Cedars-Sinai Medical Center. Lung cancer in smokers vs. nonsmokers "Some lung cancers are from unknown exposure to air pollution, radon or asbestos," adds Dr. Raja Flores , system chair of thoracic surgery at Mount Sinai, who previously interviewed with SurvivorNet. "We also see more never-smokers with lung cancer who have a family history of it." The ASCS lists the following causes for non-smoking cases:

• Radon gas, which is the second leading cause of lung cancer in the United States, and the first leading cause for nonsmokers, per the US Environmental Protection Agency (EPA). This naturally-occurring gas forms from the breakdown of uranium in rocks and soil. The problem occurs more with indoor evidence of radon, which is likely to be more concentrated.
• Secondhand smoke, which causes an average of 7,000 lung cancer deaths per year, the ACS says.
• Air pollution in bigger cities with heavier traffic "appears to raise the risk of lung cancer slightly."
• Gene mutations, since "certain changes in lung cells can lead to abnormal cell growth, and sometimes, cancer."

Advocating for Your Health

Whether you are currently battling cancer or worried that you might have it (or something equally as serious), it’s always important to advocate for your health. Cancer is an incredibly serious disease, and you have every right to insist that your doctors investigate any possible signs of cancer. 'Be Pushy, Be Your Own Advocate, Don't Settle' “Every appointment you leave as a patient, there should be a plan for what the doc is going to do for you, and if that doesn’t work, what the next plan is,” Dr. Zuri Murrell , director of the Cedars-Sinai Colorectal Cancer Center, told SurvivorNet in a previous interview. “And I think that that’s totally fair. And me as a health professional that’s what I do for all of my patients.”

Navigating Clinical Trials

Clinical trials can be an option for people with cancer at many points during the treatment process. Your doctor may have spoken with you about possibly enrolling in a trial if you have advanced disease or if there's a drug that's currently considered investigational that may work better than the standard for you. Clinical Trials Give Hope A lot of patients may feel uncomfortable about the thought of participating in a trial, but the trials can provide amazing opportunities for patients. For one thing, they give patients access to a bevy of new drugs that are currently being developed by pharmaceutical companies. Things to Consider In the U.S., all new drugs have to go through clinical trials before the Food and Drug Administration (FDA) will approve them. In addition to being potentially live-saving for patients, these trials are also necessary to advance science and cancer treatments. However, participating in a trial comes with risks as well, and it's important to talk to your doctor about this before getting involved in one. Some risks to consider are:

• The risk of harm and/or side effects due to experimental treatments
• Researchers may be unaware of some potential side effects for experimental treatments
• The treatment may not work for you, even if it has worked for others

Still, joining a clinical trial comes with benefits as well. You will be given access to treatments that could be life-saving, but simply haven't made it through the approval process yet. If you’re looking for a clinical trial, SurvivorNet can help. Check out SurvivorNet's Clinical Trial Finder .