A 37-year-old nurse got unusually short of breath on a hike. She had stage 4 lung cancer.

• Lung cancer is rare in people under 45, but more women who have never smoked are developing the disease.
• Tiffany Job was surprised by how out of breath she felt on a hike.
• She was young, healthy, and never smoked so was shocked when she was diagnosed with lung cancer.

On a hike in July 2020, Tiffany Job found herself incredibly short of breath.

"I couldn't go 20 yards without my heart rate shooting up," she told The Patient Story.

This was unusual for Job, 41, from Texas. "I maintained a healthy diet. I exercised constantly. As a Registered Nurse and part‐time pilates instructor, I was more proactive than most when it came to managing my own health and well-being," she wrote on the website of her nonprofit, Ten for Ten Million.

Then, that August she developed a cough that wouldn't go away after antibiotic and steroid treatments, so she went to see a primary care doctor who was a family friend.

Pulmonary function tests showed that Job had the lung capacity of an 80-year-old. The doctor thought she might have COVID, tuberculosis, or a fungus in her lungs.

But months after her symptoms began, Job was diagnosed with stage four lung cancer at age 37, despite being young, fit, and having never smoked.

Lung cancer is rare in people under 45, with most patients diagnosed aged 65 and over, according to the American Cancer Society. Although CDC data suggests rates of cigarette smoking, which is the leading risk factor for lung cancer in the US, have declined significantly over the last few decades, rates of non-smokers getting lung cancer are rising.

Women who have never smoked in particular are more than twice as likely to develop lung cancer than men who have not smoked, and more of the few young people who get lung cancer have never smoked, a study published earlier this year in the journal Nature Reviews Clinical Oncology found.

Researchers don't know why this is, but it could be linked to certain gene mutations, such as EGFR, which can cause cells to grow out of control and lead to cancer.

Job was diagnosed with lung cancer after switching hospitals

In October 2020, Job underwent a series of tests including a bronchoscopy, where a tube is fed down the throat into the lungs so doctors can see inside.

"Every doctor known to man" tried to figure out what was wrong, she said.

After four days of "tests and treatments and poking and prodding," Job was diagnosed with cancer, but said she was told she'd have to wait up to 14 days for the results of a biopsy to reveal what type.

Job and her husband drove four hours to the University of Texas MD Anderson Cancer Center for a second opinion. Doctors quickly identified she had stage four, non-small cell lung cancer, which had spread to her pelvis, right femur, and cervical spine. She needed to start treatment right away.

A trial treatment helped at first

Job found out that she had the EGFR gene mutation, which made her eligible for a clinical trial of an experimental lung cancer treatment starting in late 2020.

By November 2021, she was feeling like herself again — she hadn't needed supplemental oxygen since March, and was able to run a mile a day.

But in September 2022, her chest started to cramp again. By Thanksgiving, it had gotten so painful and frequent that she went to the ER, where she was told the cancer had gotten "worse," and the drugs were losing their effectiveness.

So, she started a new clinical trial in the second week of December 2022.

In November 2023, Job shared on Instagram that her primary tumor was growing, and her treatment was no longer effective. So, in December 2023, she started another round of chemotherapy and "initially had a great response," she told Business Insider.

Job's journey with cancer is ongoing

By July of this year, Job said she was no longer responding to the chemotherapy, and her tumor had started growing again.

In a post on Thursday, she wrote on Instagram that she hoped other drugs would be effective.

"My cancer diagnosis does not define me. I refuse to let it. But it does drive me. It drives me to be a better person and a more present mom and wife. And it drives me to share the hope I feel every day, not just with those who are fighting for their lives, but with those who soon will be," Job wrote on her non-profit's website.

She and her husband started Ten for Ten Million to raise funds for research at the MD Anderson Cancer Center. They told The Patient Story it gives them purpose and has allowed Job to leave an impression on the world.

The couple tries to make every day count, making sure to plan trips and have things to look forward to.

"You always think, 'Oh, when I retire, I'll go do this.' Well, that isn't going to happen for everybody. We don't know what's going to happen to us by the end of the day. We may as well just live for each and every moment," Job said.