When the pain persisted after she returned home to California, she decided to get an MRI. The scan said she had cancer.
The second scan showed the same thing, and doctors believed that the cancer found in Wojcicki’s bones had spread there from another source. “Sure enough, it was cancer, and it was metastatic,” says Wojcicki's husband, Dennis Troper, a project management director at Google. “It was a bomb dropping in the room.”
Susan Wojcicki —Courtesy Susan Wojcicki Foundation
Wojcicki decided not to reveal her diagnosis publicly and continued to work at YouTube until stepping down in early 2023. Behind the scenes, she and her sisters, Anne—who founded genetic testing company 23andMe—and Janet, spent the next two years aggressively searching for answers to the questions Wojcicki asked herself over and over again: Why did this happen? Was there something she could have done to prevent this cancer? She tested her home for radon—the second leading cause of lung cancer, behind smoking—and investigated air pollution patterns where she lived, but none yielded satisfactory answers. In the search for better treatments for her advanced disease, it became clear that she was at the vanguard of an ignored group of people who were falling through the cracks of lung-cancer care.
Dennis Troper —Carolyn Fong for TIME
Although Wojcicki died without knowing why she developed lung cancer, her family hasn't stopped looking for answers. In some of the first interviews about Wojcicki’s cancer journey, they shared with TIME, and also with Good Morning America, their decision to launch the Susan Wojcicki Foundation in order to fund efforts to diagnose lung cancer earlier, particularly for nonsmokers, and change recommendations about who should be screened for the disease. Inspired by organizations such as the Michael J. Fox Foundation, for Parkinson’s disease, and the Susan G. Komen Foundation, for breast cancer, the family hopes to reframe how the public views lung cancer and change screening guidelines to include anyone—not just smokers—who might be at higher risk of developing the disease. “If you look at non-smoking lung cancer, that is the fifth-largest killer of all cancers,” says Troper. “It’s a crisis."
Before the cancer diagnosis, the farm was a place where the Wojcicki sisters and their families would spend time together and gather for holidays. After, it became something of a headquarters for the family and the experts they invited over to figure out how to defeat her cancer. “From day one, this was a project,” says Anne of the fight to save her sister’s life—similar to the ones they would embark upon as children. “I remember [Susan] calling us and saying, ‘You guys are in charge. I can’t deal with this, so I’m putting you guys in charge of solving this.’”
Susan and her family; Susan in nature —Courtesy Susan Wojcicki FoundationAfter learning about her sister’s diagnosis, Anne called dozens of her contacts in the medical community from her years of building 23andMe, which declared bankruptcy as a commercial testing company in 2025 but now exists as a nonprofit research organization, the 23andMe Research Institute, which Anne runs. She and Janet visited leading experts at the National Institutes of Health, who weren’t optimistic about Wojcicki’s chances. Hearing this from experts on science's cutting edge was a “watershed moment," Janet says. "They said, 'It looks really bad. You should go home and appreciate the time you have.'”
Anne Wojcicki —Carolyn Fong for TIME
Driving their determination was the fast-changing world of cancer therapies, including breakthroughs in immune-based treatments and cell-based strategies known as CAR-T, which they were convinced would be able to help their sister. “The hope was that science is moving really rapidly, and it was almost like, in Susan’s mind, she needed to stay alive long enough to capture some of those changes and innovation,” says Anne. “But we knew it was an uphill battle.”
“It’s quite clear that abnormalities we see in young people with cancer of the lung are quite different than what is typically seen in [smoking-related] lung cancer,” says Dr. Edward Garon, professor and director of thoracic oncology at the Jonsson Comprehensive Cancer Center at the University of California Los Angeles (who was not involved with Wojcicki's care). While smokers typically have a multitude of mutations caused by nicotine and carcinogens in tobacco, "in patients who are younger and nonsmokers, we tend to see [a] lesser number of mutations...and the mutations tend to be drivers of the tumor.”
Research into the genetics of nonsmoking lung cancer is so nascent that Wojcicki's mutation has only been reported in 77 other cases, the sisters learned. “The only real chance of saving Susan’s life was if the cancer was caught early, when it could be cured, but she did not have that opportunity,” says Nadia Litterman, who Anne knew from 23andMe and asked to manage the growing number of projects and leads the group was pursuing to help their sister (and who is now executive director of the new foundation).
Janet Wojcicki —Carolyn Fong for TIME
In addition to funding research, the foundation is working closely with YouTube to raise awareness and change public perception about lung cancer as solely a disease caused by smoking. That role for YouTube was something for which Wojcicki had begun setting the stage years before she learned she had cancer. At a time when YouTube was known for promoting fluffy content, Wojcicki already wanted to harness its influence for more substantive goals. She recruited Dr. Garth Graham, then at CVS Health, to head up a new initiative at YouTube to provide reliable, validated health information from qualified and respected sources. “The idea she had was that many people start their health care journeys on Google and YouTube, and video is a very important part of demystifying complex clinical topics, from understanding heart disease, diabetes, and a cancer diagnosis,” says Graham.
Lung cancer is among the few cancers for which screening is determined by a lifestyle choice—smoking—in addition to age. The stigma, and guilt, surrounding lung cancer caused by smoking means that screening rates for the disease remain low. Screening guidelines involve some complicated, non-intuitive math. People who should currently get screened for lung cancer include adults ages 50-80 who smoked the equivalent of a pack a year for 20 years, who currently smoke or have quit in the last 15 years. Even within this high-risk category, only about 18-20% of eligible people in the U.S. get the screening test, a low-dose CT scan.
In their quest to cure Wojcicki's cancer, the sisters recognized that nonsmokers who develop lung cancer are a massively understudied population. Scientists still didn't know basic information about lung cancer in nonsmokers, including the comprehensive range of genetic factors driving the disease. Just a month before her death, in July 2024, the sisters opened the Lung Cancer Genetics Study to uncover more of those genes, with the ultimate goal of developing better ways to detect the cancer early.
Based on the results, health officials are now starting to screen more nonsmokers in Taiwan who have the same risk factors used in the study to see if including this population can lower lung-cancer deaths.
This is the population Wojcicki’s family is hoping to capture. With more research, they hope to change lung-cancer screening recommendations in the U.S. to include nonsmokers.
The two scientists have just finished enrolling 550 Asian-American women who were diagnosed with lung cancer but who had never smoked, along with 700 similar-aged women of any ethnicity who don’t have lung cancer as controls. All of the women answered questions about their passive smoke exposure, immigration experience, and environmental exposures, and they all provided saliva samples that might identify molecular and genetic factors differentiating those who had lung cancer from those who didn't. It's the first study of such risk factors, Gomez says.
Other scientists are also mining existing databases for clues about what makes some nonsmokers vulnerable to lung cancer. Hilary Robbins and Mattias Johansson, both scientists at the International Agency for Research on Cancer (IARC) at the World Health Organization, received one of the first two grants from the Susan Wojcicki Foundation to hunt for factors in the blood that could flag nonsmokers at higher risk of developing lung cancer. The database they're mining contains blood samples from more than 7,000 nonsmokers who developed lung cancer. “Often there are proteins perturbed by early signs of disease,” says Johansson. “Those are the signals we are looking for in our research.”
Raoof knows the challenges of creating blood tests for cancer; well-funded efforts to pick up multiple different cancers from the blood have not been successful to date. But with advances in AI and in the understanding of the genetic changes driving some of these cancers—and with enough samples from patients—she believes such a test could be available soon. “The power of the foundation is that it can help accelerate the search for new people with newly diagnosed lung cancer who are low risk,” she says. “There is a whole world of molecular biology out there that has not entered the space of screening. We believe the future of reducing deaths from lung cancer is early detection.”
Her family says Wojcicki didn’t explicitly express her desire to establish a foundation or specific initiative around lung cancer cases like hers, because throughout treatment she expected to beat the odds and stay one step ahead of the disease. She received her last therapy, an immune-based experimental treatment for lung cancer involving retraining her T cells to attack her cancer, at Memorial Sloan Kettering Cancer Center in New York City. She was hopeful enough that this treatment, which is now approved for melanoma but not yet for lung cancer, would buy her more time that she looked for an apartment in New York, anticipating returning for additional treatments. “We walked into Memorial Sloan Kettering thinking we would come out a month later, cancer-free from that treatment,” says Troper. “We had high hopes until the very end.”
The family is also determined to finally answer the question that started it all: why did she get this?
“I remember Susan and I were in the hospital room, and she was very weak at that point,” says Troper, becoming emotional at the memory. “But she looked me in the eye and said, ‘Dennis, I don’t care what you do when I’m not here, but do something meaningful.’"
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