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09/22/2009 - Articles

Lung cancer in never-smokers

By: Susan Aldridge, medical journalist, PhD


Lung cancer is so strongly associated with smoking that we may forget that never- smokers (those who smoked fewer than 100 cigarettes in their life) get the disease too.

Lung cancer in the never-smoker is the sixth leading cause of cancer-related deaths in the US and accounts for 10-15% of lung cancer cases.  Now a group of experts at Johns Hopkins Kimmel Cancer Center is calling for recognition of lung cancer in the never-smoker as a different disease from the cancer in the smoker. And, as such, they say this lung cancer needs different treatment and prevention measures.  They have therefore published a new guide to the biology, diagnosis and treatment of lung cancer in the never smoker. 


Exposure to second-hand smoke and to radon gas which leaks into homes from uranium-containing soil are the two prime causes of lung cancer aside from smoking,  Asbestos and exposure to pollution from wood-burning stoves and cooking oils are other causes.  But there is still a gap in our knowledge, for half of all cases of lung cancer in the never-smoker cannot be attributed to any of these causes.


The Johns Hopkins experts and their collaborators also call on organizers of lung cancer trials to classify their participants by smoking status and be sure to link this factor to outcomes.  Patients with lung cancer who have never smoked seem to respond better to a certain class of drugs called the EGFR inhibitors than smokers do. This is because they are more likely to have the mutations in this gene that promote cancer, and these drugs block the action of the gene. 


There is a need for more genome-based knowledge on lung cancer.  Dr William Pao of Vanderbilt-Ingram Cancer Center has set up a tissue specimen bank to aid a genome-wide study of never-smoker lung cancer. 


Women and certain populations in East Asia seem to be more susceptible to never-smoker lung cancer. It tends to present at an advanced stage with non-specific symptoms like cough and chest pain. Doctors will often diagnose a respiratory infection if the patient does not smoke. So, if you are troubled by a persistent cough, make sure your doctor does tests to rule out lung cancer.


Rudin C, Avila-Tay E, Samet J Lung cancer in never-smokers: a call to action Clin Can Res 2009;15:5622-5 


Created on: 09/22/2009
Reviewed on: 09/22/2009

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