The alarming rise of lung-cancer among non-smokers

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Lung cancer is indelibly associated in the public mind with cigarettes, and with good reason: about 86% of those who get it are smokers or ex-smokers.

Research indicates a growing number of women who have never smoked but are nevertheless being diagnosed with lung cancer when they are still “young” in medical terms – that is, under 55.

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The figures are startling. The clinical director of the center for cancer outcomes at University College London hospital (UCLH) – estimates that nearly 6,000 people who have never smoked die of lung cancer every year.

That is more than the number of people who die of cervical cancer (900), lymphoma (5,200), leukemia (4,500) and ovarian cancer (4,200): “If considered as a separate entity, Lung Cancer in non-smokers (LCIN) is reported to be the eighth most common cause of cancer-related death in the UK, and the seventh most prevalent cancer in the world,” he writes.

While about 10% of men in Britain diagnosed with lung cancer are non-smokers, the percentage of women is higher: 15-20%. The decline of cigarette consumption over the past 15 years means that the proportion of people with the disease who are LCINs is growing. In addition, the absolute numbers and rates of LCINs are going up.

The media’s focus on breast, cervical and prostate cancer obscures the fact that lung cancer is one of the biggest cancer killer, claiming about 35,600 lives a year; more than from breast, prostate, liver and bladder cancer combined. Since the late 1970s, the rate of lung cancer diagnosis has fallen by 14%. Yet while it has fallen by 44% in men in that time, it has risen by 69% in women because women began giving up smoking years later.

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There is no consensus among experts about why lung cancer is affecting more and more non-smokers.

There are however four main known causes: passive smoking; occupational factors, such as exposure to asbestos; exposure to radon gas; and a history of serious breathing conditions.

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Being brought up in a home where one or both parents smoked increases risk, as does having a close relative with the disease.

While asbestos is known to cause certain cancers, including mesothelioma, different work patterns between men and women mean that is likely to have caused few cases of lung cancer in women. One study has estimated that radon leads to 1,500 people a year developing the disease. There are also clear statistical links between tuberculosis and pneumonia and lung cancer risk.

But there are strong suspicions, too, that air pollution could be a factor. Outdoor pollution is under scrutiny, although open fires and even meat roasting may increase risk. It is noteworthy, though, that more than half of lung cancers in women in China occur in non-smokers.

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Some LCIN women believe that chemicals in perfume, makeup, aerosols or cleaning products may be to blame, but there is no evidence to incriminate any of them.

Female LCINs are a higher proportion of the cases lung cancer specialists are seeing.

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Dr Neal Navani, a specialist in respiratory conditions at UCLH, says he often has to tell previously healthy non-smoking women under 55 that they have been diagnosed with one of the most lethal forms of cancer at stage four – when it is incurable. “It’s difficult to describe the emotion they feel. Everything just drains from their face,” he says. “Today, I told two women under the age of 55 that they have advanced lung cancer. One was under 50 and had never smoked. She’d had a hoarse voice, but none of the other symptoms, such as a cough, chest pain or breathlessness. When I went over the scan with her, she reacted with total incomprehension and said: ‘Why me?’”

Navani says that doctors typically see fewer than two cases of lung cancer a year, even among smokers – so it’s unsurprising that it’s often at first mistaken for something else.

The disease is often asymptomatic until it has spread, explaining why, among those who don’t smoke, it is almost always diagnosed at a stage when the patient cannot be cured. If you’re a 35-year-old woman who has never smoked coming in with a cough, most doctors would put lung cancer at 155th on their list of likely causes.

Navani says there is a “nihilism” about lung cancer among people with the condition and health professionals, reflecting the belief that – because there are so few treatments that significantly extend life – a diagnosis is essentially a death sentence. But the outlook is starting to improve.

Crucially, new drugs are coming into use, and they are more often effective in non-smokers. There is optimism around a class of drugs called tyrosine-kinase inhibitors (TKIs), which stop the cancerous cells from spreading. Pearson’s TKI has extended her prognosis from an initial six months to at least 18 months. Platts’ tumours reduced in size after just 10 weeks of taking the anticancer drug gefitnib; since they became resistant to it, she is now having chemotherapy.

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