Article and Video CATEGORIES

Cancer Journey

Search By

Dr. Jared Weiss is an Associate Professor of Clinical Research for Hematology/Oncology at the University of North Carolina School of Medicine in Chapel Hill, NC. He completed fellowship in Hematology and Oncology at the University of Pennsylvania and residency in Internal Medicine at Beth Israel Deaconess Medical Center in Boston, MA. He received his Doctor of Medicine at Yale University School of Medicine in New Haven, CT and his B.S. in neuroscience at Brown University, in Providence, RI.

Part 1: Lung Cancer Isn’t Your Fault, Even If You Smoked
Mon, 07/01/2019 - 17:36
This is an oldie but goodie article from GRACE's archives. Enjoy!
Author
Jared Weiss, MD
Image

From the Grace Archives | Originally Published November 12, 2014 | By Dr. Weiss

Smoking is the most common cause of lung cancer; 85% of lung cancer patients have smoked at some point in their lives (or, stated another way, 15% of lung cancer patients have never smoked).  While quitting smoking certainly decreases the risk of getting lung cancer, more than half of lung cancer happens in people who have quit. 

Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, “Cigarette Smoking Among Adults – United States, 2006”, November 9,2007/56(44): 1157-1161, Table 2

Reason #1 to not blame the lung cancer patient:

He or she may have never smoked.  I just visited a very young patient of mine while he was dying at home of lung cancer.  He never smoked.

Reason #2 to not blame the lung cancer patient:

The smoking may not have caused the cancer.

Smoking is not the only cause of lung cancer.  Other causes include occupational carcinogen exposure, radon, and outdoor air pollution.  There are probably other, as yet undiscovered, causes. 

I’ll add a cause that is rarely directly discussed: an (un)healthy dose of bad luck. The majority of active smokers and former smokers do not get lung cancer.  Cigarette smoke contains numerous chemicals that can cause mutations, or changes in the DNA of cells. Some DNA codes for important proteins—mutations to these areas of DNA have the potential to cause cancer.  Other parts of DNA are “junk” that don’t actually code for anything.  While there is active research into why some people get cancer from cigarette smoking and others don’t, the luck of having these mutations in “junk” regions or in important ones surely plays a major role. 

Dr. Jared Weiss (Courtesy of UNC Lineberger)

Smokers and nonsmokers have similar chances of developing smoking-unrelated lung cancer. Scientists now believe that non-smoking related lung cancers tend to be biologically simpler—they have one or two “driving” mutations that transform a healthy lung cell into a lung cancer cell (for example, EGFR or EML4/ALK).  In contrast, smoking-related cancers may have more mutations that together contribute to transforming that healthy lung cell into a cancerous one.  But, there is absolutely nothing about smoking, even heavy smoking, that protects a person against a smoking-unrelated lung cancer.

This last point is important not only for how we think or feel about people with lung cancer, it also has a very important practical consequence for medical practice. All patients with metastatic non-squamous non-small cell lung cancer (the type that might have mutations that can be treated with targeted therapies such as erlotinib or crizotinib) deserve molecular testing, regardless of how much they smoked. 

In my practice, I have found several patients with EGFR mutation (treatable with erlotinib or afatinib) and at least 1 with EML4/ALK (treatable with crizotinib) amongst patients with a smoking history.  Statistically, patients who have smoked a lot may have a lower probability of having such mutations, but there is still a real chance, and I feel strongly that these patients deserve testing. 

 

Video Language

Next Previous link

Previous PostNext Post

Related Content

Image
Terapias Dirigidas de Cáncer de Pulmón 2023
Video
En este foro anual de pacientes en vivo, los principales oncólogos torácicos de todo el mundo discuten temas relevantes para los objetivos del cáncer de pulmón, así como mutaciones raras. En esta serie de videos los Doctores Fernando Diaz, Luis Raez, Luis Corrales, Estelamari Rodriguez y Alberto Chiappori presentan el Panel de Discusión donde hablan sobre temas relevantes del cáncer de pulmón. 
Image
Terapias Dirigidas de Cáncer de Pulmón 2023
Video
En este foro anual de pacientes en vivo, los principales oncólogos torácicos de todo el mundo discuten temas relevantes para los objetivos del cáncer de pulmón, así como mutaciones raras. En esta serie de videos los Doctores Fernando Diaz, Luis Raez, Luis Corrales, Estelamari Rodriguez y Alberto Chiappori presentan el Panel de Discusión donde hablan sobre temas relevantes del cáncer de pulmón. 
Image
September 2023 Blood Cancer OncTalk
Article
The September 2023 Blood Cancer OncTalk has now ended.  Videos are available OnDemand! The full unedited versions of the September 2023 Blood Cancer OncTalk, are now available OnDemand. These topics will be edited and offered as shorter videos in the coming weeks.   The full videos are available on our YouTube channel via this link:  https://youtube.com/playlist?list=PLWsyUmdjLXhG4km7yALHmLjQSeUQg-36x

Forum Discussions

Stan - Thank you once again for your kind words.  Thank you as well for your donation.  As you know, your donation helps us to exist and continue to fulfill our...

Hi Stan, It's good to hear your voice and know your cheesecakes are still making the rounds.  Though I'm sure startling, I imagine some of those little pockets of the house...

Hi Rutbats,  Welcome to GRACE and thanks for the kind words. 

 

We can't say what you should or shouldn't do and I can't say why your RA doc made their...

Thank you very much for your quick answer, Janine.

I have an appointment with a pulmonologist in 10 days. I will summarize the conversation with him here, so that other people...

Glad to know you're moving forward with a pulmonologist.  The more you know the better the conversation with your pulmonologist.  Remember you can help your docs know what level their conversation...

Hi Terry, Welcome to Grace. 

I saw this exact post somewhere else months back and the only response was to a lab.  I hope that doesn't happen here, we don't allow...

Recent Comments

JOIN THE CONVERSATION
Hi Stan, It's good to hear…
By JanineT GRACE … on Fri, 12/01/2023 - 07:14
Thank you Stan, for your kind words.
By dbrock on Thu, 11/30/2023 - 11:55
Glad to know you're moving…
By JanineT GRACE … on Mon, 11/27/2023 - 11:27
Thank you very much for your…
By rutbats on Mon, 11/27/2023 - 08:07