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
This is an oldie but goodie article from GRACE's archives. Enjoy!
Author
Jared Weiss, MD
Image

 

 

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 erltotinib 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. 

Part 2:

Nicotine versus heroin.

 

Video Language

Next Previous link

Previous PostNext Post

Related Content

Image
Blood Cancer OncTalk
Article
In this series of videos, Dr. Aaron Goodman chairs the discussion along with speakers Drs. Tycel Phillips, Sridevi Rajeeve, Marco Ruiz and Alankrita Taneja.  Topics include:
Article
View the full Targeted Therapies in Lung Cancer Patient forum from 2023 in YouTube and embedded here! 

Forum Discussions

Hi Blaze,

 

As much as I hate to say it, Welcome back Blaze.  It sounds like you're otherwise feeling good and enjoying life which is a wonderful place to be. ...

Waiting for my appointment with oncologist this morning. Thank you for the response. It helps. <3

It sounds like you’re thinking of this in a very appropriate way. Specifically, it sounds like the growth of the nodule is rather modest, though keep in mind that the change...

Hi and welcome to GRACE.  I'm sorry your mom is having this difficulty.  An indwelling catheter is used when the pleura space continually fills and the catheter is always there to...

Hi Oaktowngrrl,  Welcome to Grace.  I'm so sorry you're going through this.

 

 Finding a reputable dedicated thoracic surgeon for lung surgery might be difficult, as it is a complex and...

Recent Comments

JOIN THE CONVERSATION
Could you
By Maeve785 on
It sounds like you’re…
By Dr West on
Thank you Janine
By blaze100 on
Hi Blaze,

 

As much as I…
By JanineT GRACE … on