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Lung cancer trend baffles experts

Donna G

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Above is how this article was headlined in the St. Paul Pioneer Press.

Filtered out by cancer?

Lung cancer, linked strongly to smoking, is on the rise in under-50 women who never lit up or smoked little



August 11, 2005

The day after Dana Reeve's diagnosis was made public, Dr. David Johnson treated 10 lung cancer patients at his morning clinic at the Vanderbilt-Ingram Cancer Center in Nashville.

Of the 10, five were women. Of the five, four had never smoked. The oldest was in her early 50s. "Ten years ago that just wasn't the case," said Johnson, deputy director of the cancer center and one of several experts nationwide. He is convinced lung cancer is rising among younger women and those who never smoked -- as is the case with Christopher Reeve's widow.

"Now we're seeing young women who either never smoked or were light smokers, and they're as young as their 30s, sometimes you see them in their 20s, but that's rare, and most are in their 40s or 50s. ... It's a real phenomenon."

For years, the aggressive campaign to eradicate smoking offered a seemingly straightforward message: Avoid lung cancer -- don't smoke. That point was driven home by Sunday's death of anchorman Peter Jennings. The vast majority of lung cancers are triggered by smoking and former smokers continue to be at risk. But about 15 percent of the 172,570 lung cancers diagnosed each year develop in patients who never smoked.

Doctors still attribute the increase in lung cancer among women since the mid-1960s to the rise in tobacco use among women decades earlier and say the health benefits of quitting smoking are indisputable. But a consensus seems to be emerging that nonsmoking women may be more susceptible to lung cancer than nonsmoking men, and some theorize that hormones may play a role in lung cancer, the top cancer killer of both men and women. "The numbers suggest that 20 percent of lung cancers in women are unrelated to smoking, compared to 10 percent in men," said Dr. Scott Swanson, chief of thoracic surgery at Mount Sinai Medical Center in Manhattan, who is also treating younger patients. "That's a two-to-one difference between women and men. The obvious question is why."

Nonsmokers and women do tend to respond better to new treatments, experts said.

Swanson, Johnson and others said that while there is insufficient data to prove that the number of young, nonsmoking women being diagnosed is on the rise, experienced clinicians like themselves have noticed the trend and are beginning to document it. For smokers, the disease usually took decades to develop and the average age of diagnosis was 65. "It's not uncommon now to see someone in their 30s," Swanson said. "Fifteen years ago that would have been something to write up in the New England Journal of Medicine."

Other experts agreed.

"We're seeing more and more people who have never smoked," said Dr. Roy Herbst, associate professor at the University of Texas M.D. Anderson Cancer Center in Houston.

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