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Every year roughly 20,000 people who have never touched a cigarette are diagnosed with lung cancer -- and women are particularly at risk, for reasons no one understands.

Recent research has suggested that women who don't smoke are two to three times more likely than nonsmoking men to develop lung cancer.

"People talk about secondhand smoke, but there are other environmental pollutants," said Dr. Heather Wakelee, an assistant professor at Stanford University School of Medicine. "We just don't understand it."

Research also suggests that women may be more vulnerable than men to the carcinogenic effects of smoking -- in some studies, women who smoked have been shown to be roughly twice as likely to develop lung cancer as men who smoked.

Wakelee, who is set to publish a new study on nonsmoking women and lung cancer in the next few months, said the research is too new to come up with a reason for why nonsmokers get cancer, and why women are especially at risk. Almost all studies have looked at patient records -- not actual patients -- which don't include all of the environmental factors, such as exposure to airborne pollutants, that could lead to lung cancer.

The differences are particularly striking in Asian countries where few women smoke, Wakelee said. In Singapore, for example, about a third of lung cancer cases are in nonsmokers, "and most of those are women," she said

Aside from secondhand smoke, which has long been known to cause lung cancer, other environmental factors could include exposure to radon gas and "any variety of industrial chemicals," said Dr. Joseph Mason, chief of oncology at Kaiser Permanente Santa Teresa Medical Center in San Jose.

"One famous nonsmoking oncologist ... died of lung cancer, and the speculation was that it was related to the nitrogen mustards he worked with in his lab developing the early generation of cancer chemotherapy drugs," Mason wrote in an e-mail. "All this is conjectural. The most honest response is that we don't really know."

For women, there could be epidemiological reasons for the greater likelihood for getting lung cancer. Some research is looking into a cell protein that mutates and could leave people at risk for developing cancer.

Lung cancer support groups are hoping to raise money, and awareness, to get some answers.

Sebastopol resident Joyce Neifert, co-chairwoman of Lung Cancer Alliance of California, said education is the most important factor in getting support for lung cancer patients.

"Most people don't know that you don't have to be a smoker to get lung cancer," said Neifert, whose husband, a nonsmoker, died of lung cancer last year. "There's a lot of education that needs to be done, and we need to fight the stigma that you are suffering from a disease where you get what you deserve."

E-mail Erin Allday at eallday@sfchronicle.com.

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