Lung cancer in non-smokers is sixth biggest cancer killer

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Sep 15 2008

While lung cancer in smokers and former smokers is the biggest cancer killer by far, lung cancer in people who have never smoked is -- by itself -- the sixth biggest cancer killer in the United States.

"Most people are not aware that lung cancer among non-smokers has such an enormous impact," said Lung Cancer Alliance President Laurie Fenton-Ambrose today. The heavy burden of lung cancer in non-smokers contradicts the common belief that lung cancer is a disease that strikes only smokers.

Whether non-smokers are being diagnosed with lung cancer at an increasing rate and whether that rate is higher in women than men is under debate. An American Cancer Society (ACS) study released earlier this week added fuel to that debate by claiming the rate is not increasing, and that men and women who have never smoked have similar rates of lung cancer.

"Our primary concern is real people," said Fenton-Ambrose. "The statistical debate over rates will continue to play out but we must not lose sight of the actual numbers of people -- smokers, former smokers and never smokers -- who are dying from this stigmatized and underfunded cancer."

According to National Cancer Institute (NCI) estimates, 161,840 people -- smokers, former smokers and non-smokers -- will die of lung cancer in the U.S. in 2008. That is more people than the combined total of the next four biggest cancer killers: colon cancer (49,960 deaths), breast cancer (40,930 deaths), pancreatic cancer (34,290 deaths) and prostate cancer (28,660).

The generally accepted estimate -- and the estimate used in the ACS paper -- is that never smokers account for 10% to 15% of all lung cancer deaths.

With the 15% number, 24,276 non-smokers will die in 2008, making non- smoking lung cancer the sixth largest cancer killer, ahead of leukemia (21,710 deaths), lymphoma (20,510 deaths), liver cancer (18,410 deaths) and ovarian cancer (15,520).

At the lower estimate of 10%, 16,189 non-smokers will die of lung cancer in 2008, making it the ninth most lethal cancer. (See attached table.)

LCA Board member, Deborah Morosini MD, the sister of Dana Reeve, a never smoker, whose death from lung cancer in 2006 brought public attention to the full impact of the disease, called the numbers on smoking-related and non- smoking-related lung cancers "staggering."

"With smoking-related lung cancer the most lethal cancer and with non- smoking related lung cancer the sixth highest or even the ninth highest, it is clear that we must make lung cancer a national public health priority," she said. "This is not an 'either or situation'," she said. "We must address lung cancer period."

In a press release on Monday, ACS claimed its study showed that "over the last 50 to 70 years, there has been no increase in lung cancer among people who have never smoked."

However, state and regional cancer registries, which monitor the occurrence of cancer cases throughout the United States, do not routinely collect information on patient smoking history. As a result, there remains a lack of clear evidence regarding trends in non-smoking-related cancers over the last several decades.

A 2007 Stanford University study found that in adults aged 40-79 years; non-smoking women had a higher rate of lung cancer than non-smoking men. The ACS study found similar results with a higher ratio of non-smoking women to men in the 40-59 year age bracket, and similar gender specific rates in the 60-79 year age bracket. It was only among adults aged 80 years and older that women had a lower incidence rate than men in the ACS study.

The Stanford study, headed by Heather A. Wakelee MD, was prompted by clinicians who were seeing an increasing number of lung cancer patients, especially women, who had never smoked.

"I commend Dr. Wakelee for opening up this critical area to research. The bottom line is that both these papers point out the urgent need for more accurate and better collection of data on smoking history and other risk factors for lung cancer and I hope we can move forward quickly," said Dr. Morosini.

Lung Cancer Alliance (www.lungcanceralliance.org) is the only national non-profit organization dedicated solely to patient support and advocacy for those living with or at risk for lung cancer. LCA is committed to leading the movement to reverse decades of stigma and neglect by empowering those with or at risk for the disease, elevating awareness and changing health policy.

Table 1:1

Estimated Cancer Deaths in 2008

Lung Cancer (smoking related) 137,564
Colon Cancer 49,960
Breast Cancer 40,930
Pancreatic Cancer 34,290
Prostate Cancer 28,660
Leukemia 21,710
Lymphoma 20,510
Liver Cancer 18,410
Ovarian Cancer 15,520
Lung Cancer (never smoker 15%) 24,276
Lung Cancer (never smoker 10%) 16,184