Non-smokers can get lung cancer, too

Lung cancer, it’s not just for smokers.

While a non-smoker – someone who does not currently smoke and has had fewer than 100 cigarettes in their lifetime – is less susceptible to lung cancer, it does happen. In the United States, 10 to 20 percent of lung cancers, or 20,000 to 40,000 each year, occur in nonsmokers, according to the U.S. Centers for Disease Control.

So, if smoking is not the reason, what is?

Lung cancer can be caused in nonsmokers by exposure to environmental factors, such as secondhand smoke, radon, asbestos, or polluted air, said Peter Ward, MD, a medical oncologist at Cape Cod Healthcare’s Davenport-Mugar Cancer Center in Hyannis. While there are some genetic lung cancers, they are rare, he said.

Smokers are more likely to get small-cell or squamous cell carcinomas, which start in the cells lining the passages leading from the windpipe to the lungs. Non-smokers tend to have adenocarcinomas, which start in the small air sacs throughout the lungs, according to the National Institutes of Health.

Non-smokers might be less likely to be diagnosed as early as smokers, said Dr. Ward.

“It’s more difficult in non-smokers than in smokers to detect these cancers because, in smokers, there’s a higher level of suspicion [by] primary-care physicians,” Dr. Ward said. As a result, a doctor might be more likely to recommend a chest X-ray or CT scan for a smoker with a cough than a non-smoker. “It’s a little trickier for non-smokers,” he said.

Screening Tools

Cape Cod Healthcare’s new screening program for lung cancers was designed to help with detection. The program encourages smokers and former smokers ages 50 to 80 to talk to their physician about a low dose CT screening. And, both nonsmokers and smokers can assess their risk confidentially through Cape Cod Healthcare’s online lung cancer screening tool, which asks not only about smoking but also exposure to secondhand smoke and dangerous materials.

Dr. Ward outlined some of the other basics about lung cancers:

• Lung cancer might be discovered during an emergency room visit. Early lung cancers may not be obviously symptomatic, he said. But doctors may see something suspicious on imaging – X-rays or CT scans – performed on emergency room patients who have fallen or present symptoms such as shortness of breath or persistent cough. If the radiologist spots a nodule or enlarged lymph node on the scan, that would indicate further tests for lung cancer, Dr. Ward said.
• Patients may be referred for bronchoscopy or endobronchial ultrasound (EBUS). These scope procedures involve a pulmonologist inserting a flexible scope down the endotracheal tube and/or into the lungs to take a closer look and possibly take a biopsy. If cancer is confirmed by a biopsy, the patient’s case goes before the thoracic tumor board, which includes medical and radiation oncologists, including Dr. Ward, Michael Ayers, MD, FCCP, a Hyannis interventional pulmonologist, and Jeffrey J. Spillane, MD, FACS, a Hyannis thoracic surgeon. The board considers the type of cancer as well as its stage – its size and whether it’s metastasized – and develops a treatment plan.
• Treatment strategies include surgery; chemotherapy; targeted therapies, and immunotherapy and chemoradiation. Chemotherapy relies on chemicals to shrink the tumor; targeted therapies are developed to fight the specific tumor; and immunotherapies boost the patient’s immune system. Stage I or Stage II lung cancers, which have not metastasized, are generally treatable with surgery, Dr. Ward said. Some Stage III tumors can also be surgically removed but might first be treated with radiation and a low dose of weekly chemotherapy.
• “The treatment paradigm is changing because there’s been new data over the last year showing that in Stage III lung cancer, we can give immunotherapy and chemotherapy to try and shrink the cancer,”’ Dr. Ward said. “That can sometimes make the surgery easier for the surgeon to remove everything and can lead to better outcomes.” Stage IV cancers might be treated with immunotherapy and chemotherapy, depending on the molecular make-up, he said. However, lung cancers in smokers are sometimes more responsive to treatment, he said, because they have more mutations in the cancer cell DNA. “It turns out that cancers that have more mutations tend to be more susceptible to immunotherapy,” he said.
• The prognosis for most lung cancers is improving. “Overall, the prognosis of most lung cancers has improved tremendously over the past 10 years in terms of how long someone can live, even with Stage IV lung cancer,” Dr. Ward said. “And cure rates for earlier stage lung cancer are improving also because of lung cancer screening, especially in smokers.”