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Smoker or not, lung cancer could find you

Doctors say say they are seeing more nonsmokers with the disease than in the past. It's unclear why.

By LEONORA LaPETER
Published August 13, 2005

Gloria Caruso used to shoo away the smoke of her co-workers at the Eastern Airlines reservation center in Tampa some 40 years ago. On either side of her, the women lit one cigarette after another. Caruso refused.

"We used to call them coffin nails, figuring the people who were smoking were the ones who were going to have the problem," said Caruso, now 66 and retired. "Not the ones who were not smoking."

But today, it's Caruso who has lung cancer, while none of her friends from those days do.

This week, another nonsmoker, Christopher Reeve's widow, Dana, announced that she has lung cancer, focusing attention on the increasing numbers of lung cancer patients who have never smoked - particularly women. The 44-year-old's revelation came two days after the death of ABC News anchorman Peter Jennings, a longtime smoker who quit 20 years ago but reportedly resumed after the Sept. 11, 2001, attacks. About 80 percent of women and 90 percent of men who get lung cancer have smoked. It is the leading cancer killer in the United States and will cause an estimated 163,510 deaths this year, according to the American Lung Association.

While rates of overall lung cancer have gone down in men and stabilized in women during the past decade, doctors say they are seeing more nonsmokers coming in with the disease than in the past.

"It is becoming more and more common, and two out of three times these patients tend to be middle-aged females," said Dr. George Simon, a lung cancer specialist at H. Lee Moffitt Cancer & Research Institute in Tampa.

Dr. Michael Thun, who heads epidemiological research for the American Cancer Society in Atlanta, said that the population is getting larger and older may be causing more nonsmoking women to visit oncologists. Another factor may be that there are more nonsmoking women in their middle ages than men.

Overall cigarette use is down to pre-World War II levels. But men started smoking well before women did, and so the death rate for men from lung cancer peaked in 1990 before starting a gradual decline. Death rates for women, on the other hand, didn't peak until 1998, and they still haven't begun to decline.

The American Cancer Society conducted two studies of nonsmokers from the 1960s through the mid 1980s. They found no increase in the death rate among nonsmokers at that time.

Researchers continue to study the rate of lung cancer among nonsmokers, but they haven't determined whether it's going up - or what causes the disease in the first place.

One person may simply hold a genetic predisposition to get cancer and be exposed to either secondhand smoke or certain toxins or chemicals. Another may be exposed to neither.

Simon said his youngest patient was an 18-year-old boy who never smoked and was raised in a nonsmoking family. He had earned a scholarship to play baseball. He died two years after he was diagnosed.

"Why certain people get cancer and certain people don't, we don't know," Simon said. "I still don't have a clue what caused his cancer."

Researchers at H. Lee Moffit began to notice more nonsmokers coming in with the disease a few years ago so they decided to study it. They found that nonsmokers typically got one of the most common types of lung cancer, adenocarcinoma, and that they were predominantly women who responded well to treatment and survived longer.

These nonsmokers with lung cancer were more likely to keep the cancer at bay with the new wave of targeted drugs, pills such as Tarceva, which don't have as many side effects as chemotherapy and other cancer treatments.

Simon said nonsmokers tend to respond 37 to 40 percent of the time to the drugs, while smokers tend to respond only 9 to 10 percent of the time. Meanwhile, there are some 300 drugs now in development or clinical trials to target the cancer.

"The genetics of lung cancer is very complex, and I really doubt you will find a tablet that will make it go away but that day might come, hopefully in my lifetime," he said.

Caruso has taken both Tarceva and another drug, Iressa. Though she still has lung cancer, the pills stopped the cancer in its tracks, and it has been more than six years since she was diagnosed. A mother of two with six grandchildren, she retired from Northwest Airlines last year and continues to lead a full life that includes traveling.

She said her friends feel guilty that their smoke during lunches and breaks so many years ago may have caused her to get lung cancer. But she doesn't blame them because back then, no one knew secondhand cigarette smoke could be so detrimental.

Today, we know.

"Every time I see a woman with a child in her lap blowing smoke in the child's face, I start thinking 20, 30, 40 years down the road, that child's going to pay for that," she said.

- Times researcher Caryn Baird contributed to this report.

[Last modified August 13, 2005, 01:23:07]