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    Home - Health & Wellness (Specialized) - Lung Cancer in Nonsmokers: Causes and Risk Factors Explained
    Health & Wellness (Specialized)

    Lung Cancer in Nonsmokers: Causes and Risk Factors Explained

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    Lung Cancer in Nonsmokers: Causes and Risk Factors Explained
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    The explanation is complex, likely due to many factors, and is not fully understood, says Andrew Kaufman, MD, a thoracic surgeon at Mount Sinai Hospital in New York City. “We know very little about why this is occurring and why it seems to be occurring at higher rates now compared with historical time points,” he says.

    Research points to some possible explanations. “Increased secondhand smoke, radon exposure, air pollution, a family history of lung cancer, and asbestos influence this trend, accounting for nearly 6,500 of the 20,000 to 40,000 yearly cases of lung cancer among never-smokers in the United States,” says Dr. Ahluwalia.

    Here are some possible reasons for the increase in lung cancer cases among never-smokers.

    An Increase in Never-Smokers

    “The number of people who never smoked as a proportion of the general population is higher now than ever in the last 100 years because the rates of smoking have declined to about 20 percent of the adult population,” says Dr. Kaufman. “So, with fewer people having a history of smoking, there is a higher chance of diagnosing lung cancer that is not attributable to smoking.”

    As the authors of a recent Nature paper note: “With smoking rates declining, [lung cancer in never-smokers] might eventually predominate lung cancer diagnoses.”

    Genetic Mutations

    People who have never smoked but get lung cancer often have genetic mutations in their cancer cells that contribute to cancer development. “Many never-smoking lung cancers harbor genetic mutations known as ‘driver mutations’ that cause otherwise healthy lung cells to become cancerous,” says Kaufman. “But we don’t know what causes these mutations to occur.”

    Common mutations in never-smokers who develop lung cancer include changes in the EGFR, ALK, and ROS1 genes, among others. For example, Asian populations tend to have a greater frequency of EGFR mutations and ALK rearrangements, which may account for their higher rates of lung cancer in never-smokers, explains Ahluwalia.

    Fortunately, there are drugs and therapies available to target many of these mutations, which can be used alone or in combination with chemotherapy. Examples include osimertinib, lazertinib, crizotinib, and many more, says Ahluwalia, who also stresses the importance of personalized medicine for lung cancer care. “These therapies have significantly improved survival and quality of life for never-smokers [with lung cancer],” he adds.

    Family History

    People with a family history of lung cancer have a greater risk of developing the cancer themselves. This is especially true if you have a first-degree relative (a parent or sibling) who developed lung cancer before age 50.

    One review of existing studies found that the risk of lung cancer in never-smokers doubles among people who have a first-degree relative with the condition, and this risk increases further if the relative was young (under 40) when they were diagnosed — or if the person in question had multiple relatives with the condition.

    More Screening

    Doctors may be detecting more lung cancers in people who have never smoked because of the increased use of screening technologies. “We image people for so many things unrelated to lung cancer that we end up finding things incidentally,” says Kaufman. “Someone’s kidney stones may save their life if a spot on the lung is noticed and the appropriate diagnosis and care is followed through.”

    However, screening never-smokers for lung cancer specifically is not recommended by the U.S. Preventive Services Task Force. This is because the potential benefits of early lung cancer detection don’t outweigh the possible harms in this group.

    “Never-smokers with a family history or consistent exposure to occupational or environmental risks should [decide together] with their provider to assess the need for screening,” says Ahluwalia.

    Secondhand and Thirdhand Smoke

    Secondhand smoke — smoke breathed in from another person’s cigarette or tobacco product — accounts for about 7,000 lung cancer deaths each year in the United States.

    “Recent studies have reported that secondhand smoke exposure alone increases one’s risk of lung cancer by over 20 percent, even if they never partake,” says Ahluwalia.

    Researchers are also looking at the impact of “thirdhand smoke.” This is the film of nicotine and chemicals that may be left on walls, furniture, clothing, and other surfaces. These small particles can penetrate deep into surfaces, and they’ve also been found in dust samples taken from people’s homes. Current research indicates that the particles can damage human DNA in cell cultures and may raise lung cancer risk in animal studies.

    Radon Exposure

    Radon is a naturally occurring radioactive gas that trickles into homes from the ground. Researchers estimate radon gas exposure accounts for about 21,000 lung cancer deaths each year.

    Radon exposure is the second leading cause of lung cancer but the most common cause of lung cancer in nonsmokers.

    Some recent studies have suggested that modern building construction practices have led to an increase in the amount of radon concentration in homes.

    The Environmental Protection Agency estimates that 1 in 15 homes in the United States has unsafe levels of radon.

    Other Environmental Pollutants

    Other environmental factors may lead to lung cancer in people who don’t smoke, such as exposure to:

    • Air pollution
    • Diesel exhaust
    • Asbestos
    • Arsenic
    • Arsenic compounds, such as pesticides and herbicides
    • X-ray and radiation technology
    • Inhaled chemicals such as cadmium, chromium, and coal



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