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April 13, 2021
It happens in roughly 12 percent of U.S. lung cancer diagnoses: The patient had never smoked tobacco. Worldwide, half of female lung cancer patients are never-smokers compared with 15% of men. Women never-smokers are more than twice as likely to develop lung cancer as never-smoking men.
The phenomenon of lung cancer in never-smokers is detailed here in STAT, notably by Sharon Begley, an acclaimed science journalist who died of lung cancer five days after it published. She, too, had never smoked.
The proportion of lung cancer patients who’ve never smoked is rising, she reported. It’s uncertain how much of that increase is due to a decline in smoking. If a certain number of lung cancer cases occur in never-smokers year after year but the pool of smokers is declining, the share of never-smokers would grow as a matter of simple math.
Either way, “doctors and public health experts have been slow to recognize this trend, however, and now there is growing pressure to understand how never-smokers’ disease differs from that of smokers, and to review whether screening guidelines need revision” wrote Begley.
Drugs work better in smokers
In some ways, lung cancer can be worse for never-smokers than for smokers. The drugs tend to work better in smokers because the tumors are often more visible to the immune system. “Because never-smokers have fewer tumor mutations, it’s harder to find them,” Begley wrote.
Health care is now grappling with how to think about lung cancer in never-smokers. Lung cancer screening isn’t currently recommended for never-smokers – the argument being that cost outweighs the benefit. And though treatment guidelines are the same for smokers and never-smokers, that doesn’t mean the condition is the same.
Some have proposed that lung cancer in women never-smokers should be considered a separate disease. One company is working on a drug to treat it.
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