Lung Cancer and The Blame Game: Nonsmokers Can Be Victims, Too

Most lung cancers occur in smokers, but nonsmoker Dana Reeve's situation isn't as uncommon as it appears.

Like Reeve, widow of "Superman" star Christopher Reeve, 1 in 5 women diagnosed with the disease never lit a cigarette, doctors say. Yet they share an unfortunate stigma with cancer patients who smoked.

"The underlying assumption is, you were a smoker and you caused this, therefore you're not going to get my sympathy," said Tom Labrecque Jr., who started a foundation to raise awareness after his nonsmoker father died several years ago of the disease.

No one "deserves" lung cancer, doctors say. But nonsmokers do have one silver lining: They respond better to the newest targeted cancer drugs like Iressa and Tarceva.

That's because people who get lung cancer early in life, like the 44-year-old Reeve, are more likely to have genetic factors fueling their disease, doctors say. Only 3 percent of lung cancers occur in people under 45, regardless of smoking status.

Reeve, an actress who leads a paralysis research foundation named for her husband who died last year, disclosed Tuesday that she was being treated for lung cancer but gave no details on how or where. Her announcement came two days after ABC News anchor Peter Jennings, a smoker, died of lung cancer at age 67.

Despite their different smoking histories, they share the most common cancer in the world, and the deadliest. This year in the United States, an estimated 93,010 men and 79,560 women will be diagnosed with lung cancer and almost an equal number - 90,490 men and 73,020 women - will die of it.

About 10 percent of men and 20 percent of women with lung cancer never smoked, and the number of nonsmokers with the disease doesn't seem to be rising significantly, said Dr. Michael Thun, chief epidemiologist for the American Cancer Society.

But awareness may be on the rise because of the aggressive anti-smoking campaigns in recent years. And the stigma may be rising, too.

"When people get breast cancer, people say, 'What can I do to help you?' When people get lung cancer, people say, 'Did you smoke?"' said Susan Mantel, executive director of Joan's Legacy, a fund-raising group named for Joan Scarangello, a nonsmoker and former head writer for newsman Tom Brokaw. Scarangello died in 2001 of lung cancer, as did her nonsmoking mother before her.

"There is a definite stigma," said Labrecque, recalling comments after the funeral for his father, a former chairman of Chase Manhattan Corp.

"People would say, 'I didn't know he smoked,"' he said. His foundation's Web site even acknowledges this trend, by stating that more than half of people newly diagnosed with lung cancer each year have either never smoked or quit smoking. Doctors who treat the disease, like Dr. Bruce Johnson of Dana-Farber Cancer Center in Boston, bristle at the notion of "innocent" and "not so innocent" victims.

"People who smoke don't deserve to get lung cancer, and people have worked very hard to quit," he said. Nonsmokers who have surgery for their cancer have a lower risk of developing a second tumor than smokers. Also, smokers who quit after cancer surgery have better survival odds, he noted.

Nonsmokers also respond better to Iressa and Tarceva, said Dr. Alan Sandler, director of thoracic oncology at Vanderbilt Ingram Cancer Center in Nashville, who has been involved in testing these new generation drugs that more precisely attack the molecular factors making these cancers grow.

"The malignant cell in a smoker is much more complex" and has more mutations than nonsmokers tend to have, Sandler said. Researchers now are studying whether nonsmokers do better in general on chemotherapy than smokers, he said. Meanwhile, the cancer society is hoping for an eventual decline in lung cancer cases to mirror the decline in smoking rates. "Cigarette consumption is down where it was at the start of World War II. About 1 in 5 people are current smokers," Thun said. "Lung cancer death rates have fallen 17 percent in men from 1990 to 2002. Both incidence and death rates have leveled off in women, so we are turning the corner."

As for stigma, he would rather see it on those who sell cigarettes than those who use them. "If there's blame to go around, most of the blame falls on the tobacco companies," Thun said.

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