Today's blog entry is owed to a strange section of the Wall St Journal this past Friday that presented itself as educational but felt like an advertisement. The three pages on lung cancer prevention, diagnosis and treatment were spear headed by information from an organization called the Lung Cancer Alliance which is a patient focused non profit.
I feel much more comfortable with our American Cancer Society, the National Cancer Institute and others. To the side of the headline LUNG CANCER were the words Media Planet which in fact is a company that assists in placement of advertisements. Shame on the Journal this time as there is NO mention that this is an advertisement as is usually the case in papers and magazines.
Besides the placement of ads for special surgical knives and state of the art imaging machines, the part that got my research blood pumping and later boiling was this statement, "60% of new lung cancer cases are from never smokers or former smokers."
Also the article was misleading in the way it presented that small cell lung cancer which is almost always related to smoking was not the most prevalent cancer. The article/ad does correctly states that 80% of lung cancers are non small cell lung cancer which is abbreviated as NSCLC. The first time I read the article I was left with the impression that only 20% of lung cancer was related to smoking. This conclusion went against everything I know as a tobacco treatment specialist and led to an hour or so of investigation.
Most certainly I found the number one risk factor for lung cancer of all types is tobacco. In an article published by the Massachusetts's DOH in 2005, 80% of lung cancer was associated with smoking. The National Cancer Institute puts it even higher at 87%.
The main types of lung cancer are non small cell and small cell. The non small cell lung cancer has three types, with subtypes also identified. The three types are adenocarcinoma, squamous carcinoma and large cell carcinoma. (carcinoma is a malignancy in the tissue of an organ) The most common of the non small cell is adenocarinoma according to the 2005 DOH article and the American Cancer Society. The Lung Cancer Organization states that adenocarcinoma is only the most common in women and non smokers. All sources put large cell carcinoma at the bottom of the NSCLC cases.
It is clear from all sources that 80% is NSCLC and the other 20% is SCLC, small cell lung cancer. This is NOT the only lung cancer that smoker's get but the type that non smokers do NOT get. That was not at all clear in the WSJ article and I think I know why.
Again the most common cause of lung cancer of any type is smoking but in NSCLC there are other risk factors as well. In NSCLC cases one also finds the most non smokers. Other causes are of course, genetics, but more importantly, radon, asbestos and occupational chemical exposure, and second hand smoke.
The treatment is very different between NSCLC and SCLC. The odds of surviving are also different. In NSCLC the cancer is often isolated to one section or place on the lung and can be surgically removed. There is a risk of new tumors however. SCLC, the kind that is almost always the result of smoking is not isolated and is often already progressing through the body when found. It is more likely to kill a person than NSCLC and quickly.
It appears that the Media Planet article placement in the WSJ was an attempt to remove the stigma from smoking related lung cancer and encourage aggressive testing and treatment. This is not wrong, however, the best thing one can do is to NEVER smoke or to stop immediately.
Now to the final point that got my blood from pumping to boiling. I tracked down the printed statement that 60% of new lung cancer cases were never smokers or former smokers. The amount of new cases of lung cancer that are NOT current or former smokers is 15%. Which means of course that 85% of lung cancer IS related to smoking.
Lastly, lung cancer cases are most often seen in people over age 50 and that is because the cell changes in the lungs are taking place slowly over time. These changes cannot be seen on CT and other scans... because a doctor did not find a spot on a smokers lung in NO WAY indicates that the lungs are fine.
Here are some noteworthy websites:
http://www.lungcancer.org/reading/types.php
http://www.intelihealth.com/IH/ihtIH/WSIHW000/9339/24402.html
http://www.cancer.org/docroot/CRI/content/CRI_2_4_1x_What_Is_Non-Small_Cell_Lung_Cancer.asp
http://www.cancer.gov/cancertopics/factsheet/Tobacco/cancer/
Deirdre Dingman, MPH, CHES, CTTS
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