Clearing the air on lung cancer, which killed my dad, a nonsmoker
A new study focuses on a specific kind of lung cancer often found in patients who never smoked, associated with a mutation in EGFR gene. Credit: Getty Images/Prapass Pulsub
I think of my father every April. He was a certified public accountant and a devoted fan of the New York Mets. As tax season came to an end each year, you could find him outside on a lounge chair on our front lawn, listening to Mets baseball on the radio.
Nearly 19 years ago, my dad lost his two-year battle with lung cancer.
And to answer the question that jumps too quickly to everyone's lips: No. He never smoked.
At the time, there were few explanations as to how my father ended up with lung cancer, and few treatments.
What a difference two decades can make.
Lung cancer remains an incredibly difficult disease to diagnose, track and treat. And, in part because it's stigmatized as a smokers' disease, it receives less public and private research funding than other cancers. A study last year out of the Cleveland Clinic found lung cancer received $10,165 per death, compared with $91,411 for breast cancer.
Still, since my dad was diagnosed in 2002, enormous progress has been made.
In trying to determine lung cancer's causes, oncologists, researchers and others are rightly focusing more on never-smokers, who make up about a fifth of all lung cancer patients. A study released earlier this month in Nature provided one concrete explanation: Air pollution, which can cause lung cancer by waking up inactive cancer-causing mutations, allowing them to grow and form tumors.
That's eye-opening for numerous reasons. It's easy to talk about air pollution as something generically we'd like to reduce, but it's more clear why we have to combat it when it can do the same damage smoking does.
Beyond that, the research provides a window into what might be going on in never-smokers' bodies. The new study focuses on a specific kind of lung cancer often found in patients who never smoked, associated with a mutation in the epidermal growth factor receptor, or EGFR, gene. I remember hearing about the EGFR mutation when my father was sick, when it was a relatively new discovery. At the time, pharmaceutical companies also were working on new targeted therapies. Among them: Tarceva, the first lung cancer treatment to emerge from Long Island's then-biotechnology poster child, OSI Pharmaceuticals. Tarceva received its Food and Drug Administration approval in November 2004 — six months after my father died
The continued discovery since then, leading to a growing array of tools in testing to treatment, is stunning. As a result, physicians and researchers now express more optimism when it comes to treating never-smokers, an optimism that certainly didn't exist 20 years ago.
There's still far more to do. Perhaps the biggest missing ingredient lies in the diagnosis itself, which often comes far too late, especially since few physicians think of lung cancer when a patient who never smoked, complains of a cough or trouble breathing. That perception has to change. Right now, federal officials recommend low-dose CT scans annually for those considered "high-risk" — a category unsurprisingly defined by smoking. That leaves people like me — never-smokers who wonder whether they're more susceptible to a lung cancer diagnosis given their family histories — still in the dark.
Yet, the considerable shift in thinking, treatment and attention, and the sheer amount of information we have now that we didn't have 19 years ago, gives doctors, scientists and me something no one had much of when my dad was sick — hope.
Columnist Randi F. Marshall's opinions are her own.
Randi Marshall is a member of the Newsday editorial board.
