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Lung cancer is on rise for female nonsmokers

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By Carla McClain
ARIZONA DAILY STAR
March 9, .2006


Dana Reeve coughed for a year before she knew why.

She never once thought of lung cancer. She had never smoked. The cancer threat never entered her mind, so she tragically did not take the cough too seriously, she said in one of her last public interviews.

Older men with voices turned gravelly by decades of heavy smoking get lung cancer, most of us assume. Certainly not young women who have always shunned cigarettes.

How wrong we are.

Dana Reeve died Monday, six months after she learned her cough was caused by the worst of all cancer killers, lung cancer. It was an unimaginable and seemingly unfair event, occurring just two years after she lost her paralyzed husband, actor Christopher Reeve. Dana Reeve was 44.

Now, lung cancer physicians throughout the country are speaking publicly about what appears to be an ominous trend - an unexplained increase in this cancer in people who have never smoked, most often in women, many younger than 50.

"It certainly is not going down, as are the smoking-related lung cancers, and that's a cause for concern," said Dr. Jack Wei, a radiation oncologist at the Arizona Cancer Center, who treats lung cancer patients.

"We have seen a gradual drop in lung cancer, especially in men, as smoking rates have gone down in this country. But there is no such downtrend in people who have never smoked.

"And why do women seem to be especially vulnerable to this? We simply don't know."

The shocking fact is that at least 10 percent of all lung cancer victims have never smoked - a number that doubles, to 20 percent, among women.

This is a cancer that kills 60 percent in the first year, and 85 percent within five years. By comparison, the cancer that terrifies most women - breast cancer - has an 88 percent survival rate after five years.

That means many thousands of people are going to die from lung cancer every year and have no idea why, shattering the widespread notion that if you never smoked, you don't have to worry about it.

"When Dana Reeve was diagnosed in August, we got a lot of calls here - people asking, 'How could this happen, how common is this?' " said Lisa Walton, at the American Lung Association's office in Tucson. "There was a lot of shock this could happen to someone like her."

What the lung association and other experts are telling people about the risk to never-smokers are their best guesses - that it may be caused by yet unproven toxic exposures, such as asbestos, radon, arsenic, air pollution, and certainly secondhand smoke. Studies now blame at least 3,000 lung cancer deaths every year on exposure to secondhand smoke.

Dana Reeve was a former cabaret singer, who spent years in smoky venues, her friends have pointed out. That is their best, and so far only, guess about how this happened to her.

"But lung cancer happens to people with no history at all of secondhand smoke. They don't work in smoky places, they don't live with a smoker," said Wie, at the cancer center.

"So there has to be something else at work here. Genetics, something in a person's genetic makeup that predisposes them to lung cancer, may play a role."

Cigarette smoke was taboo in the home of Dora Teran. But the Southern Arizona woman got the surprise diagnosis of lung cancer six months ago, close to the day Dana Reeve's condition made the news.

"I never smoked, not once in my life. Well, I tried it once as a teenager, and gagged, and that was it," said Teran, 52, who lives in Douglas.

No one in her family smoked - not her parents, brothers or sisters, not her husband. "And we never allowed anyone to smoke in the house. We just didn't like the smell of it," she said.

But she did grow up in a town with an active copper smelter, and well remembers the years when smelter smoke filled the neighborhood.

"When I was young, the smoke would come down every afternoon around 2, and if you were outside, it burned your chest. The plants all died. You woke up with a metal taste in your mouth," Teran said.

"I have a feeling that may be it, but I'll never know. But it scares you, this cancer. It doesn't look good - you get overwhelmed."
And though she never smoked, she's had to battle the stigma of lung cancer.

"When I told people, the reaction was, every time, 'Oh, you were a smoker?' " she said. "I have been active in a lot of youth groups here and always talked to kids about no smoking, no drugs. So it was a real shock that I had this cancer.
"I spent a lot of time trying to explain that I didn't smoke, never did, but people don't believe you."

A major clue now emerging in this mystery is that the tumors of non-smokers appear to be biologically different - less complex - from those caused by smoking. Studies are being launched to find out what that means.

"We've come to believe there is a different biology going on in these never-smoking patients," said Dr. Linda Garland, director of the clinical lung cancer program at the Arizona Cancer Center. "We're trying to sort out the differences in smokers and nonsmokers, and between men and women.

"So, maybe in the future, we will have a blood test for the genetic markers that put some people at high risk for lung cancer."

On StarNet: Learn about lung cancer symptoms and treatments, and how the disease affects women differently from men at go.azstarnet.com/lungcancer

Contact reporter Carla McClain at 806-7754 or at cmcclain@azstarnet.com.



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