There are two things wrong here, according to clinicians who treat this killer of nearly 160,000 people a year — more than deaths from cancers of the breast, prostate and colon combined.
One is the element of blame, as if all smokers who get lung cancer began smoking and continued to smoke knowing the possible consequences. “Lung cancer is underfunded and a major reason is the idea that it’s all related to smoking and it’s the smoker’s fault,” said Dr. Michael Thun, an epidemiologist at the American Cancer Society. “This stigma has influenced both advocacy and research dollars.”
In fact, most smokers who develop lung cancer these days were hooked on nicotine long before it was recognized as an addictive drug and before smoking was clearly linked to cancer. I recall ads for a cigarette brand “most doctors recommend,” as well as the wanton distribution of free cigarettes to college students and young military recruits. I also recall the more recent industry ploy of marketing “low tar” and “light” cigarettes with a higher nicotine content that kept people hooked.
“Regardless of how patients get lung cancer, it’s not deserved,” Dr. Joan Schiller, an oncologist at the University of Texas Southwestern Medical Center in Dallas, told me in an interview. “Nicotine addiction is not their fault. Most became hooked at a very young age. It’s a real dependence, like heroin or cocaine.”
As for nonsmokers who get lung cancer — about two-thirds of them women — Dr. Schiller said they “are a disenfranchised group that did nothing wrong, yet women with breast cancer get all the support and empathy.”
“It’s a sizable number of nonsmokers who get lung cancer, more than get leukemia or AIDS,” she went on. “If lung cancer unrelated to smoking was listed as a separate disease, it would be the sixth or seventh most common cause of cancer deaths.”
Smoking-related lung cancer typically strikes older people (the average age at diagnosis is 71), but it often afflicts nonsmokers much earlier, in the 30s and 40s or even younger. And because doctors rarely suspect lung cancer when people who never smoked develop respiratory symptoms, the disease is typically diagnosed too late for any hope of a cure.
Many nonsmokers are treated for months for conditions like pneumonia, bronchitis or asthma before the real problem is uncovered. In fact, one type of lung cancer unrelated to smoking, bronchoalveolar carcinoma, can even look like pneumonia on a chest X-ray.