Congratulations to The Joan Gaeta Lung Cancer Funds's Medical Advisor, Dancing for Joan's Honorary Chairman, Joan Gaeta's Pulmonologist, friend, and all-around great guy - Dr. Paul Scheinberg!
From The Atlanta Business Chronicle (Jan 25-31, 2013 Edition):
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The Puzzle of Lung Cancer in Nonsmokers.Rich Barlow by Rich Barlow Originally published by BU Today on 1/22/13 at bu.edu. Avrum Spira’s aunt died of lung cancer almost 20 years ago. She was a nonsmoking exercise buff in her 40s who hadn’t been exposed to any known toxins; she worked in a government office, not a coal mine. “One of the healthiest people you could imagine, did everything right,” says Spira (ENG’02), who at the time was an internal medicine resident at the University of Toronto. The one thing she didn’t do right wasn’t her fault: she’d been born to a nonsmoking mother who had died from the same illness. “I’m absolutely convinced she had a genetic predisposition” to lung cancer, says Spira, a School of Medicine professor and chief of computational biomedicine. That conviction set him on a quest for the genetic key to a medical mystery: why some people who have never smoked fall victim to this scourge of cigarette users. Lung cancer kills more Americans than any other cancer, and twice as many women die from it than from breast cancer, although the latter gets greater public attention, says Spira. In 2008, the last year for which data was available, more than 208,000 Americans were diagnosed with lung cancer and almost 158,600 died from it. Spira says between 10 and 15 percent of these annual victims are nonsmokers (the percentage has been edging up slowly in recent years) with no apparent exposure to other toxins—a crucial caveat. “How do you know someone has been or has not been exposed to something in the environment?” he asks. Some potential toxins, like radon, are invisible, he notes, “so people who we’re seeing now, with higher rates of nonsmoking lung cancer—is it because they were exposed to radon 20 years ago?” It’s true that worldwide, the rise in the incidence of lung cancer—from the eighth leading cause of death in 1990 to fifth in 2010—is mostly a function, perversely, of good news: as living standards have improved in the developing world, more people survive into adulthood, meaning a decline in childhood deaths from malnutrition and infectious diseases. That has brought an accompanying uptick in the number of people dying from diseases mostly found in wealthier countries, among them cancer. Moreover, air pollution in industrializing countries has resulted in more lung cancer in nonsmokers there, Spira says. But in the United States, he says, doctors believe there’s a similar spurt in lung cancers in nonsmokers who’ve had no apparent contact with other toxins. The most extensive studies, incorporating detailed questionnaires and visits to peoples’ homes to see their environment, show that “there hasn’t been a clear association among nonsmokers who are getting lung cancer with exposures to other things.” Rebecca Kusko (MED’14) (left) spearheads research into lung cancer among nonsmokers in Avrum Spira’s lab. Photo by Vernon Doucette An ongoing, as-yet-unpublished study by a team that includes Spira is looking at tumor tissue and adjacent, noncancerous tissue from the lungs of 32 subjects with lung cancer: 8 smokers, 11 former smokers, and 13 who never smoked and had no apparent exposure to other toxins. The researchers ran the samples through a gene sequencer at MED, which “can give us unprecedented insight into the genomic changes leading to lung cancer” in nonsmokers, says Rebecca Kusko (MED’14), a graduate student spearheading the study in Spira’s lab. With the sequencer, “we study the normal cells from each person as a control,” says Spira, “and then what happens in their tumor right next door, and say, what’s changed?” Preliminary results suggest that in the smokers, “a huge number of cancer pathways are activated,” as genes controlling cell growth in the tumors turned on. But those pathways weren’t necessarily activated in the nonsmokers, who showed different gene changes between their healthy lung tissue and their tumorous tissue. The researchers’ hypothesis is that the nonsmokers had a genetic predisposition, a pathway, to cancer that was activated by something in their environment. That trigger, Spira theorizes, may be a viral infection (cervical, liver, and head and neck cancers are all caused by viruses, he says). The researchers are now sequencing the tumor tissue of the nonsmokers to try and find any viral genes. “Even if there’s one viral gene per million human genes, we might pick it up, we believe,” he says. The work will take a year or two. Potential therapies—which are many more years away, he warns—might include screening people with the genetic predisposition and then giving those with the predisposition regular lung scans to catch cancers early. Another possibility would be drugs that could turn off uncontrolled growth in cancerous cells. (Spira got attention in 2010 for research suggesting that the natural compound myo-inositol could turn off incipient lung cancer in smokers.) Those who walk Commonwealth Avenue and have to dodge fumes from smokers on break may wonder about secondhand smoke. Research is mixed, but Spira, who researches the amount of smoke necessary to change gene expression and possibly lead to lung cancer, believes that it takes a big dose—perhaps exposure over months or years. Almost half a century after the surgeon general first warned of smoking’s dangers, Spira says that even Hollywood is catching on that not all cancer victims heedlessly bring the disease on themselves. In 2011, he was a presenter at the Prism Awards, given for accurate portrayals of illness in entertainment media. He handed an award to an actress whose character on the soap opera The Bold and the Beautiful had lung cancer. The character was a nonsmoker. Originally published on January 16th, 2013 at dailynews.com.
By Stephanie Cary ------- A sign reading "Thank you for not smoking" hung on the front door of her home for years. Neither Carollee Stater nor her husband ever smoked cigarettes, and the sign was to prevent secondhand smoke from visitors at her Apple Valley home. But her efforts didn't stop the 73-year-old from being diagnosed with advanced lung cancer almost seven years ago. "Unless you tell them up front that you've never smoked, the first question people ask is how long did you smoke?" Stater says. "That's fairly typical. People just assume that you got it because you smoked." And the stigma is not exclusive to Stater. The Lung Cancer Project - a research collaboration aimed at better understanding lung cancer biases - found that three out of four people had a negative bias toward people with lung cancer. "We found that people had conscious and unconscious beliefs that were more negative toward lung cancer and people suffering from the disease as compared to people with breast cancer," says Brian Nosek, founder of Project Implicit, a multi-university research collaboration involved in The Lung Cancer Project. "For example, we found that people perceived those with lung cancer to be more to blame for their cancer, and that their diagnosis was more hopeless. This is probably due to the fact of the well-known association between smoking and lung cancer." And while these are only the initial findings of the ongoing study, Dr. Marianna Koczywas, an oncologist at the City of Hope who treats Stater along with many other lung cancer patients, says she has seen the negative connotation lung cancer patients, their families and the public associate with the diagnosis. Many of her patients who were smokers, or had family members who smoked, say they deserve the disease because of the habit, she says. And even those who didn't smoke are still assumed to have done so, she says. While it's true that smoking is a main cause of lung cancer - active smoking attributes to almost 90 percent of lung cancer patients, according to the American Lung Association - Koczywas says a growing number of patients diagnosed with the disease never smoked. "So I think that the thought has been changing," Koczywas says. "And I think from a physician's point of view, we're taught to educate these patients, their families and society that not everyone who develops lung cancer has cigarette exposure." Other causes of lung cancer include exposure to asbestos, radiation or toxic chemicals like radon, and medical conditions that cause recurrent lung inflammation or lung scarring from diseases such as tuberculosis, says Koczywas. In fact, radon exposure is the second-leading cause of lung cancer, accounting for 15,000 to 22,000 lung cancer deaths each year, according to the American Lung Association. Stater, who never smoked and tried to avoid being around secondhand smoke, couldn't believe her diagnosis. "I thought this is impossible, it shouldn't be happening to me," Stater says. She still can't put a finger on the possible cause of her diagnosis, but Koczywas says patients shouldn't dwell on the reason why they got the cancer, but rather focus on the future and beating the disease. Nosek hopes The Lung Cancer Project will help not only reduce the stigma associated with the disease, but also raise awareness of the other causes of lung cancer and promote treatment seeking. "Effective treatment is not just knowing what procedure to do or medicine to give. It also includes proper preventative care, treatment seeking, and many other behaviors that relate to people's beliefs about what they think they can do and their knowledge about their health and diseases," Nosek says. "Better knowledge will lead to better care," he adds. As for Stater, she just wants people to not assume that she, or other people with the disease, were smokers and deserve their diagnosis. "Even having a smoker in the house doesn't mean that you got it because of that," Stater says. "You could have picked it up anywhere, any party you've gone to, just the right amount of whatever to trigger the cancer. You just never know." This article was originally published at About.com on January 10th, 2013 by Lynne Eldridge, MD. ------- Studies have shown that when it comes to breast cancer, older women are more likely to be diagnosed with advanced stages of the disease. Not so with lung cancer - at least in recent studies in Denmark and England. Instead, it seems the slogan reads "early age later stage." Researchers in Denmark set out to evaluate the stage of lung cancer at which different age groups are diagnosed. Looking at people aged 65-69, those aged 70 to 74 were 18% less likely to be diagnosed with late stage disease. The trend continued on: Those aged 75 to 79 were 26% less likely, 80 to 84 were 27% less likely, and those over 85, 34% less likely to have a diagnosis of late disease. Since the stage at diagnosis makes a tremendous difference in long-term survival from lung cancer, this is something to stand up and take note of. Why would younger people be less likely to diagnosed with lung cancer until it's reached the later stages of the disease? Or to ask the question in another way: Why does age seem to have a protective effect against late stage lung cancer diagnosis? Possibilities shared with me by Georogios Lyratzopoulous MD, one of the investigators in another study in England demonstating "early age later stage" include:
The conclusion based on these findings is that efforts to diagnose lung cancer early need to be tailored to different age groups. The stage of a lung cancer at the time of diagnosis can have a huge impact on younger patients with lung cancer. In the study above from Denmark, only 17% of the cancers were diagnosed at stage 1 and stage 2. To tailor the diagnostic process for different age groups, we need to focus on more diagnostic research instead of just treatment research. Sources:
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