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.
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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." Originally published at espnW.com on Dec 11, 2012 by Sarah Spain Kelcey Harrison, center, and Jill Costello, right, were lifelong friends, seen here with Gianna Toboni on a grade school field trip. [Photos courtesy of Kelcey Harrison] A couple of Saturdays ago, while you were watching college football or out buying a Christmas tree, 24-year-old Kelcey Harrison was running the last 20 miles of a 3,500-mile "jog" from Times Square to her hometown of San Francisco. Harrison, who graduated from Harvard, where she played soccer, is young, healthy and motivated. By the time she completed The Great Lung Run, she had logged 30 miles nearly every day for four months straight. Harrison ran because she can. And because her lifelong friend Jill Costello -- who was also once young and healthy and motivated -- cannot. On June 6, 2009, Costello, then a junior at Cal and a member of the crew team, was diagnosed with lung cancer. The disease was already at stage 4 and had spread; she was given about a year to live. Costello spent that year finishing school, earning Pac-10 Athlete of the Year honors, acting as vice president of the Panhellenic Council and doing tireless work for lung cancer charities -- all while undergoing chemotherapy. In May 2010, doctors told Costello she could not be cured; all they could do was try to make her last few weeks more comfortable. In those last weeks she walked across the stage at graduation (with a 4.0 GPA) and helped Cal to a second-place finish at the NCAA crew championships. "Jill was really strong," Harrison said. "She was really confident that she was gonna be the one to beat stage 4 lung cancer. She was very convincing in her argument; even at the very end we really believed she was going to be the miracle." Costello died June 24, 2010. Great Lung Run Kelcey Harrison No. 1 Cancer Killer A young, vibrant nonsmoker, Costello was the last person anyone would expect to get lung cancer. But 20 percent of the more than 20,000 women diagnosed with the disease each year have never smoked. Lung cancer is the No. 1 cancer killer in the United States, taking more lives than colon, breast and prostate cancer combined. Despite the staggering stats, there are no pink ribbons worn or mustaches grown in the name of lung cancer. There is, instead, a stigma that the disease is self-inflicted; an illness brought on by a life of smoking. Research and funding is limited and the five-year survival rate for lung cancer is 15.5 percent; it hasn't budged in 40 years. More than half of all people with lung cancer die within a year of being diagnosed. Costello hung on for 18 extra days. So Harrison runs to raise money and awareness about the disease that took her friend's life. The Great Lung Run has raised more than $150,000 for Jill's Legacy, an advisory board to the Bonnie J. Addario Lung Cancer Foundation, the charity Costello worked closely with in the months before her death. Darby Anderson, the director of Jill's Legacy, said at first she didn't think Harrison would follow through with her plan to run across the country. "I thought she was nuts," said Anderson, who was a sorority sister and close friend of Costello's. "I told her to call me back when she had an actual plan and then we would take her project from there. … [That] April I saw her in D.C. when I was there for our Jog for Jill Georgetown and she had a website, route, places to stay and was ready to actually make this happen. I was blown away." Harrison was up early every morning to jog her 30 miles, taking a day off every 10 days or so to let her body rest. She took a break to walk every once in a while, but never stopped moving until the 30 miles were finished. "It's just like getting up and going to work," Harrison said. "Sure there are days where it wasn't the first thing I wanted to be doing but that was my routine and my job at the time, so just gotta get up and do it." Harrison's not sure how, but after 3,500 miles, she feels OK. "I don't have an answer as to why I'm holding up so well," Harrison said. "It's a mystery to me just like everyone else. … People said they think I have the right motivation and someone special looking over me." Harrison ran solo for the first six weeks of her trip, pushing her belongings in a jogging stroller and staying with hosts who would pick her up at the end of each run and drop her off the next morning where she left off. Eventually one of her friends from Jill's Legacy joined her on the road in a donated car, driving her to and from hotels along the way. (The donated car, by the way, was a gold Chrysler 300 with 22-inch rims. When their first donated car lost its power steering the girls ended up at Oscar's Auto Salvage in New Mexico, hoping to sell it and rent one for the remainder of the trip. Instead, Henry, the shop's owner, offered his own tricked-out car for the final months of the trip.) Kelcey Harrison Just another day at the office Running more than a marathon every day for four months sounds nearly impossible, but Harrison said from the start that if Costello could accomplish as much as she did in her last year of life, all while being ravaged by chemo, then a simple jog across the country was nothing. "I spent a week with her on the road and she'd finish up her run and it was like she had just finished a day at work," Anderson said. "We would hang out, head to dinner, chit-chat and do completely normal things, except that she had just run 30 miles that day. … Kelcey has more courage and inspiration than anyone I have ever met and I am so grateful to have been able to just be a small part of this huge adventure." The last part of The Great Lung Run was across the Golden Gate Bridge to Crissy Field. The Cal crew team, Harrison and Costello's high school crew team and other friends and family joined in for the final miles. The official completion of Harrison's run took place last Thursday -- a celebratory cocktail party at St. Ignatius College Prep, the high school she and Costello attended. Harrison had been honoring Costello's memory with each step of her journey, but returning to a place where they grew up was difficult. "It's not hard to think about Jill all the time because she sort of turns into this image, a legend" Harrison said. "What's hard is when you find those moments to step back and remember Jill your friend. Jill who did Halloween costumes with me for 16 years of our lives. That's where it's tough. "It's become bigger than her, which sometimes is sad because you feel like you're forgetting a little bit of your friend, but in her last year of life that's really what she was aiming for. All of us at Jill's Legacy are really proud of what we're accomplishing but also really sad about [the reason] we're all involved in this." Harrison will wake up this week with no miles to run, no path to follow. She's no longer interested in attending law school, but isn't quite sure what she wants to do instead. "I'll take a little time to relax and then try to figure out what's next," she said. "I'm looking out for jobs, but I'll always be tied to our foundation and the cause of lung cancer. We'll always have jogs, bar events, restaurant things; anything to get more young people involved in lung cancer awareness. That will continue forever." Lung cancer programs receive a fraction of the grants devoted to types that take fewer lives, data show. The stigma of smoking looms large. by Bridget Huber This article was originally published in The Orange Country Register on November 15th, 2012. Lung cancer takes more lives than any other cancer. This year it will kill an estimated 160,340 Americans – more than breast, colon and prostate cancers combined. While lung cancer remains largely a death sentence – just 15.9 percent of those diagnosed are alive five years later – the federal government funds far less research on the disease than on other common cancers. The discrepancy is starkest when death rates are taken into account. In 2011, the two federal agencies providing most of the research money funded breast cancer research at a rate of $21,641 per death while spending $1,489 per lung cancer death. It has been 41 years since President Richard Nixon signed the National Cancer Act, effectively declaring war on cancer. But there will be no victory without winning the battle against lung cancer, which causes more than one in four U.S. cancer deaths. Advocates say efforts to improve lung cancer patients' chances have been stalled by unexamined biases among health officials and the public as well as by scant research funds. They also cite the paradoxical invisibility of a disease that claims so many lives but has few champions of the sort who have brought breast cancer to national prominence. The stigma of smoking is largely to blame. Anti-tobacco campaigns have done their job too well, leading many to see lung cancer as self-inflicted. That stigma keeps some families and patients from speaking out, while corporate donors stay away from the disease, and some scientists and policymakers question whether scarce research dollars should be devoted to a smokers' illness. But an estimated 15 percent of lung cancers are diagnosed in people who never smoked. If lung cancer in these people was considered a separate disease, it would still be the sixth-leading cancer killer in the U.S., ahead of liver, ovarian and esophageal cancers. Researchers estimate that an additional roughly 50 percent of lung cancer cases involve former smokers who quit the habit years ago. "This is a public health problem that needs to be addressed regardless of how it came about," said Dr. David Carbone, a leading lung cancer researcher at Ohio State University. "We need to take care of those who are sick and need to do everything we can from a public policy perspective to reduce the number of people at risk in the future." Funding questions Recent breakthroughs in cancer genetics and lung cancer screening have added urgency to advocates' calls for more money for lung cancer research, which will get $231.2 million this year from the two main federal agencies funding such work. "We are at a precipice where we could really break through," said Kim Norris, president of the Lung Cancer Foundation of America. But these advances have come at a time when funding for all research is scarce. And many influential scientists balk at letting pressure from advocates influence research priorities. In their view, it could set the entire cancer research field back by creating a quota system for research on specific cancers that could divert funds from the most cutting-edge science. Carbone, however, says unless a portion of federal funds is specifically directed to lung cancer, advances in the field will remain baby steps. "We didn't send people to the moon because we happened to have a rocket ship sitting around. We sent people to the moon by saying, 'That's what we want to do.' And then we figured out how to do it." Making that moonshot will mean convincing the public and policymakers that lung cancer victims are worthy of support. Part of the challenge is that the disease is so deadly that there is no critical mass of survivors to raise its profile. Most people are diagnosed at an advanced stage and die within six months, said Jeffrey Borgia, a cancer researcher at Rush University Medical Center in Chicago. "There's not much time to fit a walkathon in," he said. In contrast, breast cancer advocates have raised millions through everything from road races to galas. The White House is lit pink each October for Breast Cancer Awareness Month. Pink ribbons have been attached to items including pistols and fried chicken buckets, becoming so ubiquitous that some question whether the cause has become too commercialized. Lung cancer groups, however, have struggled to attract attention. The original color for lung cancer ribbons was clear – as in, invisible. Perhaps the best example of how strong advocates can spur scientific research is the Defense Department's medical research program. In 1992, the National Breast Cancer Coalition, led by a breast cancer survivor and lawyer Fran Visco, persuaded the Defense Department to create a breast cancer research program funded by Congress. The resulting Congressionally Directed Medical Research Program has been allocated $2.8 billion for breast cancer research in the past two decades. But even though the armed forces skew heavily male and military members smoke at high rates (cigarettes once were included in soldiers' rations and have been sold at cut-rate prices on military bases), it was 17 years before the program began researching lung cancer in 2009. "It's really challenging now. There just isn't a champion," said Regina Vidaver, executive director of the National Lung Cancer Partnership. The stigma problem Before it can find its champion, lung cancer will have to shed its stigma. Last summer, advocates released an ad campaign aimed at shocking the public into examining its biases against people with lung cancer. Posters featuring a young man with geeky glasses and a plaid scarf began popping up across the country. "Hipsters deserve to die," they read. "Cat lovers deserve to die," read another. The point was provocation, said Kay Cofrancesco, a spokeswoman for the Lung Cancer Alliance, which sponsored the ads. When a person hears that an acquaintance has lung cancer, she said, a question immediately springs to mind: Did he or she smoke? The answer often is no. Yet the stigma persists, even though lung cancer among nonsmokers is rising, with women accounting for two-thirds of these diagnoses. One famous example is Dana Reeve, the singer-actress and widow of Christopher Reeve. A nonsmoker, Reeve was just beginning to emerge from the grief of losing her husband when she was diagnosed with stage 4 lung cancer at age 44. Yet blaming smokers who fell prey to cigarette marketing seems inconsistent – after all, society condemns tobacco companies for deceiving customers and even maximizing the addictiveness of cigarettes. We should "vilify the tobacco industry instead of vilifying patients," said Dr. Carolyn Dresler, an official with the Arkansas Public Health Department. Lung cancer can be caused by such factors as exposure to radon, asbestos and other toxins. About 10 percent of lung cancer deaths are linked to heredity, said Ann Schwartz, a researcher at Wayne State University in Detroit. Yet lung cancer's image as solely a smoker's disease can undercut support for research that looks at other causes, such as heredity. Changing the money Many lung cancer advocates and researchers have called for a reassessment of the way money is distributed at the country's largest funder of cancer research, the National Cancer Institute. Research grants from the NCI are the most important financing a cancer researcher can get. But the NCI's funding, allocated by Congress, has remained nearly flat since 2003, though it did get an additional $1.26 billion as part of the stimulus package of 2009. Congress does not dictate how much NCI can spend on each type of cancer. Instead, NCI funds the cutting-edge science most likely to move the entire field of cancer research forward. Lung cancer receives less funding than other cancers under this approach, too. In fiscal year 2012, the NCI will devote $221 million in research grants to lung cancer and $712 million to breast cancer, according to National Institutes of Health estimates. NCI officials caution against reading too much into these numbers. Most of the research it funds is basic research applicable to multiple types of cancer. The institute also funds tobacco control and financed the National Lung Screening Trial, a large, multiyear study that showed that screening smokers via low-dose CT scans reduces the number of lung cancer deaths. But some researchers, like Carbone, say the problem with the NCI's prerogative of funding the most advanced cancer research, regardless of what organ it involves, is that research on some types of cancer is further along than others. Breast cancer, for example, has been better funded for longer and had earlier breakthroughs that attracted more top researchers and more funding, from the federal government and other sources. "The infrastructure in the one disease is better than the other. It's a self-perpetuating problem," Carbone said. Cancer research is increasingly focused at the molecular level instead of at the organ level. Researchers now know that cancers at different sites in the body can be caused by some of the same genetic mutations. But a single mutation can behave differently in different organs, so it is still necessary to look at particular cancers such as lung cancer, Carbone said. The other side of the argument is represented by Dr. Harold Varmus, the NCI's director. He declined to be interviewed, but in a speech at the National Press Club in September, he said he would "object dramatically" to efforts such as legislation that would force the NCI to set aside specific pots of money for certain cancers. This approach, advocated by some groups over the years, would "take the decision-making about grant making out of the hands of the NCI and [put] it in the hands of advocacy groups," he said. A huge "Thank You" to Owner Kim Evans and Director Christina Motes at Woodchase Academay in Vinings for their Lung Cancer Awareness Month fund raiser! Through the generosity of the Woodchase families, they were able to raise $1,000 for The Joan Gaeta Lung Cancer Fund! Proceeds go to the research being done at ALCMI, as well as awareness efforts in North Georgia. Thank you, Woodchase! by By Lynne Eldridge MD This article was originally published at About.com on November 29th, 2012. As Lung Cancer Awareness Month draws to a close I'm glowing from hearing about all of the events - and how each year there are more and more advocates investing their precious time and energy to spread awareness and provide funding for lung cancer research. But amidst that glow is a sadness. It seems just when I get excited about a new organization or another medical institution promoting awareness, I read the second line. "The key to reducing lung cancer deaths is to launch more anti-smoking campaigns." Yes, those campaigns are important. But if we want to reduce lung cancer deaths, anti-smoking campaigns just aren't going to do it. Or even come close. I'm sure many of you are saying, what in the world is she talking about? A statistic may help:
Maybe a few numbers will make it even clearer. In 2008, the last year from which we have numbers available, there were 158,592 deaths from lung cancer in the United States, including 70,051 deaths in women. (Note that in the same year, there were 40,589 breast cancer deaths in women.) Using the 80% statistic, 126,874 of these deaths could not have been prevented by anti-smoking campaigns. So why are we focusing on anti-smoking campaigns? Why are we focusing our attention on only 20% of people who develop lung cancer? Don't get me wrong. This group of 20% who are current smokers deserve our love and attention just as much. But what about the other 80%? Since one of my pet peeves is listening to people rant who don't have a solution in mind, I'll offer a few. Perhaps we should be focusing more attention on other known causes of lung cancer. Radon is the second leading cause and is totally preventable. Checking for radon in your home doesn't even take willpower. Occupational exposures need more attention as well. And we need to focus more energy on treatment research. Even if we focus our efforts on the 20% with smoking cessation programs, many of those people will still develop lung cancer due to their history of smoking in the past. To do this we need funding. To get funding, lung cancer needs to recognized. Thanks to everyone who worked so hard to make this year's Lung Cancer Awareness Month more visible. Blessings to all of you. Sources:
A young woman is nearly finished running from New York City to San Francisco to raise awareness and funds for lung cancer. Over the last few months, this story should have been all over the internet, newspapers, magazines, and on TV. It is not. Why? Follow The Great Lung Run today. Share it. Know someone in the media? Forward this to them.11/15/2012 2012 Bonnie J. Addario Lung Cancer Foundation 7th Annual "Simply the Best" Gala Video. Please watch!Read NowCongratulations to Bonnie Addario, her family, and everyone at The Bonnie J. Addario Lung Cancer Foundation and ALCMI for yet another outstanding fund raising event! The Joan Gaeta Lung Cancer Fund continues to be a very proud affiliate and are honored to know them and to work with them. Please take a few minutes to watch the video below, which was part of their Seventh Annual "Simply the Best" Gala last week. It is truly inspirational and very informative. |
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