Many lung-cancer patients never lit up

Most lung cancers occur in smokers, but not always.

Like Dana Reeve, "Superman" star Christopher Reeve's widow, who announced yesterday she has the disease, one in five women with it never lit a cigarette, doctors say.

Yet those patients share an unfortunate stigma with cancer patients who smoked.

"The underlying assumption is, you were a smoker and you caused this, therefore you're not going to get my sympathy," said Tom Labrecque Jr., who started a foundation to raise awareness after his nonsmoker father died several years ago of the disease.

Reeve, an actress who leads a paralysis-research foundation named for her husband who died last year, made her announcement two days after ABC News anchor Peter Jennings, a smoker, died of lung cancer at age 67.

Despite their different smoking histories, they share the most common cancer in the world — and the deadliest. This year in the United States, an estimated 93,010 men and 79,560 women will be diagnosed with lung cancer and almost an equal number — 90,490 men and 73,020 women — will die of it.

Even though many women are more concerned about breast cancer, lung-cancer deaths in women are expected to exceed breast-cancer deaths this year by 30,000.

About 10 percent of men and 20 percent of women with lung cancer never smoked, and the number of nonsmokers with the disease doesn't seem to be rising significantly, said Dr. Michael Thun, chief epidemiologist for the American Cancer Society.

But awareness of smoking's dangers may be on the rise because of aggressive campaigns in recent years. And stigma around the disease may be rising, too.

"When people get breast cancer, people say, 'What can I do to help you?' When people get lung cancer, people say, 'Did you smoke?' " said Susan Mantel, executive director of Joan's Legacy. The fund-raising group is named for Joan Scarangello, a nonsmoker and former head writer for newsman Tom Brokaw. Scarangello died in 2001 of lung cancer, as did her nonsmoking mother before her.

"There is a definite stigma," Labrecque said, recalling comments after his father's funeral.

"People would say, 'I didn't know he smoked,' " Labrecque said.

Doctors who treat the disease, such as Dr. Bruce Johnson of Dana-Farber Cancer Center in Boston, bristle at the notion of "innocent" and "not-so-innocent" victims.

"People who smoke don't deserve to get lung cancer, and people have worked very hard to quit," he said.

Nonsmokers who have surgery for their cancer have a lower risk of developing a second tumor than smokers. Also, smokers who quit after cancer surgery have better survival odds, Johnson noted.

By the numbers


• Almost 350,700 Americans are estimated to be living with lung cancer.

• About three out of five people with lung cancer die within a year of being diagnosed. The expected five-year survival rate is 15 percent.

• An estimated 1 million people worldwide die from lung cancer annually.

• Lung cancer causes more deaths than the next three most common cancers — colon, breast and prostate — combined.

Source: American Lung Association

Nonsmokers also respond better to new-generation drugs Iressa and Tarceva, said Dr. Alan Sandler, director of thoracic oncology at Vanderbilt-Ingram Cancer Center in Nashville, Tenn.

That's because people who get lung cancer early in life, like the 44-year-old Reeve, are more likely to have genetic factors fueling their disease, doctors say. Only 3 percent of lung cancers occur in people under 45, regardless of smoking status. Sandler has been involved in testing drugs that more precisely attack the molecular factors making the cancers grow.

"The malignant cell in a smoker is much more complex" and has more mutations than nonsmokers tend to have, Sandler said.

Meanwhile, the cancer society is hoping for an eventual decline in lung-cancer cases to mirror the decline in smoking rates.

"About 1 in 5 people smoke, Thun said. "Lung-cancer death rates have fallen 17 percent in men from 1990 to 2002. Both incidence and death rates have leveled off in women, so we are turning the corner."

As for stigma, he would rather see it on those who sell cigarettes than those who use them.

"If there's blame to go around, most of the blame falls on the tobacco companies," Thun said.

Additional cancer data from Florida Today