Joan H. Schiller, MD; Alice Goodman, MA


July 18, 2013

In This Article

Never-Smokers: A Growing Trend

Medscape: How do explain this trend in young female never-smokers?

Dr. Schiller: The short answer is that we don't know why lung cancer is on the rise in young women who are never-smokers. There are so few data. We are seeing larger numbers of younger women who are never-smokers diagnosed with lung cancer. Nobody knows why.

One hypothesis is that it is somehow related to estrogen. Preclinical studies suggest that there is a 2-way relationship between estrogen and the epidermal growth factor receptor pathway. The suggestion came from population studies that looked at hormone replacement therapy (HRT) retrospectively and showed that lung cancer patients on HRT had a poorer prognosis than those who never took it.

Other pieces of evidence are accumulating about the connection with estrogen, but this needs to be studied further.

Medscape: Lung cancer is a devastating diagnosis.

Dr. Schiller: Yes, it is. An often-quoted fact is that lung cancer kills more than breast, colon, and prostate cancer combined. In the United States, lung cancer is the cause of one third of all cancer deaths; it is the second most common cause of death after heart disease.

In my opinion, patients with lung cancer should not feel guilty and ashamed. In the 1960s, the tobacco companies had huge marketing campaigns; they gave away free cigarettes and even had ads with doctors endorsing different brands. Once people started smoking, most of them could not stop.

Medscape: Why did Genentech support this study?

Dr. Schiller: Drug companies want patients to be empowered so that they will be compliant with their regimens. If patients feel bad about themselves, they will not be proactive and they will not demand the best care. Our ultimate goal is to overcome the stigma so that lung cancer patients will be empowered to seek the best care and not to be satisfied with no care, or only 1 line of treatment, inadequate clinical tests, and lack of clinical trials.


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