DRHOOK- Bad luck: Smoking not sole lung-cancer cause

the handsome doctor John Hong

"Speechless" is a glam-rock type of song from the one, the only: Lady Gaga. Love Lady Gaga. Want to see her perform in Atlantic City, but I can't find anyone to join me to see her brilliance. I wonder if Thomas Jefferson will be speechless when she performs at John Paul Jones Arena. 

Many things can leave us speechless. A teenage girl telling her parents she's going to the prom will Billy and they're having a baby five months later can leave her parents speechless. A successful person employed for 30 years at the same job suddenly laid off is probably speechless. The word "cancer" can leave friends and family speechless.

What do you say to a person with primary lung cancer who never smoked a cigarette in his life?

It happens. When we hear of lung cancer, the victim usually is or was a smoker. Lung cancer is the number-one cause of cancer deaths: worldwide, one million a year. Exposure to tobacco smoke is seen as the main cause, and the rate of lung cancer has decreased in the U.S. with the drop in the number of Americans who smoke.

A nonsmoker is a person who has never smoked or smoked fewer than 100 cigarettes in his lifetime. The incidence of primary lung cancer (the cancer starts in the lung and isn't from a different cancer site that metastasized there) in nonsmokers is fortunately pretty low– about 12-30 times less than among smokers.

Non-smoking women for some reason have 3-4 times more lung cancer than men. I wonder if it is because women typically smoke less than men, and so women get second-hand smoke. This is seen particularly in Asia, where smoking is to men as handbags are to women.

Lung cancer in non-smokers often occurs in younger people, some in their 40s. There was a well-loved and respected local doctor who never smoked but who died of stage IV lung cancer a few years ago. He was in his 40s, and it was a shock to everyone. 

We just sold our house, and radon testing was done. (Thankfully we passed!) Radon is not a synthetic fiber; it's an odorless gas from decayed uranium-238 and radium-226 that causes damage to the lung. Because it's in soil, rock, and groundwater, it can accumulate in houses, often in basements.

Asbestos is well known to be a cause of lung cancer, in particular if the person is a smoker. That's why any house remodeling has to be professionally done if there is asbestos in the pipes, shingles, insulation, etc.

Arsenic and Old Lace was a cute Cary Grant movie, and I wonder if his aunts got lung cancer as retribution for their crimes. Arsenic in drinking water (as in Taiwan and Chile) is associated with lung cancer.

Even though Julia Roberts ruined her Oscar win when she laughed like a hyena on stage (though the vintage dress was lovely), Erin Brockovich showed how a bad form of chromium caused many cancers. 

Genetics and viruses might play a role in lung cancer in people who never used tobacco. Data is still inconclusive.

No one knows what the future has in store. Is it life's cruel way of keeping us on our toes? I have never been a smoker; and I advocate to all my patients, family, and friends to not smoke or hang around second-hand smoke. Steering clear doesn't just mean that your clothes and hair smell better, but also there's less risk of lung disease, heart disease, and many types of cancer. It's no guarantee, but it's a choice worth making. And I'm not just blowing smoke.


Dr. Hook cracks a joke or two, but he's a renowned physician with an interesting website, drjohnhong.com. Email him with your questions.