As I have written elsewhere, lung cancer used to be an almost unknown disease. I have a paper in which lung cancer is described as a rare form of a rare disease (cancer is rare).
While the Victorians did not possess sophisticated diagnostic or screening technology, they were as able to diagnose late stage cancer as we are today; but this was an uncommon finding. In that period, cancer carried none of the stigma that it has recently acquired, and was diagnosed without bias. For example, in 1869 the Physician to Charing Cross Hospital described lung cancer as ‘… one of the rarer forms of a rare disease. You may probably pass the rest of your students life without seeing another example of it.’ 1
Yet today, lung cancer has become the number one killer cancer worldwide. Lung cancer is the most common cancer worldwide, accounting for 1.8 million new cases and 1.6 million deaths in 2012.2 What has changed?
We can’t say air pollution because it was far worse in Victorian times than today. The air in major European and US cities was appalling. Here’s a note I found on Victorian Web:
Londoners’ intensive use of coal for hearth fires helped raise the ambient temperature of the city two to three degrees Fahrenheit above that of the surrounding countryside, with a corresponding rise in humidity. Gas lights, introduced in the 1830s, produced another four to five degrees difference and added their fumes to the atmosphere.
The smoke, mixed with caustic exhausts from coal gas works and the miasmas emanating from polluted watercourses, caused chronic respiratory ailments among its less fortunate denizens and blocked out perhaps three-quarters of the sunshine normally enjoyed by country towns.3 [my italics]
Rats monopolized the city’s sewers, and wrens proliferated amid the piles of manure in city streets. Pigeons, of course, adapted well to a regime of garbage and building ledges. Long before Darwin, they selectively bred for dark coloring as camouflage against the soot-covered buildings.4
What’s Happening to People Who Have Never-Smoked?
What is really creepy it we are seeing an alarming rise in lung cancers in non-smokers, according to two new studies presented here at the 16th World Conference on Lung Cancer. I’m in that category and it’s become insecure, even scary!
According to one of these studies, the incidence of never-smokers diagnosed with non-small-cell lung cancer (NSCLC) jumped from 13% to 28% during a 6-year period, Eric Lim, MD, from the Royal Brompton & Harefield NHS Foundation Trust in London, United Kingdom. And many of these patients initially presented with advanced-stage disease.
The second study, at the University of Texas Southwestern Medical Center in Dallas, the Parkland Hospital in Dallas, and Vanderbilt University in Nashville, Tennessee, demonstrated that the incidence of lung cancer in non-smokers is increasing in the United States. This was observed in three facilities, most significantly for non-small cell lung cancer (NSCLC). At one institution, for example, the incidence among never-smokers climbed from 8.9% in 1990–1995 to 19.5% in 2011–2013.
But in contrast, the number for small-cell lung cancer [SCLC] stayed the same—typically 1% to 2%.
“When we think of lung cancer, we think of smoking,” Dr Lim noted. It’s true that anti-smoking strategies implemented in the early 1980s have led to a decrease in smoking-related lung cancer.
But instead, what we are seeing is an increase in the incidence of nonsmoking-related lung cancer. That’s weird.
Annual Incidence Doubles
According to Dr. Lim, “We have seen more than double the amount of patients coming to us.”
The annual increase in the incidence of never-smokers developing lung cancer rose from 13% in 2008 to 15%, 18%, 19%, 20%, and 28% in the subsequent years of the study. This was attributed to an absolute increase in number, not to a change in the ratio of never-smokers to current and ex-smokers.
Early detection is important but challenging in this population, Dr. Lim noted.
52% of patients had no clear symptoms when discovered. Cough, not surprisingly, was a presenting symptom in 34% of patients. Other specific symptoms, such as coughing blood, were experienced by only 11% of patients, and general but related symptoms, such as chest infection, were experienced by only 18%.
A full 36% were discovered by chance while imaging. That means screening the entire population isn’t going to do much good. It’s all a worry.
As the impact of lower smoking levels bites deeper, we should see a decline in that type of lung cancer, which has been predominant until now. But as that trend continues, clearly the new never-smoked related NSCLC tumors will increase steadily in proportion.
One of the obvious questions is why is this shift happening? It’s not clear. But we do now realize that side stream or second-hand smoke is a real concern. So is pollution, radon, and small particles in the air. Anything in an aerosol format is bad news. It vaporizes and enters the indoor air. Particles below a certain size just stay there, suspended, waiting to be breathed in by everyone in the household.
You have to remember that your lungs are very vulnerable to anything which is in the air. My wife uses hairspray, despite my disapproval. It makes her look pretty, true. But I hold my breath and leave the bathroom immediately when she uses it. I cannot for the life of me see why something that is supposed to be sticky and gluey on your hair would have any other effect when you breathe it in and it hits the lining of your lungs. It’s designed to gum things up. And over time, well…
What You Can Do Today…
So, even good habits and a never-smoker lifestyle no longer seems to protect. What should you do? There is clear reason to be concerned. We are now talking about the number one cancer, worldwide.
As always, my teaching is that any good health measure is an anti-cancer measure.
But it seems to me the real issue is avoiding atmospheric pollution, at least on a personal scale. You can’t clean up the air of your city single-handed, or prevent the fallout of Chinese industry from falling on your local community, but you can clean up your own home and put up some protective barriers.
Stop spraying anything into the air at home. Remove all chemicals that will evaporate and enter the air (anything which smells strongly, in effect). Invest in an activated-carbon air filter. Better still get the HEPA and carbon combined. HEPA stands for high efficiency particulate air filtration. It’s your best protection.
But you need the carbon filter too, to filter our volatile organic poisons, like VOCs (volatile organic compounds), benzene compounds, xylene, toluene, etc. These show up from fabrics, flooring, carpets, modern furniture, COOKING, fire retardants, cleaning fluids, food wrappers, felt markers and cosmetics.
Remember eating organic and wearing cottons won’t protect you from this onslaught!
Do it, please. I ask you…
1. Hyde Salter H. On the treatment of asthma by belladonna. The Lancet. 1869:152–153
2. World Health Organization. International Agency for Research on Cancer. GLOBOCAN 2012: Estimated Cancer Incidence, Mortality and Prevalence Worldwide in 2012. Lung Cancer. Accessed November 10, 2014
3. Excerpted from Dale H. Porter’s The Thames Embankment: Environment, Technology, and Society in Victorian London, courtesy of “the Victorian Web”.
4. Porter, Dale H. The Thames Embankment: Environment, Technology, and Society in Victorian London. Akron, Ohio: University of Akron Press, 1998
5. 16th World Conference on Lung Cancer (WCLC). Presented September 8, 2015.