63% of never-smoker Asian female lung cancer patients has EFGR gene mutation

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https://www.farrerpark.com/farrerhealth/articles/detail.html?id=6111116

Smokers are Not the Only Ones Who Get Lung Cancer​

• 09 Mar 2021
• 
  
• 4 mins

Many people wrongly associate developing lung cancer with those who regularly smoke cigarettes over an extended period of time. Despite the fact that smoking does increase the risk of developing lung cancer (as well as other cancers) multitudinously, we should also pay due attention to the fact that there are increasing data that shows how never smokers are contracting lung cancer, especially women1.
In this article, we speak to Dr. Toh Chee Keong from Curie Oncology and dive into the world of lung cancer in never-smokers.

Understanding Lung Cancer​

In order to understand lung cancer, it is useful to first know what cancer actually is and understand how it affects us.
Cancer occurs due to mutations in your DNA, namely specific genes that regulate how your cells divide, called proto-oncogenes and tumor suppressor genes. These mutations result in cells dividing uncontrollably and invading nearby tissues. Certain substances and behaviors, known as mutagens, can increase the likelihood of these mutations.
For lung cancer, due to the direct involvement of inhalation in the process of smoking, mutagens such as aromatic amines and acetaldehyde2 are absorbed by lung cells and substantially increase the risk of developing lung cancer, making smoking by far the biggest risk factor. However, there are many more.
Likewise with smoking, many of these likelihood-increasing factors are linked to inhalation of potentially damaging substances, such as secondhand smoke, radon gas, air pollution, diesel exhaust and asbestos particles. Of these, radon gas, something many people have never heard of, is the second most likely cause of lung cancer3.
For example, of the roughly 30,000 non-smokers who died of lung cancer in the United States in 2018, around 21,000 of these deaths were due to exposure to radon4. Luckily, partially since most Singaporeans live in high-rise apartments, exposure to dangerous concentrations of radon in Singapore tends to be very rare.

More Lung Cancer Cases Reported in Singapore​

A study by the National Cancer Centre Singapore found that 3 in 10 patients with lung cancer were never-smokers, a value higher than the global average. Furthermore, it has also been observed that this risk is particularly high among Chinese females, with 70% of never-smokers with lung cancer being women, and the rate of overall incidence of lung cancer in this demographic being higher in Singapore, where only 4% of Chinese women smoke, compared to Western countries like Germany or Italy, where approximately 20% of women smoke, but the prevalence of lung cancer in women is lower5. So why is this?
Research shows this high prevalence is usually due to a specific mutation called “EFGR”. For example, one study showed that the number of never-smoker Asian female lung cancer patients with an EFGR mutation was 63%6.
The most common type of lung cancer diagnosed in non-smokers is adenocarcinoma, which starts in mucus-producing cells on the outer regions of the lungs. Symptoms usually start spreading when the cancer spreads. For instance, pain in the bone would be experienced if cancer has spread to the bone. If it spreads to the brain, symptoms such as headaches would occur. Due to this, even though it is generally diagnosed at a later stage due to often being attributed to respiratory infection or even allergies, some studies suggest the prognosis of disease survival is better for non-smokers7.

 

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What Can Non-smokers Do to Protect Themselves Against Lung Cancer?​

For those who do not work in a profession where they are regularly exposed to mutagens, simple preventive measures can be taken to reduce the likelihood of developing cancer, even if you already don’t smoke. These include, maintaining a healthy diet, exercising regularly, avoiding secondhand smoke, and checking your home for radon. For those who work in fields where they may be exposed to mutagens, use of respiratory protection equipment may also help to reduce the risk of developing lung cancer. Regular health screening can also help to detect abnormalities in the body and spot cancer early.

Finally, non-smokers with lung cancer often suffer from a different set of psychological symptoms compared to smokers. There is a perception that people with lung cancer “brought it on themselves” by smoking. An attitude such as this can be damaging to both smokers and non-smokers, however this feeling of being misunderstood can often make non-smokers feel more alone and less supported than people with other types of cancer. This stigma associated with lung cancer provides no purpose except to dismiss those who need compassion and support. After all, cancer can occur in anyone, regardless of their lifestyle choices, and is one of the most difficult things people and their families may ever have to face.

 

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EGFR and NSCLC​

There are two main types of lung cancer: small-cell and non-small cell lung cancer (NSCLC). Most lung cancer cases are NSCLC.

About 32% of NSCLC cases worldwide involve an EGFR mutation. The most common subtype to have an EGFR mutation is adenocarcinoma.

People at the highest risk of having EGFR-positive lung cancer include:

• People who’ve never smoked or only smoked a little
• People with lung adenocarcinoma
• Women
• Young adults with lung cancer
• People of Asian or East Asian heritage

Your chances of getting lung cancer are also higher if you:

• Smoke
• Are exposed to radon
• Breathe in particle pollution often
• Have a family history of lung cancer

https://www.webmd.com/lung-cancer/egfr-mutations-defined-nsclc

 

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https://www.cdc.gov/radon/radon-test.html

Test Your Home
Testing your home is the only way to know if radon levels are high. You and your family could be at risk for lung cancer from radon.

When to Test Your Home​

You should test your home’s radon levels

• If it’s never been tested or radon levels are unknown
• When preparing to buy or sell
• Before and after any renovations, especially after making any repairs to reduce radon levels
• Before making any lifestyle changes in the home that would cause someone to spend more time in the basement or lower level (like converting a basement to a bedroom)

Ways to Test Your Home​

Contact your state radon office for specific information and resources in your area for testing and for a list of qualified radon testers. You can either hire a radon tester or purchase a radon test kit from a hardware store and do it yourself. However, the Environmental Protection Agency (EPA) recommends hiring a qualified tester if you are buying or selling your home.

 

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There are two general types of radon test kits:

• Short-term kits measure radon for 2–90 days for quick results.
• Long-term kits measure radon in your home for over 90 days and are more likely to tell you your home’s year-round average level. The longer the test, the better the results will reflect your home and lifestyle.

Do It Yourself Test Kits​

Your state radon office can give you information on where to get a test kit and whether your state offers free or discounted test kits. You can purchase a radon test kit online, in many retail or hardware stores, or order one through the National Radon Program Services.*
Once you have your kit:

• Follow all instructions carefully. This will include placing a small measuring device in your basement or the lowest level of your home, raised three feet off the ground, in the middle of the room.
• If your home is in a multi-unit building, you can test your unit by placing the device in the lowest level within your unit.
• Leave it there for the amount of time instructed. Short-term testing can take 2–90 days and long-term testing takes more than 90 days. The exact length of time for testing depends on the specific test.
• Once the test is completed, follow the directions on the test kit packaging to find out where to send the device to get the results.

*The National Radon Program Services is maintained by Kansas State University through a Cooperative Agreement with EPA.

Understanding Results​

Radon is measured in units of picocuries per liter (pCi/L) of air. Radon is naturally found in outdoor air at very low levels and some radon will always be in your indoor air. According to EPA, the average radon level in American homes is about 1.3 pCi/L.
EPA recommends contacting a licensed professional to install a radon reduction system if your radon level is at or above 4 pCi/L of air. EPA also recommends taking action to reduce radon if your radon level is from 2 pCi/L through 4 pCi/L. There is no known safe level of radon so you should always aim to have the lowest radon levels to reduce the risk of lung cancer.

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