Exploring treatment options in cancer: tumor treatment strategies
Why Are Cases Of Lung Cancer Rising In Nonsmoking Females?
While there's no single cause of lung cancer in nonsmoking females, research suggests that a combination of toxin exposure, genetics, and hormones may play a role.
Tobacco smoking continues to account for most lung cancer cases and 80% of related deaths. But even if you don't have a history of smoking, you might develop lung cancer. In fact, lung cancer rates are rising in nonsmokers — particularly females.
Research suggests that while smoking rates are decreasing worldwide, lung cancer rates are increasing. And about two-thirds of lung cancers in people who do not smoke occur in females.
In the United States, lung cancer is the leading cause of cancer-related deaths in women.
Smoking is still the greatest modifiable risk factor for lung cancer, but it's also important to be aware of other reasons this type of cancer may be on the rise in nonsmoking females.
Most cases of lung cancer in nonsmokers are non-small cell lung cancer, such as adenocarcinoma.
Rather than a single risk factor, lung cancer development in nonsmoking females may be due to a combination of factors, including toxins, genetics, and hormones.
This article takes a closer look at the risk factors for lung cancer in nonsmoking females.
Language mattersIn this article, we talk about lung cancer in people who are assigned female at birth. It's important to note that not everyone assigned female at birth identifies with the label "female" or "woman." However, at times we use "female" or "woman" to reflect the language in a study or statistic.
We also occasionally use "female" or "woman" to make sure people can find this article with the terms they search for. When possible, we aim to be inclusive and create content that reflects the diversity of our readers.
Whether you're exposed to secondhand smoke at home or at work, the carcinogens can increase your risk of developing lung cancer, as well as heart disease and stroke. There's no "safe" level of secondhand smoke exposure — even short-term exposure is considered unsafe.
According to the American Lung Association, more than 41,000 people per year die as a result of complications of secondhand smoke exposure. Secondhand smoke contains a variety of toxins, including:
The risk of secondhand smoke-related lung cancers appears to be greatest in people who have a spouse or partner who is a smoker.
Lung cancer in nonsmokers may also have a genetic component. The genetic mutations (changes) that could contribute to it are mostly the type you can acquire during your lifetime, not the type you might inherit from your parents.
Acquired gene mutations that are involved in nonsmoking lung cancer development are called driver mutations. Examples include:
Genetic mutations are usually not detected until after a lung cancer diagnosis. But genetic testing is still important in these cases because it can influence a doctor's decisions about treatment. If driver mutations are present, certain targeted therapies can be most effective.
Driver mutations can also develop in people who have a history of smoking, but this is less common.
The problem is that these guidelines do not account for nonsmokers who might have other risk factors, such as a history of secondhand smoke exposure. Furthermore, nonsmokers who develop lung cancer tend to do so at a younger age than those who have a history of smoking.
The USPSTF does not recommend annual screenings for nonsmokers because the risk of radiation exposure from regular CT scans could possibly outweigh the benefits.
But if you wait to get screened until you have symptoms of lung cancer, the cancer will likely already have become advanced or spread. This can be a challenging situation to navigate.
Instead, a doctor may recommend regular screenings based on other individual risk factors. If you think you may need screenings, talk with a doctor. They can help you figure out your next steps.
Lung cancer symptomsContact a doctor right away if you're experiencing the following possible symptoms of lung cancer:
While smoking rates are decreasing, lung cancer cases are increasing among nonsmoking females. Researchers believe this could be due to toxin exposures in work and home environments, as well as genetics, hormones, and other risk factors.
Because there are currently no screening guidelines for nonsmokers, lung cancer can be difficult to detect in its early stages.
Consider talking with a healthcare professional if you develop respiratory symptoms that concern you or if you have risk factors for lung cancer.
Monitoring Treatment With Different Types Of Biopsies In Lung Cancer
An expert discussed how liquid and tissue biopsies can help monitor treatment and detect potential resistance in patients with non-small cell lung cancer.
Monitoring cancer treatment and detecting resistance is crucial for the effective care of patients with non-small cell lung cancer, an expert said.
There are two ways to assess for potential treatment resistance: liquid biopsy and tissue biopsy. In particular, liquid biopsy, a less invasive approach, involves analyzing DNA fragments in blood to identify potential resistance mechanisms. On the other hand, tissue biopsy, a more invasive approach, provides a deeper understanding of tumor biology.
At the 2024 ESMO Congress, CURE® spoke with Benjamin Besse, medical oncologist and director of Clinical Research at Gustave Roussy in Villejuif, France, to learn more about the benefits of each approach and how they can be used in the care of patients with non-small cell lung cancer.
Transcript:
There are many ways to monitor treatment resistance. Either you can do the liquid biopsy. It's very simple because you can repeat these tests a lot of time, and you capture in the blood small fragment of the DNA of the tumor. Then you can analyze the gene and understand if new mutations, for example, appear and explain the resistance to the treatment.
The other option is more invasive, is to repeat the biopsy on the solid tumor. It's maybe a bit painful, maybe some complications, but you [have] much more information. Obviously, you can extract the DNA of the cells, but you can look also at the expression of proteins and other markers.
So the more convenient one is probably liquid biopsy, but with a bit less, let's say, deep learning on the resistance mechanism.
My feeling is that today, it should be restricted to the research area. In the context of care, it's mandatory when you have a diagnosis of non-small cell lung cancer to have a molecular profile to be sure that you don't find targets for which we have targeted therapies.
But during treatment evolution, you always learn in medicine that if you order a test for patients, it means that this test will impact the way you treat patients after that. And so far, we don't have a test that allows us to sequence and select the next treatment, but it's mandatory to go on with this effort on research.
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I Still Reflect On My Lung Cancer Treatment Decisions
When I was diagnosed with lung cancer, I didn't want to receive chemotherapy, especially when I was a good candidate for immunotherapy.
Sue McCarthy received diagnoses of breast cancer in 2001 and lung cancer in 2018. Catch up on all of Sue's blogs here!
For the past six years, I've wondered why my primary treatment for lung cancer was cisplatin, a harsh chemotherapy, despite the fact that my PD-L1 test results were at 60%, which made me an excellent candidate for immunotherapy.
Six years ago this month, I sat in the waiting room of my hospital's cancer center, anticipating my first appointment with my new doctor. The medical oncologist had come highly recommended by my thoracic surgeon.
I trusted my surgeon and felt comfortable with him. He had removed malignant tumors, one from each of my lungs in the summer of 2018. My non-small cell lung cancer was diagnosed as stage 3B: two tumors and eight cancerous lymph nodes, taken from my chest during the first of my two surgeries.
Despite feeling discouraged and rather negative, I sensed a bit of optimism for one reason and one reason only. My thoracic surgeon had my PD-L1 tested and the results, at 60%, indicated there was a good chance I would benefit from a checkpoint inhibitor type of immunotherapy. Not only was I happy with what my surgeon had shared with me, but I was also terrified of chemotherapy.
As I continued to wait for the doctor in an examination room, anxious thoughts bounced back and forth in my mind, from my fear of chemo to my hope in the newer cancer treatment: immunotherapy. It would use my own immune system to kill cancer cells. In my mind, there was very little doubt that immunotherapy was the better choice for me, specifically better than platinum-based chemotherapy. I was feeling good as the doctor walked in; I sensed that my oncologist would trust the PD-L1 results and choose immunotherapy as my primary treatment. However, not so! Why not? I wondered.
It was hard for me to even listen to the oncologist after he started talking about my planned chemotherapy regimen. Cisplatin and Alimta (pemetrexed disodium) were in the drug cocktail which I would receive every three weeks. My oncologist's manner indicated that he was stressed; I sensed no compassion in his voice.
I saw myself only as a victim that day. A life-threatening cancer had taken hold of me and then a reputable oncologist had just explained to me what I must do to survive. I knew I must tell him that I had a high PD-L1 score of 60% and I did, yet he gave me no explanation for his choosing cisplatin as my primary cancer treatment. And I wondered.
Yet, in a matter of minutes, my experience changed significantly. As a new oncology patient, I needed to have blood work done, and as I waited for the phlebotomist, my doctor tapped me gently on the shoulder and quietly said, "It will be OK." I felt relieved. He cared.
One week later, after another scan to make sure there was no change in the stage of my cancer, and a procedure to implant a port in my upper left chest, it was time to begin chemotherapy. I was called into the treatment area, this time with a much different attitude; I was absolutely ready to begin the infusion.
Resilience is a trait I've had many chances in life to practice — from years of family issues to earlier serious illnesses. I smiled at the kind, caring oncology nurse, but was not surprised as she read me the long list of side effects commonly suffered by patients with cancer who receive cisplatin. In anticipation of intense fatigue, nausea, diarrhea and vomiting, my husband drove us home. However, it took almost four days for me to become ill.
My chemotherapy treatment had taken place on Thursday, Sept. 6, 2018, but it wasn't until the following Monday evening that the full force of the harsh, platinum-based chemo, went to work on my body. I felt sick — sicker than I had felt in my entire life. Maybe chemo would do me in. I was scared I wouldn't make it. Not just physically, but mentally and emotionally. At that point, I was too sick to wonder.
Anxiety gripped me as I called the oncology office first thing Tuesday morning. I was able to get an appointment to see the doctor later that day, but the movement of the car and my sense of nausea as my husband drove toward the doctor's office caused me to vomit before we arrived at the cancer center. I clung to my husband, enabling me to walk the short distance from the parking lot to the medical building.
The medical assistant took my vital signs, and all were fine. However, I weighed only 103 pounds, despite my height of 5 feet 6 inches. One of my oncologist's associates examined me more thoroughly and diagnosed me with dehydration. "Drink more fluids," he said. "You are fine. All your symptoms are normal."
Astounded to hear that, I felt a bit embarrassed but trusted the doctor and appreciated that I was not nearly as ill as I thought I might be. I knew I would get through that first round of chemotherapy. Drinking water, even sip by sip, was a priority, as was eating simple and bland food that my stomach could tolerate.
From that point forward, I did well with all my treatments, including the optional immunotherapy I received at the end of my treatment. Some would question why I continue to wonder about the immunotherapy as my primary treatment, but to me, it was completely clear: if not to help me, then to help the next patient.
I visited my daughter for the weekend soon after and while at their home I talked to my son-in-law, a PhD research microbiologist. He explained to me: PD-1 is a protein found on T cells that helps control the body's immune response. When PD-1 is attached to another protein, PD-L1, it helps keep T cells from destroying cancer cells. The checkpoint inhibitor immunotherapy blocks PD-1 and allows T cells to kill cancer cells. Again, I understood some more, and again I wondered.
Today I saw my primary care physician for my annual exam, and when the topic of my lung cancer journey came up, he said, "That…PD-L1 score saved your life."
I thought, but for only a moment. Then again, I wondered. Why?
For more news on cancer updates, research and education, don't forget to subscribe to CURE®'s newsletters here.
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