US EPA

3079679 

Journal Article 

Review 

Lung cancer in never smokers: a review 

Subramanian, J; Govindan, R 

2007 

Yes 

Journal of Clinical Oncology
ISSN: 0732-183X
EISSN: 1527-7755 

25 

5 

561-570 

English 

17290066 

10.1200/JCO.2006.06.8015 

WOS:000244176000016 

Lung cancer is the leading cause of cancer-related death in the United States. Although tobacco smoking accounts for the majority of lung cancer, approximately 10% of patients with lung cancer in the United States are lifelong never smokers. Lung cancer in the never smokers (LCINS) affects women disproportionately more often than men. Only limited data are available on the etiopathogenesis, molecular abnormalities, and prognosis of LCINS. Several etiologic factors have been proposed for the development of LCINS, including exposure to radon, cooking fumes, asbestos, heavy metals, and environmental tobacco smoke, human papillomavirus infection, and inherited genetic susceptibility. However, the relative significance of these individual factors among different ethnic populations in the development of LCINS has not been well-characterized. Adenocarcinoma is the predominant histologic subtype reported with LCINS. Striking differences in response rates and outcomes are seen when patients with advanced non-small-cell lung cancer (NSCLC) who are lifelong never smokers are treated with epidermal growth factor receptor tyrosine kinase (EGFR-TK) inhibitors such as gefitinib or erlotinib compared with the outcomes with these agents in patients with tobacco-associated lung cancer. Interestingly, the activating mutations in the EGFR-TK inhibitors have been reported significantly more frequently in LCINS than in patients with tobacco-related NSCLC. This review will summarize available data on the epidemiology, risk factors, molecular genetics, management options, and outcomes of LCINS. 

Antineoplastic Agents; Environmental Pollutants; Hormones; Tumor Suppressor Protein p53; ErbB Receptors; EC 2.7.10.1; Index Medicus; Genetic Predisposition to Disease; Cooking; Risk Factors; Lung Diseases -- complications; Treatment Outcome; Tumor Suppressor Protein p53 -- genetics; Tumor Virus Infections -- complications; DNA Methylation; ErbB Receptors -- genetics; Environmental Pollutants -- adverse effects; Hormones -- metabolism; Chromosome Aberrations; Sex Factors; Sex Distribution; Mutation; Genes, ras; Smoking -- adverse effects; Lung Neoplasms -- genetics; Carcinoma, Non-Small-Cell Lung -- drug therapy; Adenocarcinoma -- metabolism; Carcinoma, Non-Small-Cell Lung -- genetics; Adenocarcinoma -- drug therapy; Lung Neoplasms -- drug therapy; Lung Neoplasms -- metabolism; Carcinoma, Non-Small-Cell Lung -- metabolism; Carcinoma, Non-Small-Cell Lung -- epidemiology; Carcinoma, Non-Small-Cell Lung -- etiology; Adenocarcinoma -- genetics; Adenocarcinoma -- epidemiology; Adenocarcinoma -- etiology; Lung Neoplasms -- epidemiology; Lung Neoplasms -- etiology