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Don’t Smoke? Lung Cancer Can Still Leave You Breathless!

By Dara Mormile


Lung cancer is the leading killer in both men and women in America, taking more lives every year than any other cancer.


While you may think that you’re “doing all of the right things” for your health as a non-smoker  - and that you take care of your body - did you know that the list of alleged environmental contributors to lung cancer continues to grow? Despite so-called clean air initiatives, non-smokers are exposed to a slew of hazards that could be detrimental to their health.


“Lung cancer carries a stigma: that only smokers get it. A lot of times when someone who doesn’t smoke is diagnosed, they find it hard to even pinpoint what they were exposed to and how it developed. They say ‘I didn’t do anything wrong… I didn’t smoke… I followed all of the rules.’ It’s a tough conversation to have with a patient,” said Dr. Micheal A. Spallone, MD, Thoracic Surgeon at Palisades Medical Center and Packsack Valley Medical Center. “It can be troublesome or frustrating for the provider and the patient when don't know the contributing sources.”


Preferred Health Magazine asked Dr. Spallone to debunk some of the myths associated with non-smokers developing lung cancer to help us understand which environmental pollutants/toxins have been found to endanger our respiratory system. According to the Lung Cancer Research Foundation, those who never smoked account for 20% of lung cancer diagnoses every year with an estimated 47,660 of non-smokers diagnosed in 2023.


What are some reported environmental toxins that could be dangerous for a non-smoker?


Secondhand smoke: Statistically, chronically breathing in smoke from others can be dangerous. According to the Centers for Disease Control and Prevention, secondhand smoke still leads to more than 7,300 lung cancer deaths per year in the U.S.


Occupational Hazards- Includes exposure to:

           - cooking oil fumes (such as harmful gasses in unventilated kitchens)

           - asbestos/radon (construction and building trades, mining, milling, among other industries)

           - diesel exhaust/car exhaust (railroad workers, miners, mechanics, toll booth workers)


Genetics- According to the National Institutes of Health, about 8 % of lung cancers are inherited or occur as a genetic predisposition.

“If you have a genetic mutation, which increases your likelihood of developing cancer in the first place, exposure to environmental dangers could add to your risk,” Dr. Spallone said.


What symptoms possibly indicate respiratory problems for non-smokers?


Dr. Spallone noted that even if you don’t light up, chronic coughing, weight loss, shortness of breath, and chest pain could be a sign of something more serious. Fluid around the lungs also may occur.

“Also, if you have a cough that persists despite treatment of antibiotics, it’s possibly a sign of something more serious,” he said.


Do tests and X-rays of non-smokers’ lungs appear different and why?


“This depends on a lot of factors,” he said.  “A lot of smokers have concurrent diseases like COPD or asthma, which are more prevalent in scans. But the appearance of damage isn’t different and image characteristics are similar on CT scans versus X-rays with non-smokers. We found that the damage to the lungs from other contributors appears the same.”


Are there ways non-smokers can protect/monitor their respiratory health if they are in environmentally toxic environments?


The New Jersey-based specialist said personal protective equipment (PPE) can be sometimes useful.

“We have a lot to learn about environmental exposure and how it develops into cancer in non-smokers. Some formal recommendations of protection may come after years of research and developing links between cause and event,” he said, adding that there are no official guidelines on staying safe. “It’s rudimentary right now and still a precaution we’re learning about and studying. We can recommend wearing a mask, but as we saw from the Covid pandemic, masks were mandated, then they were found later to possibly not be that effective.”


The hardest aspect of fighting the disease is diagnosing cancer in its early stages. Dr. Spallone said this is a challenge with the current medical landscape.

“There are no mandated screenings for lung cancer, unfortunately. Unlike colon or breast cancer - where you reach a certain age and you automatically get screened,” he said. “Despite the fact that this is the deadliest cancer, it’s tough to catch in the early stages since serious symptoms don’t arise until the cancer is advanced.”


The surgeon admits that there’s a disparity in testing since patients can’t just get a CAT scan due to their genetics or age. “Unfortunately, routine testing doesn’t weigh out in our healthcare system; it’s not practical to scan a group of patients for lung abnormalities just to find one case, but hopefully we’re getting closer to understanding the need for prevention and screenings.”


How long does it take a non-smoker, exposed to various carcinogens, to develop cancerous cells in their lungs?


“In terms of time of exposure, there are no solid answers yet. We’ve learned that the basic timeline is years, if not decades, of exposure before the cancer cells form and is found in most cases,” Dr. Spallone said. “We have to ethically study humans over the years and each patient is different in how they handle environmental exposure. We can’t just test humans and we have to answer the question - how do they respectively handle smaller doses of exposure concentrations? Every patient's response is different, of course… And we also have to account for their genetic predisposition to cancer, which adds to their chances of developing respiratory abnormalities.”


Some think that vaping isn’t as ‘harsh’ as smoking. How do you feel about this fad and its possible impact on the rise in cancer cases?


“It doesn’t matter - vaping is still damaging to the lungs…It will take another 5 to 10 years to understand what the long-term consequences are,” Doctor Spallone said.  “I think there might be some progress to gauge the damage that will be done to the lungs, even if it doesn’t result in cancer but I feel that we’ll find some long-term side effects of this trend.”


Lastly, Dr. Spallone explained that the treatment of lung cancer for non-smokers is the same as that of smokers - staging followed by the best-individualized plan of radiation, chemotherapy drug options, etc.


With so many harmful environmental agents invading our everyday lives, it’s important to know that our bodies are limited in their internal defense mechanisms. Never take your lungs for granted with each breath you take!


Dr. Michael Spallone, M.D., MBS is a board-certified thoracic surgeon who is a part of the Hackensack Meridian Medical Group family at 20 Prospect Avenue, Hackensack, NJ, where he has been practicing since August 2022. Prior to this, his training was at Morristown Medical Center (Morristown, NJ), General Surgery Residency from 2015 to 2020. He completed his fellowship training at Mount Sinai Hospital in New York, NY (Cardiothoracic Surgery) from 2020 to 2022. His office can be reached at 551-996-5960.

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