​Reporter John Stossel Treated for Lung Cancer

Stossel developed lung cancer even though he never smoked.

Emmy award-winning consumer affairs reporter John Stossel, 69, was recently diagnosed and treated for lung cancer. Stossel, a former anchor on ABC News’ 20/20, who currently has his own show on Fox Business called Stossel, wrote a column for Fox News in April 2016:

"I write this from the hospital. Seems I have lung cancer.

My doctors tell me my growth was caught early and I'll be fine. Soon I will barely notice that a fifth of my lung is gone. I believe them. After all, I'm at New York-Presbyterian Hospital. U.S. News & World Report ranked it No. 1 in New York. I get excellent medical care here."

He also wanted readers to know that smoking was not a cause of his lung cancer, saying, "I've never smoked cigarettes. Some people who don't smoke get lung cancer, too."

Lung Cancer in "Never-Smokers"

Lung cancer is the leading cause of cancer deaths worldwide, and tobacco use is the leading cause of lung cancer. However, a significant number of patients with lung cancer have never smoked.

The term "never-smoker" is defined by the U.S. Centers for Disease Control (CDC) as someone who has smoked fewer than 100 cigarettes in a lifetime. It can be difficult to determine exact numbers of never-smokers who develop lung cancer because most population-based cancer registries (including the NCI’s SEER database) don’t collect information on whether patients smoke or not.

It is estimated that 10 to 15 percent of patients with lung cancer are never-smokers. The National Cancer Institute (NCI) estimates that there will be 224,390 new patients diagnosed with lung cancer and 158,000 deaths from the disease in 2016.   

Nearly half of women with lung cancer worldwide are never-smokers, compared with 15 to 20 percent of men. In Asia, as many as 80 percent of women with lung cancer  did not smoke.   

At the September 2015 World Conference on Lung Cancer, researchers presented information that shows that the rates of lung cancer in never-smokers may be rising. One study, done by researchers at the University of Texas Southwestern Medical Center in Dallas, the Parkland Hospital in Dallas, and Vanderbilt University in Nashville, Tennessee, showed that the incidence of non-small cell lung cancer (NSCLC) in never-smokers had nearly doubled over the study period (from 8.9 percent to 19.5 percent), while the incidence of small cell lung cancer (SCLC) had remained steady.

What Causes Lung Cancer in Never-Smokers?

Although the causes of lung cancer in never-smokers are unknown, several risk factors are considered to be important. The most important may be exposure to secondhand smoke, which may account for 15 to 35 percent of non-smoking patients with lung cancer. The risk may be even higher for those whose smoke exposure occurred when they were younger than 25 years old. Non-smoking spouses of smokers have a higher risk of lung cancer than those with non-smoking spouses.

Radon, a gas present in soil, rock, and groundwater, is a proven risk factor for lung cancer in uranium miners, and may play a role in causing lung cancer in never-smokers.

Other environmental exposures may put an individual at increased risk. These include exposure to asbestos, chromium, and arsenic. Pollution, both indoors (from cooking oil and burning coal) and outdoors (from diesel exhaust and traffic-related air pollution) may also be factors.

Several studies have shown that never-smokers who have a family history of lung cancer may be at higher risk due to genetic factors. Some families may pass on genetic material that makes them more susceptible to lung cancer.
Other factors under investigation include exposure to hormone replacement therapy, micronutrients, infectious agents, such as human papilloma virus (HPV) and human immunodeficiency virus (HIV), ionizing radiation, and a previous history of lung disease, such as pulmonary fibrosis, tuberculosis, and asthma.

Is Lung Cancer in Never-Smokers Different Than That Found in Smokers?

There are two general forms of lung cancer: small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). There are several types of non-small cell lung cancer, each type growing and spreading in different ways. The types of non-small cell lung cancer are named for the kinds of cells found in the cancer and how the cells look under a microscope:

  • Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells that look like fish scales.
  • Large cell carcinoma: Cancer that may begin in several types of large cells.
  • Adenocarcinoma: Cancer that begins in the cells that line the alveoli and make substances such as mucus.

Although smoking increases the risk of both SCLC and NSCLC, never-smokers are much more likely to have adenocarcinoma, while heavy smokers have a higher incidence of squamous cell carcinoma and small cell lung cancer.

Perhaps the most important differences between lung cancers in smokers and never-smokers have been found through greater knowledge of the molecular biology of lung cancer. Mutations in the gene called epidermal growth factor receptor (EGFR) are much more common in never-smokers vs. smokers. Another mutation, in a gene called ALK, is also more prevalent in never-smokers. Mutations in these genes can lead to an overgrowth of cells (i.e. cancer).

The precision diagnosis of these gene mutations in individual cancers has critical importance for personalized treatments.

Cancers due to a mutation in the EGFR gene can be treated with an oral medication (e.g. erlotinib (Tarceva) or with a "biologic" drug called cetuximab (Erbitux) that is given by injection. Tumors that have an ALK gene mutation can be treated with an oral medication called crizotinib (Xalkori) that blocks the actions of the mutant ALK protein.

Learn about new therapeutics approved for the treatment of lung and other cancers on our FDA Approvals page.   

For more information on lung cancer and precision medicine, see our story on Ragtime author E.L. Doctorow.

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Celebrity Diagnosis: Teachable Moments in Cancer is produced by Celebrity Diagnosis LLC to raise awareness and knowledge of health and medical issues. The information on the subjects of these articles is derived from public news sources. Celebrity Diagnosis LLC and its employees are not involved in the care of any of the subjects nor do they have access to, or knowledge of, the subjects' medical records or personal health information. Celebrity Diagnosis LLC is solely responsible for the contents of these articles.​​

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