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Many lung cancers are now in non-smokers. Scientists want to know why

Many lung cancers are now in non-smokers. Scientists want to know why

NZ Herald4 days ago
'My family needs me,' she recalled thinking.
Chen's case represents a confounding reality for doctors who study and treat lung cancer, the deadliest cancer in the United States.
The disease's incidence and death rates have dropped over the last few decades, thanks largely to a decline in cigarette use, but lung cancers unrelated to smoking have persisted.
The thinking used to be that smoking was 'almost the only cause of lung cancer', said Dr Maria Teresa Landi, a senior investigator at the National Cancer Institute, which is part of the National Institutes of Health.
However, worldwide roughly 10% to 25% of lung cancers now occur in people who have never smoked.
Among certain groups of Asian and Asian American women, that share is estimated to be 50% or more.
These cancers are increasingly drawing the attention of researchers like Landi, who are studying the role that environmental exposures, genetic mutations, or other risk factors might play.
They have already found some early hints, including a clear link to air pollution.
Physicians are also testing new approaches to better detect lung cancer in non-smokers.
They are trying to understand why it is more prevalent: in people of Asian ancestry; in women; and why it is being seen among younger people.
'We all still think about the Marlboro man as what lung cancer looks like,' said Dr Heather Wakelee, chief of oncology at the Stanford University School of Medicine.
In many cases, though, that's no longer true. 'We're just baffled as to why,' she said.
Looking for Clues
Many lung cancers in non-smokers have no known cause and are discovered only by chance.
That was the case for Sandra Liu, 59, who lives in New Jersey.
Liu was diagnosed this year with adenocarcinoma, the most common type of lung cancer among non-smokers.
Doctors found the mass after she had a full-body check-up during a visit to China — a process popular with some Chinese expatriates visiting the country that includes a chest scan.
'I would have never thought to go for a CT,' she said, noting she had no major symptoms and never smoked.
Scientists are starting to see that the biology of cancer in non-smokers like Liu differs from cancers seen in people with a smoking history — and may require different strategies for prevention and detection.
One large study, called 'Sherlock Lung' and led by Landi and colleagues at the University of California, San Diego, is looking at the mutational signatures, or patterns of mutations across the cancer genomes, of 871 non-smokers with lung cancer from around the world.
Their latest findings, published in Nature this month, showed that certain mutations, or changes to DNA, were much more common in people who lived in areas with high amounts of air pollution — for example, Hong Kong, Taiwan, and Uzbekistan.
More pollution was linked to more mutations. The study did not include data from India, considered to have the highest levels of outdoor pollution.
The researchers didn't just find that pollution may directly damage DNA. They also saw signs that pollution causes cells to divide more rapidly, which further increases the likelihood of cancer.
Studies have also shown that people who don't smoke but have a family history of lung cancer, such as Chen and Liu — both of Liu's grandfathers had the disease — are at increased risk.
This could be because of shared genetics, a common environment or both, said Dr Jae Kim, chief of thoracic surgery at City of Hope in Duarte, California.
And scientists know that non-smokers with lung cancer are more likely than people who smoked to have certain kinds of 'driver' mutations, changes to the genome that can cause cancer and drive its spread, Kim said.
In contrast, people who smoke tend to accumulate many mutations over time that can eventually lead to cancer.
This difference in the type of mutations may be one reason why lung cancer among people under-50 is more prevalent among nonsmokers than smokers.
Leah Phillips at her home in Peewee Valley, Kentucky. Photo / Jon Cherry, the New York Times
There are probably other factors, too, including exposure to radon, asbestos and possibly aristolochic acid, a compound once common in traditional Chinese medicine.
Landi's research linked the compound to lung cancer mutations among Taiwanese patients. Taiwan banned products containing it in 2003.
Studies from Asia have also suggested second-hand smoke, fumes from cooking oils, and a history of tuberculosis or other lung disease as possible culprits.
However, these potential contributors are less common in the US, where Asian American women who don't smoke are still nearly twice as likely as other women to be diagnosed with the disease, said Scarlett Gomez, a professor of epidemiology and biostatistics at the University of California, San Francisco.
To understand what's driving the disparity in the US, Gomez, Wakelee and colleagues at other Northern California institutions are now studying the relationships among genes, environmental contaminants and lung cancer in Asian American non-smoking women.
'Ultimately, we want to be able to come up with actionable risk factors, just like we do for breast cancer and colorectal cancer,' Gomez said.
Revisiting Screening Guidance
Studies like Gomez's may help address the question of who should be screened for lung cancer.
In the US, routine screening is recommended only for people aged 50 to 80 who smoked at least the equivalent of one pack of cigarettes per day for 20 years.
Because of that, lung cancer in non-smokers is often not caught until it's advanced, said Dr Elaine Shum, an oncologist at NYU Langone Health.
That can have devastating consequences for patients like Chen, who is still undergoing treatment after a third metastasis of her cancer.
Shum and others are now exploring whether screening should be expanded.
In Taiwan, a nationwide trial tested the effectiveness of CT scans in people aged 55 to 75 who never smoked but had one other risk factor.
Doctors detected cancer in 2.6% of patients — enough that Taiwan now offers routine screening for non-smokers with a family history of lung cancer.
Shum and colleagues recently ran a similar pilot study among women of Asian ancestry who were 40 to 74 and had never smoked.
In preliminary results from about 200 patients, they found invasive cancer at comparable rates to the Taiwan study. Data from the full set of 1000 patients who were screened is forthcoming.
Still, it would take far more research to determine who in the US, if anyone, would benefit from broader screening and whether it could meaningfully reduce lung cancer deaths.
Screening more people can lead to more false positives, which may mean patients get biopsies and other interventions they don't need.
And some cancers doctors find are so slow growing that they may never cause harm, said Dr Natalie Lui, a thoracic surgeon at the Stanford University School of Medicine.
'What if we're taking out all these tiny lung cancers that would not have been life-threatening?' Lui said.
On the flip side, she thinks of the patients she regularly sees who have aggressive or advanced lung cancers but never smoked.
'If there was screening, we could save their life,' Lui said.
The good news is that survival with advanced cancers has improved with newer therapies that effectively keep the disease at bay for years in many patients.
Such treatments have benefited Leah Phillips, of Pewee Valley, Kentucky.
Doctors first mistakenly diagnosed her with asthma and then anxiety. Later, they said she had pneumonia.
When an oncologist finally told her in 2019 that she had metastatic lung cancer, he gave her six to 12 months to live.
'Go home and get your affairs in order,' Phillips remembered him saying. She was 43, and her children were 9, 13, and 14.
'I'm not leaving my kids,' Phillips thought.
After getting a second opinion, she started taking a drug that targets one of the driver mutations in lung cancer. She prayed to make it to her eldest child's graduation. 'I cried through his entire senior year,' she said.
In June, she watched her middle child graduate. 'Now I need to make it to the next one,' she said.
Phillips, who co-founded a non-profit called the Young Lung Cancer Initiative to increase awareness of the condition, said people look at her askance when she tells them she has lung cancer but never smoked. They didn't know it was possible.
It's not your grandfather's lung cancer anymore, she tells them.
This article originally appeared in The New York Times.
Written by: Nina Agrawal and Allison Jiang
Photographs by: Shuran Huang, Jon Cherry
©2025 THE NEW YORK TIMES
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Many lung cancers are now in non-smokers. Scientists want to know why
Many lung cancers are now in non-smokers. Scientists want to know why

NZ Herald

time4 days ago

  • NZ Herald

Many lung cancers are now in non-smokers. Scientists want to know why

'My family needs me,' she recalled thinking. Chen's case represents a confounding reality for doctors who study and treat lung cancer, the deadliest cancer in the United States. The disease's incidence and death rates have dropped over the last few decades, thanks largely to a decline in cigarette use, but lung cancers unrelated to smoking have persisted. The thinking used to be that smoking was 'almost the only cause of lung cancer', said Dr Maria Teresa Landi, a senior investigator at the National Cancer Institute, which is part of the National Institutes of Health. However, worldwide roughly 10% to 25% of lung cancers now occur in people who have never smoked. Among certain groups of Asian and Asian American women, that share is estimated to be 50% or more. These cancers are increasingly drawing the attention of researchers like Landi, who are studying the role that environmental exposures, genetic mutations, or other risk factors might play. They have already found some early hints, including a clear link to air pollution. Physicians are also testing new approaches to better detect lung cancer in non-smokers. They are trying to understand why it is more prevalent: in people of Asian ancestry; in women; and why it is being seen among younger people. 'We all still think about the Marlboro man as what lung cancer looks like,' said Dr Heather Wakelee, chief of oncology at the Stanford University School of Medicine. In many cases, though, that's no longer true. 'We're just baffled as to why,' she said. Looking for Clues Many lung cancers in non-smokers have no known cause and are discovered only by chance. That was the case for Sandra Liu, 59, who lives in New Jersey. Liu was diagnosed this year with adenocarcinoma, the most common type of lung cancer among non-smokers. Doctors found the mass after she had a full-body check-up during a visit to China — a process popular with some Chinese expatriates visiting the country that includes a chest scan. 'I would have never thought to go for a CT,' she said, noting she had no major symptoms and never smoked. Scientists are starting to see that the biology of cancer in non-smokers like Liu differs from cancers seen in people with a smoking history — and may require different strategies for prevention and detection. One large study, called 'Sherlock Lung' and led by Landi and colleagues at the University of California, San Diego, is looking at the mutational signatures, or patterns of mutations across the cancer genomes, of 871 non-smokers with lung cancer from around the world. Their latest findings, published in Nature this month, showed that certain mutations, or changes to DNA, were much more common in people who lived in areas with high amounts of air pollution — for example, Hong Kong, Taiwan, and Uzbekistan. More pollution was linked to more mutations. The study did not include data from India, considered to have the highest levels of outdoor pollution. The researchers didn't just find that pollution may directly damage DNA. They also saw signs that pollution causes cells to divide more rapidly, which further increases the likelihood of cancer. Studies have also shown that people who don't smoke but have a family history of lung cancer, such as Chen and Liu — both of Liu's grandfathers had the disease — are at increased risk. This could be because of shared genetics, a common environment or both, said Dr Jae Kim, chief of thoracic surgery at City of Hope in Duarte, California. And scientists know that non-smokers with lung cancer are more likely than people who smoked to have certain kinds of 'driver' mutations, changes to the genome that can cause cancer and drive its spread, Kim said. In contrast, people who smoke tend to accumulate many mutations over time that can eventually lead to cancer. This difference in the type of mutations may be one reason why lung cancer among people under-50 is more prevalent among nonsmokers than smokers. Leah Phillips at her home in Peewee Valley, Kentucky. Photo / Jon Cherry, the New York Times There are probably other factors, too, including exposure to radon, asbestos and possibly aristolochic acid, a compound once common in traditional Chinese medicine. Landi's research linked the compound to lung cancer mutations among Taiwanese patients. Taiwan banned products containing it in 2003. Studies from Asia have also suggested second-hand smoke, fumes from cooking oils, and a history of tuberculosis or other lung disease as possible culprits. However, these potential contributors are less common in the US, where Asian American women who don't smoke are still nearly twice as likely as other women to be diagnosed with the disease, said Scarlett Gomez, a professor of epidemiology and biostatistics at the University of California, San Francisco. To understand what's driving the disparity in the US, Gomez, Wakelee and colleagues at other Northern California institutions are now studying the relationships among genes, environmental contaminants and lung cancer in Asian American non-smoking women. 'Ultimately, we want to be able to come up with actionable risk factors, just like we do for breast cancer and colorectal cancer,' Gomez said. Revisiting Screening Guidance Studies like Gomez's may help address the question of who should be screened for lung cancer. In the US, routine screening is recommended only for people aged 50 to 80 who smoked at least the equivalent of one pack of cigarettes per day for 20 years. Because of that, lung cancer in non-smokers is often not caught until it's advanced, said Dr Elaine Shum, an oncologist at NYU Langone Health. That can have devastating consequences for patients like Chen, who is still undergoing treatment after a third metastasis of her cancer. Shum and others are now exploring whether screening should be expanded. In Taiwan, a nationwide trial tested the effectiveness of CT scans in people aged 55 to 75 who never smoked but had one other risk factor. Doctors detected cancer in 2.6% of patients — enough that Taiwan now offers routine screening for non-smokers with a family history of lung cancer. Shum and colleagues recently ran a similar pilot study among women of Asian ancestry who were 40 to 74 and had never smoked. In preliminary results from about 200 patients, they found invasive cancer at comparable rates to the Taiwan study. Data from the full set of 1000 patients who were screened is forthcoming. Still, it would take far more research to determine who in the US, if anyone, would benefit from broader screening and whether it could meaningfully reduce lung cancer deaths. Screening more people can lead to more false positives, which may mean patients get biopsies and other interventions they don't need. And some cancers doctors find are so slow growing that they may never cause harm, said Dr Natalie Lui, a thoracic surgeon at the Stanford University School of Medicine. 'What if we're taking out all these tiny lung cancers that would not have been life-threatening?' Lui said. On the flip side, she thinks of the patients she regularly sees who have aggressive or advanced lung cancers but never smoked. 'If there was screening, we could save their life,' Lui said. The good news is that survival with advanced cancers has improved with newer therapies that effectively keep the disease at bay for years in many patients. Such treatments have benefited Leah Phillips, of Pewee Valley, Kentucky. Doctors first mistakenly diagnosed her with asthma and then anxiety. Later, they said she had pneumonia. When an oncologist finally told her in 2019 that she had metastatic lung cancer, he gave her six to 12 months to live. 'Go home and get your affairs in order,' Phillips remembered him saying. She was 43, and her children were 9, 13, and 14. 'I'm not leaving my kids,' Phillips thought. After getting a second opinion, she started taking a drug that targets one of the driver mutations in lung cancer. She prayed to make it to her eldest child's graduation. 'I cried through his entire senior year,' she said. In June, she watched her middle child graduate. 'Now I need to make it to the next one,' she said. Phillips, who co-founded a non-profit called the Young Lung Cancer Initiative to increase awareness of the condition, said people look at her askance when she tells them she has lung cancer but never smoked. They didn't know it was possible. It's not your grandfather's lung cancer anymore, she tells them. This article originally appeared in The New York Times. Written by: Nina Agrawal and Allison Jiang Photographs by: Shuran Huang, Jon Cherry ©2025 THE NEW YORK TIMES

Wētā Workshop Designed TCM Cultural Experience Center Opens In Guangdong China
Wētā Workshop Designed TCM Cultural Experience Center Opens In Guangdong China

Scoop

time6 days ago

  • Scoop

Wētā Workshop Designed TCM Cultural Experience Center Opens In Guangdong China

From the lotus petal-shaped building to the larger-than-life hyper-realistic figures, magical forests, and a futuristic herbal laboratory — these are just some of the aspects of the new TCM Cultural Experience Center designed by Richard Taylor and his team at Wētā Workshop, working in close collaboration with Wellington and China-based creative practitioners and companies. This unique and striking center opened on Saturday 19 July at the Guangdong-Macao Traditional Chinese Medicine Science and Technology Industrial Park, China. The Guangdong-Macao Traditional Chinese Medicine Science and Technology Industrial Park features a mix of facilities, including offices, R&D centres, hotels, retail streets, an experience centre, pharmaceutical plants, testing and extraction centres, and staff apartments. As a core part of the park, the five-storey TCM Cultural Experience Center, with a floor area of 36,000 square metres, is the flagship of its health sector and a powerful symbol of cultural integration in the Greater Bay Area. This new TCM Cultural Experience Center offers a fully immersive experience that brings the culture of traditional Chinese medicine to life, guiding visitors on a journey from its mythological origins to the advancements in modern practices, and on into thefuture. This natural approach to medicine is a critically important part of Chinese wellbeing, and the TCM Cultural Experience Center aims to inspire future generations to learn about this important cultural practice. Taylor, alongside creative collaborator Sam Gao, worked over seven years to realise the project in close collaboration with client Hengxin Shambala. Wētā Workshop's Co-founder and Chief Creative Officer, Richard Taylor, says, 'For me it was critical to approach the subject with a deep sense of commitment, and to learn all that I could of the mythology, history, science, and culture of this fascinating subject. By exploring the use of herbal medicine over centuries of Chinese wellbeing, a complex and intriguing story begins to unfold.' The TCM Cultural Experience Center is Wētā Workshop's largest project to date, and their second large-scale immersive experience project in China, following the completion of their award-winning work on Aura: The Forest at the Edge of the Sky at the duty-free shopping mall in Haikou, on Hainan Island in 2022. The TCM Cultural Experience Center is especially significant for Taylor and the team at Wētā Workshop, not only due to the size and scale of the project, but the extent to which the team researched and designed the experience, from the uniquely designed building itself, through to the cultural narratives within its spaces. Taylor adds, 'As I have spent close to three decades working in China, it came as an extraordinary treat to work so comprehensively on something as monumental as this experience. What started as a white board drawing in my office now stands as a magnificent structure containing an utterly unique cultural exhibition.' 'This was a very special project that is testament to the tight collaboration and creative exchange between two teams — one in New Zealand, and one in China — united by the collective endeavour of creating the world's most unique TCM Cultural Experience Center,' Taylor adds. 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Taylor adds, 'This project is the cumulation of a near three-decade long relationship that I have had with China, and celebrates the strong creative exchange we have established with friends and colleagues in both countries.' The TCM Cultural Experience Center adds to Wētā Workshop's growing portfolio of immersive experiences work globally, with significant projects in New Zealand, China and the Middle East. About Wētā Workshop Wētā Workshop brings imaginary worlds to life by delivering concept design, physical effects, collectibles, immersive visitor experiences, creative media and digital games to the world's entertainment and creative industries. Established by Richard Taylor and Tania Rodger in 1987, they are best known for their screen work on The Lord of the Rings and Hobbit trilogies, the Avatar films, District 9 and Dune to name a few. Their work in immersive visitor experiences, such as Gallipoli: The Scale of our War, Expo 2020 Dubai's Mobility Pavilion, Aura: Forest at the Edge of the Sky and Wētā Workshop Unleashed. Based in Wellington, New Zealand, Wētā Workshop's ground-breaking work has earned them multiple international awards including five Oscars and three THEA awards. About the TCM Cultural Experience Center The TCM Cultural Experience Center is the world's first large-scale TCM-focused experience that offers an immersive journey through an informative and visually unique experience. Designed by Richard Taylor, creative director, five-time Academy Award winner and co-founder of Wētā Workshop, the centre delivers a fantastical experience that celebrates in the culture, mythology, science and history of traditional Chinese medicine.

Labour ponders free tests as Government struggles with slow path to cervical cancer elimination
Labour ponders free tests as Government struggles with slow path to cervical cancer elimination

NZ Herald

time16-07-2025

  • NZ Herald

Labour ponders free tests as Government struggles with slow path to cervical cancer elimination

A report, obtained by the Herald under the Official Information Act, noted that screening rates had fallen across the board during the pandemic, with the national rate of people up-to-date with their screening falling from 71.2% in October 2019 to 67.4% in October 2023. Slowly, screening rates have climbed, including among Māori, Pacific and Asian women, whose screening rates have tended to be below the national average. Rates of screening for Māori women only exceeded 2019 levels earlier this year. The report said that recovering screening rates were largely the result of new HPV self-tests. Of the 450,000 HPV primary screens completed between the rollout of HPV primary screening in September 2023 and October 2024, 81% were self-tests, the report said. Every three years, the Health Minister must appoint a Parliamentary Review Committee (which despite the name, does not include MPs) to review the National Cervical Screening Programme (NCSP). The figures in this story were included in a briefing Brown received in October on the progress Health New Zealand Te Whatu Ora was making towards the 31 recommendations made by the 2021-2023 committee. The briefing warned that the recommendations were 'highly ambitious and unfunded' and made during a time of 'tight fiscal settings'. Officials produced a traffic-light chart of all 31 recommendations, charting which ones were tracking to plan and which were not, rating them green to red for their deliverability. One recommendation that had been 'orange – paused' was 'considering options for the development of an elimination strategy' for the cancer. Brown said this had been started again. 'The Ministry of Health is leading the development of a cervical cancer elimination plan in partnership with the Cancer Control Agency,' he said. The only recommendation to be given a 'red – critical' rating was the recommendation to roll out free screening to all populations. 'Funding has not yet been secured for all population to receive free cervical screening in NZ,' the paper said. In 2023, the then Labour Government rolled out a new HPV test which could be self-administered. HPV causes over 95% of cervical cancers. This was accompanied by $7.3m to pay for free tests for some populations. The ability to self-test is meant to appeal to people who felt uncomfortable with the likes of a smear test, which are administered by someone else. Verrall said the cervical cancer screening programme was 'the only national screening programme where people are expected to pay for access'. 'Women might well ask, if I'm screening myself now, why do I have to pay?' she said. While some providers offered the service for free, others did not and required a co-payment or similar charge. Verrall said the test can be delivered in a diverse range of settings, allowing eligibility for free tests to be widened further. 'People who have the lowest participation and screening are those who sometimes struggle to pay,' she said.

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