From Name
Leach, Joseph W. (M.D.)

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While it's not definitive, presence of a mutation of the epidermal growth factor receptor at exon 19 or 21 is very suggestive of a non-smoking etiology.  Mutations are present in over 50% of never-smokers
but only around 5% of smokers. 
 
http://www.ncbi.nlm.nih.gov/pubmed/16505411
 
http://www.asco.org/portal/site/ASCO/menuitem.34d60f5624ba07fd506fe310ee37a01d/?abstractID=31355&am…
 
This suggests a different biology and perhaps different pathogenesis of histologically similar but genotypically different cancers.  I think it begs the question of whether smokers with an EGFR mutation
actually acquired their cancer through a different pathway than tobacco use.  I've never seen a study looking at this subset of patients and possible radon exposure but it would sure be an interesting thought.
 
Joe
 
Joseph Leach, MD
Medical Director, Oncology Research
Park Nicollet Institute
Phone: 952-993-3248
Fax: 952-993-5235
From: International Web Resource for Radon Professionals [mailto:RADONPROFESSIONALS@LIST.UIOWA.EDU]
On Behalf Of Phillip H. Jenkins
Sent: Wednesday, January 07, 2009 3:34 PM
To: RADONPROFESSIONALS@LIST.UIOWA.EDU
Subject: Re: [RADONPROFESSIONALS] Radon studies targeting NEVER-SMOKERS and the Incidence of Lung Cancer from Radon Exposure
Kevin,
Bingo....my point exactly.  Unless someone knew of some way of looking at a specific lung cancer case and definitively proved the cause, in which case I would really be interested in that.  I probably wouldn't understand it....but I'd be interested nonetheless.
Thanks,
Phil
Phillip H. Jenkins, PhD, CHP
Senior Health Physicist
Bowser-Morner, Inc.
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From: Kevin Stewart [mailto:kstewart@LUNGINFO.ORG]
To: RADONPROFESSIONALS@LIST.UIOWA.EDU
Sent: Wed, 07 Jan 2009 16:17:02 -0500
Subject: Re: [RADONPROFESSIONALS] Radon studies targeting NEVER-SMOKERS and the Incidence of Lung Cancer from Radon Exposure
I will defer to the oncologists and the epidemiologists to address most of these questions, but some authoritative information (peer-reviewed journals) accessible
through the webpage at http://en.wikipedia.org/wiki/Lung_cancer shows that non-small cell lung cancer is so much more frequent than small cell carcinoma (see the tables) that it cannot be true that “lung
cancer caused by smoking and second hand smoke is always from ‘small cell cancer’.”  The roughly converse statement, that “small cell carcinoma is almost exclusively associated
with exposure (direct or secondhand) to cigarette smoke” is a different matter.
 
As to Steven Melia’s and Phillip Jenkins’ questions about definitive tests for causative agent, I have always understood, as Joseph Leach points out, that
“there is no way to prove that any particular lung cancer was definitively caused by smoking…” 
If this is true for the number-one cause of lung cancer, I do not see that such certainty would obtain for any other
relatively minor cause of lung cancer, including radon.  We are then left with common sense and probabilities:  If a person who smokes three packs of cigarettes a day for decades develops lung cancer, and has no discernable confounding exposure,
that person’s lung cancer is reasonably attributable to the smoking behavior.  Likewise, if a lifelong never-smoker is exposed for decades at home to radon levels on the order of 1000 pCi/L and develops lung cancer (I am familiar with such a case), that person’s
lung cancer is reasonably attributable to the radon exposure.  Even so, so far as I am aware, there is no “100.0% proof” of causation in either of these cases even though the epidemiological (i.e., population-based) findings can allow us to make reasonable
attribution.
 
Kevin M. Stewart
Director of Environmental Health
American Lung Association of the Mid-Atlantic
 
From: International Web Resource for Radon Professionals [mailto:RADONPROFESSIONALS@LIST.UIOWA.EDU]
On Behalf Of John Shane
Sent: Wednesday, January 07, 2009 3:28 PM
To: RADONPROFESSIONALS@LIST.UIOWA.EDU
Subject: Re: [RADONPROFESSIONALS] Radon studies targeting NEVER-SMOKERS and the Incidence of Lung Cancer from Radon Exposure
 
I do know that lung cancer caused by smoking and second hand smoke is always from "small cell cancer". These cells are smaller than most other lung cells. I do not know how one would recognize radon-affected cancer cells.
 
On Jan 7, 2009, at 12:05 PM, Steve Melia wrote:
Dear Radon professionals,
I delivered a radon presentation to a group of physicians yesterday and several physicians asked for any studies that specifically targeted Never-Smokers
and the incidence of lung cancer from radon.
What studies would any of you suggest that can address this inquiry of Never-smokers and the incidence of lung cancer from radon?
When responding, please “Reply to all”
Sincerely,
Steven M. Melia; MSPH
Wyoming Dept of Health
LEAD/Radon Program Manager
6101 Yellowstone Rd; Qwest #510
Cheyenne, WY 82002
307-777-6015
steve.melia@health.wyo.gov
 
 
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