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Lung cancer in never-smokers: a hidden disease (2019) (sagepub.com)
140 points by YeGoblynQueenne 12 days ago | hide | past | favorite | 169 comments

This is me. I'm 34 years old and was diagnosed with stage 3B non-small cell lunge cancer in February- a 3cm adenocarcinoma in my right lung as well as metastases in some lymph nodes. When they tested me they found my cancer to have an ALK+ biomarker which is frequently found in young, non-smokers. Luck of the draw I guess.

Sorry to hear. I don't know much about cancer, but that sounds scary to say the least.

What was your pathway to diagnosis? Was it picked up in a routine checkup, or did you feel symptoms that convinced you to see a doctor?

I had a dry cough for about 3 months that only seemed to crop up in the evenings. I didn't think much about it as I have quite a few allergies and chalked it up to that. I decided to visit the doctor when I started getting some chest tightness when I was going to sleep and I was also getting what I can only describe as hot flashes just as I was falling asleep. It felt like just as I was about to fall asleep I'd get an adrenaline shot and I'd spring back up wide awake.

My PCP did a clean EKG which showed nothing, then it showed up on X-Rays. I immediately got PET scans which showed 2 masses. I then had a bronchoscopy to ensure it was malignant where they noticed additional lymph nodes. I then had a mediastinoscopy showing spread in 3 clusters of chest lymph nodes. I went through 6 weeks of chemo and radiation that resulted in a 25% reduction in the primary tumor and no change in the metastases in a hilar lymph node. I'm now scheduled for a bi-lobectomty to remove my superior and middle lobe on the right side, as well as however many lymph nodes they can get a hold of (check out "da vinci thoracic surgery" to see the robot beast the surgeon will be using).

I have almost no symptoms outside of a slight cough and still run 1-2 miles per day.

I've generally been a grin-and-bear-it guy when it comes to my health. Please suck up your pride and stay on top of your health.

I was diagnosed with "Thymus Carcinoma", pretty similar story as yours. Had chemo, surgery and radiation. Doctors also did "hot chemo" during the surgery. With the grace of Jesus I am alive today.

It was a tough few months, but because of my trying times I think I got stronger in my faith and I would say it was worth it. It's a good feeling to live life knowing that God is by you, makes one more empathetic and puts value back on the important things like family.

Everyone has their own journey, I just want to encourage you :)

Thank you for sharing this extremely detailed experience. I could definitely see your comment helping to save some stranger's life when they google something like "adrenaline shot before sleep chest tightness."

Best of luck with your impending encounter with the da Vinci bot and life after cancer.

You’re an awesome human. I’m in awe of your composure and wish I could do the same if it ever happened to me.

The "adrenaline shot" you describe -may- be normal. It's called a [hypnic jerk](https://en.wikipedia.org/wiki/Hypnic_jerk).

That sounds a lot like it. Maybe the cancer triggered it or maybe I just lucked out with an unrelated symptom prompting me to visit a doctor.

Thank you for sharing your story, that pathway sounds scary to say the least. I am absolutely impressed how well you seem to take it.

I which you the best of luck and a long life after your encounter with that incredibly scary yet fascinating robot!

I'm sorry to hear that. You might want to look into high dose IV Vitamin C injections for solid tumors (which have the oppposite effect of oral Vitamin C).

High-dose vitamin C enhances cancer immunotherapy https://stm.sciencemag.org/content/12/532/eaay8707

Scroll down to cancer treatment: https://ods.od.nih.gov/factsheets/VitaminC-HealthProfessiona...

I was about to downvote but that first study actually looks legit. Still a mouse model, but maybe worth looking into further.

My understanding is that Linus Pauling and others had incredibly promising human trials, but attempts to replicate always seem to alter one 'minor' detail or another like adding glutathione (an anti-oxidant) or giving high dose vitamin C orally instead of intravenously. This is before they knew that Vitamin C is pro-oxidant when deliver at high dose in the blood. You want anti-oxidants to prevent cancer but once you have cancer you want oxidants. Like you want bullets.

What the mouse model suggests is that you need an immune system in the first place to get the benefits of high dose IV vitamin C (HDIVC), since the mice lacking an adaptive immune system didn't get the effect. It's unclear how exposure to different amounts of chemo, which messes with the immune system, disrupts the effectiveness of HDIVC. i.e should it be tried first, or in what combination?

Interesting that patients who already had high vit C / good immune system in their body did not see a significant or relevant change.


"During the 1970s, studies by ... Pauling suggested that high-dose vitamin C has beneficial effects on quality of life and survival time in patients with terminal cancer. However, some subsequent studies—including a randomized, double-blind, placebo-controlled clinical trial ... did not support these findings. ...patients with advanced colorectal cancer who received 10 g/day vitamin C fared no better than those receiving a placebo. The authors of a 2003 review assessing the effects of vitamin C in patients with advanced cancer concluded that vitamin C confers no significant mortality benefit."

Definitely not the craziest think I've heard (vitamin B17 is). I'll check it out.

My sister (age 67) was diagnosed with exactly this a year ago, except she's stage 4. She's on Alecensa (alectinib) and is doing well, all things considered. Her left lung doesn't work very well, but she's dealing with it. Her cancer isn't localized, so surgery isn't an option. She did have radiation therapy on one tumor.

Alecensa is freaking expensive. Even with Medicare, it's costing her about $10,000 a year in deductibles and copays.

I wish you all the best for your treatments.

That's actually better than I heard. Since ALK is more generally rare biomarker (as opposed to EGFR) more of the drugs are still in trial. I asked an oncologist friend about costs and she said $11,000/month.

The raw cost of Alecensa is around $18,000/month, if I recall correctly. Medicare covers all but $800 of that, once the copays are spent.

That's the cancer my dad has - non-smoker, just a surprise stage 4. He's had great success with a few different inhibitors over the years.

His doctor's approach has been using them to reduce the cancer to near-zero, and then radiation (and in future, chemo) to knock down any stray masses that get a foothold.

I'm very sorry to hear that. It is my understanding that there are several ALK tyrosine kinase inhibitors that have specific approval for use in your condition (crizotinib, ceritinib, alectinib, and brigatinib) and I do hope you get the best care you can possibly get and fight the good fight.

That is correct. Unfortunately the TKIs are more for slowing/stopping spread temporarily until the cancer no longer responds - then on to the next one. My doctors were going for curative so I've been going the more traditional route and those will likely be tagged on post-surgery in an effort to keep anything missed in check. Also ALK+ is non-responsive to immunotherapy which would have been nice weapon to have in the arsenal as a cleanup crew.

It may be a pipe dream, but I'm hoping to hold on long enough that some of these new mRNA approaches start offering clinical trials I might be able jump in on.

If you haven't, ask your doctors where it might to spread to, and carefully monitor changes in those areas.

I have experienced three cases in my close relationships where spreading was not picked up for a long time due to being in different body parts.

In one of the cases asthma medication and physiotherapy was prescribed for a year before an unrelated shoulder x-ray caught the attention of the radiologist, and further images showed the cancer had spread to lungs and spine...

I hadn't considered that. Thank you, I'll bounce that off them.

> It may be a pipe dream, but I'm hoping to hold on long enough that some of these new mRNA approaches start offering clinical trials I might be able jump in on.

According to Vince DeVita (ex head of NCI) it was the way they did things in the early days. Make people survive until something new came up.

Hopefully with the advances in medical research things will accelerate.

Best wishes

I am very glad to hear that you are getting neoadjuvant chemotherapy. I really do hope the resection is complete, and the chemotherapy works.

Regarding "holding on long enough" -- something that there has been shoddy but interesting evidence for over a number of years in dragging yourself further to the right of a Kaplan-Meier plot is dietary modification. As you probably know, one of the hallmarks of cancer is metabolic dysregulation [1] -- specifically a shift towards "anaerobic" glycolysis, that is, the increased uptake of glucose and an increase in the proportion of which ends up as its ultimate metabolic fate as lactate rather than entering the TCA cycle as pyruvate and being oxidised. Some thing that has been explored in the past is providing the organism with ketones as a primary fuel source (which enter the TCA cycle directly as either beta-hydroxybutyrate or acetoacetate) and do not get transported through the glut glucose transporters: in non-cancerous cells with some degree metabolic flexibility there is significant scope for generating other needed metabolites from the TCA cycle and a series of beautiful pathways to let that process happen. As a result, there are a series of papers that indicate that a purely ketone-based diet (exogeneous or endogenous) may be associated with an increase in life expectancy [2, 3, 4; or google scholar GS1] as -- the narrative goes -- cancer cells can't utilise the alternative fuel source as effectively. In mice, with a well controlled tumour xenograft, this has shown to extend survival, fairly significantly.

However, take this with a large grain of salt: there is some evidence that ketone utilisation might be associated with "stemmness" and baddness in general [5, 6] which (and herein starts a "I am hypothesising" warning) may be due to a selection pressure for metabolic flexibility and the return to a more fetal phenotype. The diets are also very difficult to adhere to in patients. These diets are just starting to be assessed properly, in people, in RCTs (e.g. [7]), but I can't find any evidence of a trial in lung cancer patients without a background of smoking specifically.

The most recent major review on the topic I can easily find [8] does seem to hint quite strongly that it might be worth considering, and there is some evidence that it potentiates tumours to other chemotherapies. If I were in your unfortunate position, I would personally discuss the concept with the oncologist in charge of my care – the basic idea "makes sense" to me, at least.

---- [1] https://www.sciencedirect.com/science/article/pii/S009286741... or https://sci-hub.st/https://www.sciencedirect.com/science/art...

[2] https://onlinelibrary.wiley.com/doi/abs/10.1002/ijc.28809 or https://sci-hub.st/https://onlinelibrary.wiley.com/doi/pdfdi...

[3] https://nutritionandmetabolism.biomedcentral.com/articles/10... or https://sci-hub.st/10.1186/1743-7075-4-5

[GS1] https://scholar.google.co.uk/scholar?hl=da&as_sdt=0%2C5&q=ke...

[4] https://link.springer.com/article/10.1007/s12032-017-0930-5 or https://sci-hub.st/https://link.springer.com/article/10.1007...

[5] https://www.tandfonline.com/doi/abs/10.4161/cc.10.8.15330 or https://sci-hub.st/10.4161/cc.10.8.15330

[6] https://www.tandfonline.com/doi/abs/10.4161/cc.9.17.12731 or https://sci-hub.st/10.4161/cc.9.17.12731

[7] https://www.mdpi.com/2072-6643/10/9/1187

[8] https://www.sciencedirect.com/science/article/pii/S221287781...

I have been turned off by how the approach is to treat me and I'm primarily a passenger for this ride. In response, I did the same research you did and came across the same stuff. During the chemo/radiation I was on a strict ketogenic diet with a less strict intermittent fasting schedule. Post-surgery I'm going to go the full 9 yards and extend to 7-day fasting once a month after hearing this anecdotal story:

https://www.saronarameka.com/ https://www.frontiersin.org/articles/10.3389/fonc.2020.00578...

If you are looking for recipes or a second opinion relating to food, my girlfriend (who used to work as an neuro-immunologist doing cancer research) now does keto coaching and also has a ton of recipes online.


Thank you. This is exactly the stuff I'm looking for as a newbie to keto.

"Cancer as a metabolic disease" seems to be getting popular, but traditional oncologists are very suspicious of those approaches. Cases like Steve Jobs gave them a bad reputation, but they should be considered as an addition to traditional therapy, rather than a replacement. It is also harder to design and fund such a study - e.g. dietary changes or repurposed medicine like Metformin may not work accross different cancer types or even different geographies, based on local dietary patterns - especially if expecting the same effects in America, Europe and Asia. Someone has to pay for a study, and it's easier to find funding for $10,000 per month therapy rather than a dietary change or a generic diabetes drug.

https://www.amazon.com/How-Starve-Cancer-Jane-McLelland/dp/0... seems to be recommended as an introduction, but I still didn't finish it.

"Cancer as a metabolic disease" has been known since the 1920s when Otto Warburg discovered that shift towards "aerobic glycolysis"; that is, glycolysis even in presence of adequate oxygen for fatty acid oxidation. It's the basis of some treatment and medical imaging approaches – e.g. 18-FDG PET images the extra uptake of glucose caused by cancers' voracious thirst for glucose.

I agree that interest in diet is an increasing vogue – and I would never recommend replacing a medical therapy with dietary modification, but some of the citations I linked to above indicated that it may potentiate the effect of some other chemotherapies, particularly those that themselves have a metabolic effect. I agree with you about the difficulty in funding such trials, and the difficulty in both monitoring patient compliance with them and obtaining a robust and reproducible readout of their effects. Cancer is a heterogenous disease of life, and its response to therapy is too.

My mother is on Osimertinib for Adenocarcinoma with EGFR Exon 19del mutation. Oncologist only recommended Osimertinib without any additions. Oncologist won't recommend anything that hasn't been confirmed by Phase 3 study. Phase 3 studies in oncology seem to be rare for treatments you can't make money on like $10K per month Osimertinib therapy. There are many things that have been shown effective alongside EGFR TKI inhibitors with minimal side effects based on smaller studies, cell models, retrospective data analyses etc.

So far we added Metformin [1][2] (not as diabetic drug), Aspirin[3], Vitamin D, low glycemic index, no red meat, mediterranean diet, freshly made juices from vegetables and fruits with anti-angiogenic or confirmed anti-cancer properties (e.g. kale, brocolli, apples, carrots, celery, turmeric, red grapes, berries). Metformin has been confirmed with an endocrinologist.

One issue with things like Keto is that it is too extreme to convince a regular 50+ years old person to consider such approaches. And frankly, neither of us has medical training, so we are afraid of trying too-unconventional approaches. Some other medications or supplements I heard recommended, but we didn't decide to include yet are reservatol, simvastatin, altrexone, doxycycline, boswellia, quercetin, keto, intermittent fasting.

1. https://jamanetwork.com/journals/jamaoncology/article-abstra...

2. https://www.frontiersin.org/articles/10.3389/fonc.2020.01605...

3. https://www.lungcancerjournal.info/article/S0169-5002(20)305...

What level of air pollution exposure do you have? Have you monitored your indoor air quality with a PM2.5 device, or used an air purifier? Do you live near a busy road, or a coal plant?

Good luck for your treatment and recovery.

I live in Denver. I have not done any testing but moved into this house June 2019. Our inspection found the radon levels to be 3.9 pCi/L (4.0 is the recommended actionable cut-off). I recently installed a radon abatement system as we're refinishing the basement. Wish I knew for sure.

Holy shit, my best to you.

My great grand mother died from lung cancer and never smoked one cigarette in her life. She was a humble and very sober woman. (no alcohol, no tobacco or drugs, just her medication). The reason, why she died of lung cancer is, that the area, where she grow up, was near coal mine & chemistry plant. LVL 89 tho, nice age anyways. RIP Grandma. On the other hand, my neighbor from the rural area, where my mother was born & raised, lived all the way up to LVL 93. He had one shot of hard liquor every day and smoked exactly 3 cigarettes a day. His calm live and routines granted him a superior lifespan. He died from age, calmly in the bed, with relative good health for his level.

> His calm live and routines granted him a superior lifespan.

That's just conjecture on your part. Some people are lucky, others are not, it's not always due to behavior. 3 cigarettes a day is also extremely low - the average is apparently 14[1] right now.

[1] https://www.cdc.gov/media/releases/2018/p0118-smoking-rates-...

It’s low but the risk of smoking one a day isn’t 1/10 of smoking 10 a day, it’s probably much higher.


When I was young, I figgured what would be the big deal smoking a few cigarettes per day. By the time I was 25 I realized that two packs per day was getting out of control.

I don't believe there is any harmful information but the whole picture is that most folks cannot smoke a few per day. Eventually cigarettes will own most smokers.

You probably have to differentiate risk. I assume for some risks associated with smoking there is a linear correlation with exposure, where it's on/off for others, or e.g. following a logarithmic function.

Nicotine, CO and radioactive toxicity have a long half-life, where primary radical damage or reactive carcinogen burden is dose dependent stochastics.

Also people forget, you are much, much more likely to die from cardio-vascular damage or COPD as a consequence of smoking, than lung cancer.

> 3 cigarettes a day is also extremely low

The addictive nature of cigarettes makes it very hard to stick to 3 a day.

I remember that when I was 18 I wanted to become a smoker, but I never could because I don't do anything consistently.

> His calm live and routines granted him a superior lifespan.

My mean, spiteful and horrendous grandmother in law was nothing but pure bile and hatred. Every day she lived her life in perpetual outrage and never had a moment's peace.

She lived to 96.

She probably outsourced the hate and outrage to those around her, inwards she was 100% peace.

This is known as projective identification.

Yep. My wife's grandma is probably the most evil human being I've ever met in person, and she's very healthy now at 88.

Those two things are correlated, in fact. I can't get the citation now, but it's in the literature.

Those people may actually be able to offload stress, anxiety and worries...

I fear most evil folks sleep well at night.

That's my theory too. Mean people cause stress to others and send them to early graves. They themselves live free of illness causing stresses.

Karma is something people invented for some temporary solace.

> was near coal mine

In Europe, coal typically kills more than 20,000 people _every year_: https://www.theguardian.com/environment/2013/jun/12/european...

[ And yet Germany and Belgium decided to end nuclear energy because people are afraid of the "risks", but keep coal plants. ]

> Belgium

Belgium doesn't have coal plants.

Belgium's nuclear plants are/were scheduled to close because they've surpassed their initial lifespan. An extension was added but that has almost been surpassed as well. These are plants which have been in operation for 40-50 years.

Replacements aren't being build because they are "unsafe". They aren't being build because it's economically not viable to do so in a country like Belgium. Not at this moment in time, not in the past 20 to 30 years.

Belgium's major energy operators are also largely controlled by French energy conglomerates such as ENGIE.

At least for Germany this isn't true, both nuclear and coal are phased out with about the same end date.

it doesn't work quite like that, though; while nuclear is down to ~13%, a quarter of the german energy sector is still burning coal. in fact, the plan to shut down fossil fuels was hindered by (imo) the short-sighted view to curtail nuclear before it was necessary.

Coal is down from 45% in 2013 to 23% in 2020. https://en.wikipedia.org/wiki/Energy_in_Germany

During the same time, nuclear is down from 17% to 13%. https://energy-charts.info/charts/energy_pie/chart.htm?l=en&...

Still too little too late in my opinion, but one has a hard time arguing that nuclear plays a role here at all.

the point i was making was less that this speedup of nuclear draw down was problematic so much as the whole viewpoint that ending advancement of nuclear power as a whole. germany limiting the lifespan and new construction of nuclear power dates back to the early 2000s, fukushima just reset the timelines back to the original 2022 closing dates.

I find it quite amusing that Germany seems to be very anti-nuclear as a culture, yet they are right next door to France which has plenty of Nuclear power plants.

And many Germans absolutely loathe the French reactors. Especially because France loved to place many of them directly at the border to Germany. There were several news pieces over the past century where the condition of some of those reactors was questioned.

> condition of some of those reactors was questioned

The nuclear security agency in France is one of the toughest in the world, and is independent. They notably demand "current" state-of-the art security for all nuclear plants (vs. state-of-the-art at the time of building in the US, typically)

French nuclear plants typically never killed anyone (and will never), unlike German coal plants (which are at least partially responsible for the 22,000 coal-related premature deaths every year)

Nuclear energy is a very emotionally polluted debate (no pun intended), but facts tend to shows that this is the cleanest and safest energy.

Every country does that because there's a big circle around power plants that is in danger if something goes wrong. So as much as possible of that area preferably either be the sea or someone elses territory.

FTR Fessenheim has been shut down in 2020. As for Cattenom, it's still operating.

>both nuclear and coal are phased out with about the same end date [in Germany].

The future is uncertain, and I hope the German people don't suffer shortages of electricity as a result of these phase-outs.

Why would you not prioritize ending coal first??

Because Fukushima provided a once-in-a-lifetime opportunity for politicians to go against the local energy giants without them being able to gain the upper hand in the inevitable fight about the narrative in the local media. This is all power politics.

We're not keeping coal in Belgium. The last coal mine in Belgium closed in 1992, the last coal power plant closed in 2016.

Yup, actually the Belgian government plans to close all nuclear plants real soon now, and replace them all with imported gas. This is beyond stupid on so many levels.

Would that be Russian gas they can then use as a bargaining chip?

Who knows. They plan to shut them off so quickly it may not even be possible to build the necessary gas plants (of course they promised to replace them "mostly" with solar and wind, which is a complete joke and would require at least a decade of building at full speed, not a mere couple of years).

Germany and Belgium have cultural hangups about nuclear that relate to the fact most Germans (and probably also Belgians) felt they'd be the first to die if there was a nuclear war. Not that this excuses them from being reasonable, of course, but it is worth keeping in mind just how occupied by the threat of nuclear annihilation many people in those countries were, and for how long.

I’m a fan of nuclear, and I suspect you’re right. The reasons people say they oppose even existing nuclear (cost, waste, safety) don’t usually pass scrutiny. I suspect it is primarily due to their association with nuclear weapons. It instills a pretty deep fear, which I don’t entirely blame them for. ...however it has pretty terrible health, environmental, and economic consequences to prioritize nuclear phase out over fossil fuels (especially coal).

The reason I'm against nuclear power is the human greed factor. See my past comment for more details and sources:


I find none of this convincing. Industrial accidents happen with all thermal power plant types. And coal ash disposal has a worse track record than nuclear waste. (Coal ash being naturally radioactive!) And the aerosols produced from coal transport and burning are a continual problem of lung cancer.

Nuclear is remarkably well-regulated by comparison. I understand why people may want to get rid of it eventually, but compared to coal, it's sunshine and rainbows.

we are having way to ensure beter compliance. may be we need for to make nuclear executive responsible with jail time if requirements broken. certainly nuclear safety has more importance than sox compliance.

Until the ones who gain profit from nuclear power would also pay for an insurance that covers for the worst possible accident, I think you will have a hard time to argue for nuclear energy.

I grew up in WV. I have many friends from near the DuPont plant. We like to joke about how we grew up drinking dupont water...kind of morbid though since it's pretty true.


Level. Like in a video game. Don’t you think of the lifespans of your friends in family and terms of video game levels?

No. Leveling up implies some sort of growth or improvement. We all know people where one year older doesn't mean they leveled up.

People are still figuring the rules for the game as it came without any manual:


Level in games doesn't necessarily correlate with skill. People can build their character badly and end up with subpar skills for their level.

In a way life is about maxing skills and avoiding perma-death.

thanks, you feel me.

No offense intended, I just felt your motor memory wrote LVL but you meant age. I apologize.

None taken.

Well, I tried to ascend one or two times, but never did it :-)

Me too... some mysterious synonym for "years"?

I think it means level. I assume the reason to say that is that having a higher level in a video game is considered good, whereas it is common for people to discriminate against people of more age.

Here in Ireland we have a lot of limestone and new houses must have radon barriers in their foundation. People living in older houses without them are susceptible to lung cancer. Growing up my parents always kept our windows open when possible. My grandmother, a non-smoker, died of lung cancer.

My parents house was part of a national radon survey in Ireland back in the 90's I think. I had a small little black monitor/'counter' in my bedroom for maybe a year (I'm a bit fuzzy on the details). Anyway, they sent us the results when the experiment ended and we sent the device back.

The results were quite bad I seem to recall (I may be mis-remembering according to [0]) Our house was in rural Cork and was build by my parents in the 80's.

My father died from lung cancer but he was a heavy smoker; my mother smokes very occasionally and she's fine.

However, my aunt, who lived next door, maintained a very healthy lifestyle and also died of lung cancer; her husband is also fine.

[0] https://www.epa.ie/radiation/radonmap/

It's a good idea to test basement radon levels when buying a new house. In my state, it's a check box on the required paperwork, so every buyer can see it's an option. The tests are cheap and quick. Check with your state for any help with finding testers or paying for the tests and mitigation systems.

Radon levels vary a lot. In Pennsylvania, the worst areas lie along the Appalachians, but even then neighboring houses can have huge differences in radon. So even if your soon-to-be neighbors didn't have a problem, do the test.

Glad someone brought up radon. No one knows about it. Get a HRV or ERV and ideally slab depressurization, Google the terms if unfamiliar folks! Enjoy the diy projects haha

Slab depressurization (essentially creating a partial vacuum under a building's concrete slab floor) can work very well. These days usable radon concentration meters are quite affordable. I used one in a building I own to verify the effectiveness of a slab depressurization system. It reduced measured radiation levels to a small fraction of the baseline. Of course you need a building with a slab foundation to use this technique.

Yeah it’s an amazingly simple approach. I did it in a house i renovated, the building inspected tried to stop me as he wasn’t familiar with the system and thought it would actually allow radon in. Turns out he had a family member die from lung cancer and they believed they was a possible link. I expect at some point it’ll be part of most modern building codes where there is a basement connecting to a living space.

My mom died of lung cancer (actually brain cancer which often is the end result) but never smoked; however her father smoked all his life, and my dad smoked for decades before quitting. We never did figure out where the original cancer came from. End stage lung/brain cancer is a terrible way to go, which is why I have zero idea why anyone smokes at all.

If you don't die from lung cancer you'll die from some other terrible thing. I don't smoke but I can see why, if it gives someone satisfaction and/or relaxation, they would be willing to risk that kind of death in exchange for a lifetime of mental hacks (though there are arguably safer methods of similar efficacy).

The nicotine is what CAUSES the stress in the first place, and you have to relive it by smoking or ingesting the nicotine in another way. So essentially what you have done is raised the baseline stress level and you temporarily lower it when you get your nicotine. Then the stress levels will be ascending proportionally to the nicotine concentration in your blood which is constantly metabolized and descending. Nicotine has a half life of about 1-2 hours, so it doesn't last very long.

Hard to follow this. Do you mean the lack of nicotine causes stress during withdrawal? Of course it does, but that doesn't mean a person can't get a net overall decrease in stress by smoking regularly. I'm not suggesting it of course, but I can understand the personal motivation of someone who does.

The nicotine levels rapidly decrease just minutes after smoking and stress levels are beginning to climb in response until you smoke another cigarette. The cycle repeats and the average stress levels over time than for a non-smoker. If you're addicted you always stress about when you are getting your next dose of nicotine.

What about non-regular smokers? Anecdotally I smoke once a month to once a year (sometimes not cigarettes but vape, hookah, cigars) and feel the stress relief without going into cycles. Even when I was semi-regularly vaping nicotine heavy liquid it wasn't because of _need_ to get the next dose, but the distinct relief.

Unfortunately smoking doesn’t really do that either. I’d say it has close to no benefits from a day to day cognitive perspective anecdotally. I think it’s the same for coffee.

Great for socialising though . Smokers have more fun at parties since you end up chatting to other smokers whilst outside in sub zero weather sucking on your death stick.

And damn do I miss a cig after dinner

I was a smoker for 20 of the 45 I've been alive. Around 1 pack a day.

It was exactly the social aspect of smoking that I liked the most, now that I look back at it.

Smokers have an easier time establishing a bond, when placed in new groups like work or school. They meet up at the designated smoking spot and chat while smoking. It's a great ice breaker.

I found that I had an easier time, when having to do group work, than non-smokers since there was already a loose connection with the other smokers. It was always the non-smokers, who were having difficulty finding group mates.

I now vape on an e-cigarette instead. Still go with the smokers, so I have not lost the social benefits :)

I highly recommend giving e-cigarettes a try, for any of you smokers out there, who are having a difficult time, quitting the habit.

I'm aware that it's in no way healthier, but am convinced that it's less damaging. Anecdotal, yes, but it sure feels like a better alternative. Tried nicotine gum, band-aids etc., but I guess there was more to my addiction than just the nicotine. The rituals of inhaling and fondling with something. It's the only thing that's worked for me.

I got one of those vape things people use for dry weed that gets up to 405F and vape dry rolling tobacco. You can do it inside as it doesn't smell or the smell is pleasant or you can use as an excuse to go hang out with the other smokers too.

You also are only burning tobacco and inhale almost no plant matter. I would give it a try. I feel better with that than with e-cigs.

Correction. Can't edit, but the last paragraph should've been:

"I know that it's in no way HEALTHY*, but..."

What? Who are you responding to? I said it helps one relax and/or gives satisfaction, and then you said "it doesn't do that" (using a personal anecdote as evidence?) but then your last sentence suggests you did actually experience those things you said you didn't? I can't understand what your point was here.

You have more fun in the actual party inside.

Your comment made me smile :)

Man, lung cancer and stomach cancer are two of the worst ways to go...

Not much different than other ways of slowly dying TBH. They're all mostly horrible.

i have knew persons who were dying in peace while sleep. i only am hoping i shall be this fortuneate.

That happened to my grandfather as well. 3 pack a day smoker and died in his sleep at 70.

But I agree otherwise. My wife’s parents both lived into their late 90’s but had lost most of their cognitive ability for the last 5 years - so much they couldn’t live independently. Not sure that’s a great alternative death.

My mother was recently diagnosed with stage 4 lung cancer. Never smoked, no alcohol. For 3 months doctors were diagnosing her coughing as probably covid related, even when tests came negative. Probably a lot more people got late cancer diagnosis due to Covid. And lung cancer deaths are at 150K vs 577K for Covid.

As article says, genetic mutations are much more common among non-smokers. Exon 19 deletion egfr mutation was detected, so she started on Osimertinib that works very well. Sadly Osimertinib will work for a year or two, and then cancer mutates and gains resistance.

What about Radon exposure? Big problem in Canada in certain cities:

"Over 16% of lung cancer deaths are attributed to radon exposure in Canada. It is estimated that more than 21,000 Canadians will die from lung cancer this year, and more than 3,000 of those deaths are because of exposure to radon indoors."

No radon risk in north-eastern Poland according to some Googling. Only risk factors was pneumonia many years ago and maybe a wood fireplace. Wood fireplace seemed properly insulated, chimney was regurarly inspected and no smoke escaped, but who knows.

Just to add a clarification for the rest of HN, since this is a common source of confusion... Every cancer has gene mutations. Typically these mutations are only present in the cancer cells and are not there from birth. They don't indicate a hereditary predisposition to getting cancer.

Really sorry to hear what your family is going through. This kind of stuff is never easy to deal with.

For some reason, non-smoking lung cancer means 2-3x higher chance of finding a mutation that could be used for targeted therapy - e.g. EGFR, ALK, ROS1 and others. It doesn't mean that this mutation was present at birth, but at some point some cells mutated and became cancer cells.

My uncle died of lung cancer in Korea; neither him nor anyone in his family smoked. If culprits were to blame, it's probably his coworkers - Korean men are notorious smokers even today and it was worse when he was of prime working age. (quick Google stats indicate 40% of men smoking vs. 16% in the US as of 2016, and it's obvious many, many men smoke if you just live their and peoplewatch.)

His death is one reason I really hate smoking. In Manhattan it's especially annoying when you have to go past an honor guard of smokers wreathed in a carcinogenic miasma cloud of smoke when you enter or leave office buildings, or if you're walking in a tightly packed crowd and someone ahead of you decides to light one up and cropdust everyone behind with a blessing of cancerous smoke.

You don't think that diesel fumes are a more likely culprit?

I saw this study mentioned which showed negligible risk for passive smoking unless you are actually living with a smoker. https://www.forbes.com/sites/danielfisher/2013/12/12/study-f...

Korean corporate culture is extremely workaholic - even today but especially during his working years (1970s to early 2000s) - he probably spent more time with his coworkers than his family.

Also people likely smoked indoors in the office when he was working. Indoor no smoking bans didn't come until later in his career, and even today I think enforcement is much more lax compared to the US.

From the article he linked.

The study found no statistically significant relationship between lung cancer and exposure to passive smoke, however. Only among women who had lived with a smoker for 30 years or more was there a relationship that the researchers described as "borderline statistical significance." Over at the Velvet Glove, Iron Fist blog, however, journalist Christopher Snowden notes "there's no such thing as borderline statistical significance. It's either significant or it's not," and the reported hazard ratio was not.

> he probably spent more time with his coworkers than his family.

This is so sad. Unless he didn’t like his family.

Various scientists and organizations have been yelling for years that air pollution is one of the leading causes heart disease and cancer. It's not "hidden", it's being ignored...


Radon is the second leading cause of lung cancer

Does the possibility of other causes (like air pollution) also mean that some portion of lung cancer incidents are misattributed to smoking, overstating its dangers by some amount?

Smoking increases your risk of cancer from air pollution, so it's not so simple

Air pollution was a huge issue when I was growing up as a kid, the #1 environmental cause. At some point people stopped talking about it and focused mostly on global warming.

Do you, or anyone around here, use air cleaning devices in your homes ?

I have an air quality monitoring device and I live in a place with clean air, so I just open a window. A PM2.5 of 2.318 (ug/m3) inside my room at the moment.

It's not hard to build a DIY air filter with a box fan. Lots of videos on youtube.

But that just removes the problem into making a fpp / hepa filter

You simply buy them.

Old wood burning stoves are also quite unhealthy, and perhaps even dangerous. My wife won't let me use ours, which is only 20 years old.

The EPA issued new regulations such that all new stoves manufactured after 2020 emit far less smoke and particulate both indoors and out.

The American Lung Association actually runs programs that will pay you to replace your old wood stove, which probably says something about their potential impact on health.

What about barbecues?

All sorts of fires contribute to air pollution and barbecues are not an exception.

The compounding factor with woodstoves is that they are indoors and they are often the primary source of heat for months on end, meaning they they emit smoke and particulates into the air you breathe all day and all night.

Don't forget asbestos, which despite all the hubbub never got banned. It's used in all kinds of stuff and just one or two microfibers of it in your lungs and your fate of a slow painful death is sealed.

> Don't forget asbestos, which despite all the hubbub never got banned.

I was a bit astonished by that claim since I had thought that the entire developed world has banned asbestos usage for decades... turns out that while the US does have bans on certain products, there is no federal ban on the stuff (https://en.wikipedia.org/wiki/Asbestos_and_the_law_(United_S...).

Jesus. WTF?

Asbestos is an almost magical material and if handled carefully (say similar levels that medical workers have to take for covid, surgeries, microbiology, etc) there isn’t much risk. It shouldn’t be in common construction or household materials but i’m not too worried about specialized industrial applications.

No, there is nothing magical about asbestos. There is no application for it that can't be performed just as well by safer synthetic mineral fibers.

The only thing special about asbestos is its extremely low cost.

In a similar vein, Japan only stopped using Asbestos in construction materials in 2005. So anyone buying an old house in Japan is pretty much guaranteed to have Asbestos...

Good luck finding an old house in Japan!

I mean old by the definition of Japan. As in > 30 years old :)

> just one or two microfibers of it in your lungs and your fate of a slow painful death is sealed.

Hell of a claim. Sources?

>The one asbestos disease that is different is mesothelioma. Very small amounts of asbestos can give you mesothelioma. Asbestos workers' families have gotten mesothelioma from the dust the workers brought home on their clothes.



> Necroscopic studies have led to the determination of asbestos fibre load and the demonstration of a dose related effect, thus making improbable the argument that mesothelioma only requires one fibre of asbestos for initiation of the malignancy.

Furthermore, asbestos exposure in urban settings is very common: https://www.atsjournals.org/doi/10.1164/arrd.1980.122.5.669

> We isolated uncoated asbestos fibers from the lungs of 21 urban dwellers who had fewer than 100 asbestos bodies/gram of lung, a level shown previously to be associated with environmental rather than occupational exposure to asbestos

Considering that Mesothelioma can take 30+ years to manifest, that info about exposure being common does _not_ improve my day.

The truth is, it's hard to unravel: especially with 100s of billions of dollars on the line in liability, there is probably some "sugar science" going on - maybe on both sides even.

What I _do_ know is that: 1. It's harmful af (regardless of "how much" the research says, the fact is: harmful af). 2. Everyone thinks it's banned, but it's not. 3. Some people make billions of dollars continuing to use it (enabled by #2) 4. I'm not in the set of people described in #3

I'd like it to be banned.

I certainly agree with all that. It should be banned.

The magic word there is of course can. Although both asbestos and mesothelioma are very nasty, I fail to see evidence for your claim that your faith is sealed.


* In July 1984 the Health and Safety Executive (HSE) published an update to guidance note EH10, Asbestos – Control Limits, measurement of airborne dust concentrations and the assessment of control measures, which introduced a limit value of 0.01 fibre/ml.*

That’s 100 fibers/liter, so at least that with every breath you take.

Because of that, I think that, if that claim is true, it only is if you wouldn’t die of something else first.

The stance of the HSE in 2010 is worth mentioning:

> There is a lack of scientific consensus as to whether there exists a threshold of exposure to asbestos below which a person is at zero risk of developing mesothelioma. However, there is evidence from epidemiological studies of asbestos exposed groups that any threshold for mesothelioma must be at a very low level - and it is fairly widely agreed that if a threshold does exists then it cannot currently be quantified. For practical purposes HSE does not assume that such a threshold exists.


The town of asbestos in Quebec (which they renamed last year because it was too shameful) had one of the largest (the largest?) asbestos mine in the world. It closed in 2011 with plans from the government to inject close to 60 million $ to reopen it... it didn’t go through because the party that promised it lost the elections to the party that promised NOT to do it, but note that the question of whether anyone would still buy asbestos never entered into consideration. So yeah all this asbestos must be going somewhere if it’s still profitable to mine.

AFAIK inhaling in some fibers usually shows an effect after around 20 years. If you breathed in a lot of them (working with asbestos without protection for a long period), then you will most probably start experiencing some breathing problems first of all. Absestosis I think is the correct term ?

Actual cancer would depend on a lot of different additional factors.

Mesothelioma is a particularly nasty form of lung cancer. Asbestosis is dose-related, but mesothelioma is not. Details: https://www.health.state.mn.us/communities/environment/asbes...

stupid warning for the vintage crowd, lots of device had asbestos in the materials (among other toxic substances now banned), be careful

I fervently hope mass adoption of EVs will lead to a marked decrease in cancer, and not just lung. Who knows what oil, antifreeze, additives, and all the chemicals used in processing no longer being emitted on tailpipes, dumped as part of refining byproducts, and the like are no longer placed into the environment.

My friends grandfather died from a lung cancer he got from years of soldering before they introduced the lead free stuff.

lead is terribly toxic stuff, but the lung cancer would most likely be caused by the flux, which you will still find in lead free solder. Which is why You should always ensure good ventilation when soldering.

My father also died last year from lung cancer and never smoked in his life.

Sorry for you to hear that :(

before I can find a nicer source, here are some geographical maps of lung cancer


helps getting an idea of environmental impact

I good reminder to test your home for Radon. Check your local Radon maps, there are hot spots throughout the world that vary locally. Even if maps show low values it is worth testing.

my dad died from lung cancer. He smoked his whole life. His MRI's looked pretty good. So this is interesting. Makes sense. Poison, radiation.

And I suspect these unfortunate individuals are treated with suspicion / lack of respect from the medical and insurance industries.

I grew up in a household where they chain smoked inside. Pretty much just waiting to get cancer at some point.

The article is interesting for what it doesn’t call out. There are people that get lung cancer without a cause - just an unlucky lottery of errors introduced through natural processes.

If I recall correctly, 1/3 to 1/2 of all cancers don’t have a cause. Just bad luck.

> There are people that get lung cancer without a cause

I'd be quite surprised if breathing in microplastics does not contribute to the risk of lung cancer -- and essentially every human being is exposed.

We use plastics in medical implants so it’s unlikely.

I'd assume that the plastic used for medical implants is not endocrine disrupting and carcinogenic -- unlike the microplastics which we breathe in every day. My assumption might be wrong, though: Cigarettes were considered to be good for your health / warding off disease until rather recently, after all.

I wouldn't count on them not being endocrine disruptors or carcinogenic, but they are solid, macroscopic chucks, which limits surface area and thus the amount of diffusion of the nasty chemicals into the rest of the body.

Don’t have a cause or don’t have a known cause? There’s a big difference between random mutation and unknown precipitator.

It's not the cancer caused by moral failure, it's the good kind which is caused by God's plan.


Well considering we already know of inheritable cancers that have no cause other than bad genes, it’s clear a large portion of cancers have no environmental causeZ

Yes, but then are others like our recentish discovery that drinking hot liquids often can cause mouth/throat cancer.

Could microplastics, aerosolized in seawater be playing a role in this? I saw something that most of the non-smoking related lung cancers are in coastal regions

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