Donna Summer, Lung Cancer, and the Fact That Nonsmokers Can Get It Too

What her family confirmed

Donna Summer, the singer known as the "Queen of Disco," died on May 17, 2012, at age 63. CNN reported that a representative for the family said she was not a smoker, and that her cancer was not related to smoking. The family issued that statement because early reports about the cause of her death were not accurate.

Nothing else about her medical care was made public, and this page will not guess at it. Her family's correction is worth repeating for one reason: it points at a fact that a lot of people still miss.

Lung cancer without a smoking history

The National Cancer Institute (NCI) reports that about 10% to 20% of lung cancers occur in never smokers in countries where smoking is common. The established causes in that group include radon, secondhand smoke, asbestos, radiation, and indoor smoke from burning coal or wood.

Radon is a gas you cannot see or smell that seeps out of soil and rock and can build up inside a house. NCI states that indoor radon exposure raises both lung cancer cases and lung cancer deaths. Secondhand smoke raises risk by about 20% compared with nonsmokers who are not exposed. Outdoor air pollution counts too. People in the highest exposure category carry roughly 40% more risk than those in the lowest.

Radon is the one most households can act on directly, because test kits are cheap and a high reading can usually be fixed with a vent fan and piping.

Two diseases under one name

Doctors split lung cancer into two families, and that split drives almost everything that follows.

Non-small cell lung cancer (NSCLC) accounts for most cases. NCI's clinical summary divides it into adenocarcinoma (about 40%), squamous cell carcinoma (about 25%), and large cell carcinoma (about 10%). Adenocarcinoma starts in gland cells and often grows in the outer part of the lung, while squamous cell carcinoma starts in the flat cells lining the airways and is tied more strongly to smoking than the other kinds.

Small cell lung cancer is the second family, and because it grows and spreads faster it is treated on an entirely different plan.

What it feels like

Symptoms usually show up late. MedlinePlus lists a cough that will not go away or keeps getting worse, chest pain, coughing up blood, shortness of breath, wheezing, hoarseness, trouble swallowing, loss of appetite, unexplained weight loss, and fatigue.

NCI adds that some warning signs come from spread rather than from the lung itself, so bone pain can mean the cancer has reached the skeleton, and new headaches, seizures, or weakness on one side of the body can mean it has reached the brain.

Get checked if this is you

Call a clinician, and use the word "lung," if you have:

• A new cough lasting more than three weeks, or an old cough that has clearly changed
• Any blood in what you cough up, even once, even a streak
• Chest pain that gets worse with a deep breath or a cough
• Hoarseness for more than three weeks with no cold to explain it
• Shortness of breath doing something you used to do easily
• Weight loss of more than 10 pounds that you did not intend

None of these prove cancer, but every one of them is worth a chest image, so ask outright whether a chest CT scan makes sense in your situation.

How the diagnosis gets made

NCI describes the usual sequence, which starts with your history, a physical exam, blood work, a chest x-ray, and a CT scan with contrast dye. A biopsy, meaning a small piece of tissue removed for study, is what confirms the diagnosis. A pathologist reads that tissue to decide between NSCLC and small cell disease, because the answer changes everything downstream.

Staging comes next. A PET scan hunts for cancer in the lymph nodes of the mid-chest and elsewhere in the body. Brain imaging by CT or MRI looks for spread that no exam could detect. NCI notes this turns up hidden brain disease in roughly 11% of stage III cases.

The tumor's genes

For NSCLC, the tumor itself is now tested for gene faults as a matter of routine, and NCI lists EGFR, ALK, ROS1, BRAF, RET, MET, HER2, NTRK, and KRAS among the targets. Each of those names a specific fault that a specific drug may be able to block.

This matters most for never smokers. NCI reports EGFR faults in 52% of never smokers with this cancer, compared with 6% of current smokers. ALK fusions, meaning two separate genes joined into one, turn up in 3% to 7% of cases overall. Tumors are also tested for PD-L1, a protein that helps predict how well immunotherapy will work.

If this is your family's situation, ask whether full molecular testing was completed and what it showed.

Treatment, by stage

NCI groups treatment this way. Stage I and stage II disease is treated with surgery to remove the tumor, with chemotherapy after surgery for stage II. Stage III usually means chemotherapy and radiation given together, although selected cases can still be operated on. Stage IV is treated with drugs, including chemotherapy, targeted drugs matched to the tumor's gene faults, and immunotherapy, with radiation used to control symptoms.

What the group numbers show

SEER, the federal cancer surveillance program, puts five-year relative survival for lung and bronchus cancer at 29.5% overall, counting people diagnosed between 2016 and 2022. By stage at diagnosis it runs 65.5% for localized disease, 38.2% for regional disease, and 10.5% for distant disease.

Stage at diagnosis is why those gaps look so wide. Only 24% of cases are caught while the cancer is still localized, and fully 51% are found after it has already spread far. Those figures are group averages across an entire country, and they cannot tell any single person what will happen to them.

Who screening is for

Screening uses a low-dose CT scan. The National Lung Screening Trial enrolled people aged 55 to 74 with at least 30 pack-years of smoking who either still smoked or had quit within the past 15 years. It cut lung cancer deaths by about 20% compared with chest x-ray. The European NELSON trial found a similar reduction of about 24%.

The harms are real, and NCI reports a false-positive rate of 24% at the first scanning round. There is also no screening test proven to help people with no smoking history at all, which is exactly why paying attention to symptoms matters so much for that group.

Sources

• https://www.cancer.gov/types/lung/hp/non-small-cell-lung-treatment-pdq
• https://www.cancer.gov/types/lung/hp/lung-prevention-pdq
• https://www.cancer.gov/types/lung/hp/lung-screening-pdq
• https://seer.cancer.gov/statfacts/html/lungb.html
• https://medlineplus.gov/lungcancer.html