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Interviewer: For patients with lung disease, deciding what medical center you'll partner with for a lung transplant is a big decision and there are a lot of factors to take into consideration. But today, we're going to help answer some of those questions you might have.

Dr. Matthew Morrell, he's dedicated his career to ensuring patients who need lung transplants get them and also have the best outcomes possible. He's been at some of the biggest lung transplant centers in the United States, and now he's the medical director of The Lung Transplant Program at University of Utah Health.

Dr. Morrell, thank you for sharing your expertise. And the first question is I learned that sometimes a patient diagnosed with lung failure isn't even told that a lung transplant is an option. That really surprises me. Explain that for me.

Dr. Morrell: Honestly, it's interesting. Not a lot of people or lung doctors in the community even think this is an option. There's a lot of misinformation, miscommunication between providers and patients that are out there. So our goal has really been to reach out to providers, to reach out to doctors, to really educate them about lung transplant as a potential option.

Interviewer: So if a patient has been . . . if that's never been mentioned, or they've been told, "Maybe that's not an option," it might be a good idea to seek out a second opinion.

Dr. Morrell: That's exactly right. So we here at the University of Utah, we're always willing to talk to any patient that has any questions, even those that don't necessarily even have a referral from a lung doctor, their lung doctor isn't in the community. We've seen patients that call up and just want to say, "Hey, I want to speak to somebody that can give me more information about lung transplant," and, "Hey, am I a candidate? What makes a good candidate? What doesn't?"

Interviewer: Yeah. Obviously, you know all those things. You live it every day. Let's say a patient has been told that they are a candidate for a lung transplant, or maybe that's an option they should consider. Based on what you just said, maybe a patient thinks that a transplant would be a good option for them. Does the patient get to pick the medical center where the procedure is done, or is it kind of when I've got a cold, I'm going to go to the nearest InstaCare?

Dr. Morrell: Well, patients, yes, they have the option of choosing where they want to go to get their lung transplant. Insurance sometimes does dictate where they can go, but honestly, if a patient says, "Hey, I want to come to University of Utah," they just talk to the provider, and that provider can make that referral down to us.

Interviewer: So that's great that a patient gets to choose. In a way, that's great, right? But it also comes with a lot of decisions that have to be made, a lot of things that have to be weighed. So what would you say to a patient that's trying to make that decision of choosing a center? What are some of the things they should consider?

Dr. Morrell: Well, honestly, you want to look at the center's history. How long has that center been doing lung transplants? How many patients have they transplanted? How many patients do they transplant a year? Are they doing research in the field of lung transplantation at that institution?

And also, talk to patients that have actually had transplants there. We can give you the names of a couple of patients that have had transplants and you can call them, speak with them, and they can tell you their personal opinion about how that process was for them.

You can speak to a coordinator and get your questions addressed even before even coming to the University of Utah. And when you do come for your initial appointment, it's mostly a meet-and-greet. No pressure. It's just an information gathering. How do you feel? Have you made that bond with that physician? Is that physician someone who you can trust? Is that someone who you want to be your advocate for you going forward as you get evaluated for lung transplant?

Interviewer: One of the challenging things for lung transplantation is you're on that waiting list and you're waiting for that match, that donor match to come. And sometimes, it can just by chance come very quickly, or sometimes it might take a while. Are there things that are done at particular institutions such as University of Utah that could help increase the chances that a lung donor gets a match more quickly?

Dr. Morrell: Oh, absolutely. So we are the only lung transplant program in the Intermountain West. So that means that not only do we see a lot of patients from not only inside of Utah, but the surrounding states, Colorado, Nevada, Oregon, Idaho, Montana, parts of Arizona. We're getting patients referred to us.

On top of that, we have to get donors. If there's a donor that is in another state, that does come to us. So we do have a lot more access to some of these donors versus if you were living in a city like Los Angeles. There are a lot of other centers there. There's a handful of lung transplant centers.

And so there's a lot of competition when a donor becomes available to try and match that to a recipient versus us. We're it in the Intermountain West. So if you get evaluated and get placed on the list, your chances of getting a transplant are pretty good.

Interviewer: Another consideration with lung transplant is rejection. But technology and techniques are improving. Tell me about some of the things that are done at University of Utah Health that help reduce that risk of rejection and help treat rejection.

Dr. Morrell: We are very aggressive once a patient gets a transplant in terms of keeping an eye on someone's lung function, on their blood work. We have patients coming pretty frequently after surgery for follow-up when rejection is the highest. So if rejection is going to happen, we catch it firsthand and we deal with it.

We're involved in some of these research trials for some of these new medications to treat rejection. So if rejection is going to happen, we catch it early, we handle it, we treat it, we resolve it. And for those patients that may have rejection that is more difficult to control, we're using the cutting-edge research technology to cure rejection, to overcome it, and to improve survival.

Interviewer: Another component of lung transplantation is the average life expectancy after a lung transplant, which kind of shocked me. It's about five years. I thought it was a lot longer than that. But are there some things that you can do that actually will help stretch that out?

Dr. Morrell: We are very vigilant at catching problems if they do happen. We have access to nutritionists, a physical therapist that if someone has something that could affect their overall survival, we have access to state-of-the-art therapies even outside of lung transplant here at the hospital that can really help and improve survival.

Interviewer: What I'm really getting about lung transplantation, the skill of the team that is doing the transplant is super important. But with lung transplantation, it sounds like the work that's done before the transplant, and even the work after the transplant, is really important. And that a patient should feel as though when they're at an institution, that if they have an issue, they're going to be able to contact somebody, and that they're going to hear back from the department. I mean, it sounds like that could be a matter of getting more years out of your transplant or not.

Dr. Morrell: Exactly. There's always a nurse coordinator here on call 24/7. There's a pulmonologist on call 24/7. And along that pre-transplant side of things, as you mentioned, I want to add that we encourage patients to come early for their evaluation so we can take a look at you. And if there is a problem, if there's something we can work on, if you're a little bit overweight, we can address that, get you to lose weight. If you need some exercise, some rehab, we get you plugged into that too. If your heart needs to be looked at, we get you into the cardiologist.

We want to have that time to really optimize you, to get you in the best shape you can be prior to your surgery, prior to your transplant, to really have you be that patient that exceeds that average survival, that you're that patient that 25 years out from transplant, you're loving life, you're active, you're traveling, you're living life to the fullest, and you're as healthy as you can be.

Interviewer: So the average time of survival is five years, but you just mentioned 25 years.

Dr. Morrell: Oh, yeah.

Interviewer: It can go much longer than that.

Dr. Morrell: Oh, yeah. That's the average survival. You take everyone that's had a transplant.

So sometimes in transplant . . . and again, not just here, this is everywhere in the world. Sometimes patients are super sick at the time when they go on that list. They may have some medical problems that ultimately recur after transplant, and sometimes they die within that first year.

On the opposite end of the spectrum, we have patients that are over 20 years out. It's so rewarding to me to see these patients that are doing so well. It's wonderful. That's why I do what I do.

Interviewer: Are you pretty good at being able to determine when a patient gets a lung transplant kind of what the average survival rate might be for that particular patient?

Dr. Morrell: Yeah, I think we get a general sense when someone does come. We take a look at somebody, we know their medical history, we go into very, very good detail, and so we do know risk factors. "Hey, I say because of X, Y, and Z, because of your previous chest surgery, because you're on this medication, this specific one, that you do fall into this high-risk category. You may be somebody that we really have to hope for the best for after transplant. If we choose to put you on the list, complications may happen."

When patients come for their evaluation, we don't want to commit them to a transplant early. We don't want to potentially shorten your survival by saying, "Hey, we're going to do a transplant even though you're not quite sick enough for a transplant." We do these early referrals that allow us to work on some of these modifiable risk factors that can influence survival.

But if we have time beforehand, we'll say, "Hey, you know what? Things look good right now, but let's have you come back in six months and if you start getting sicker, if you start needing more oxygen, and if your lungs start limiting your activity level, you may kind of be pushed into that gray zone where we say, 'Okay, now is the time. Now is the time when we need to get you on that list because based upon my assessment, you may not live without a transplant longer than a year. So now may be the time to get you on the list to really improve . . .'" The goals of transplants are improve longevity, improve quantity of life, and also improve quality of life.

Interviewer: If you want to learn more, just Google "lung transplant at University of Utah Health." There are a lot of great resources on that page there, including types of lung disease and the transplant surgeries that you might need for those. There's "The 10 Things to Know About Lung Transplant," patient stories about their transplant experience at University of Utah Health. Again, just Google "lung transplant University of Utah Health" to get those stories.

Dr. Morrell, thank you very much.

Interviewer: What does a physician want their lung cancer patient to know after a positive diagnosis? We'll find out next on The Scope.

Announcer: Health tips, medical news, research and more for a happier, healthier life. From University of Utah Health Sciences, this is The Scope.

Interviewer: Dr. Wallace Akerly is at Huntsman Cancer Institute. He's a lung cancer expert and I want to have a brief conversation. After you have a patient that has a lung cancer diagnosis, what are typically some of the things that you would tell them? Because at the time, it's probably a little overwhelming so this might give that patient opportunity to hear that information again?

Dr. Wallace: So the first thing we talk about with a patient is typically explaining what's happened is in the past and every patient has to know what the cancer is and where it has spread. So the test they may or may not understand, but the what part is a biopsy and they've probably already had that before they come to see me. We look at it under the microscope and explain or look at these cancer cells and see that these were once normal cells that are behaving very differently. And they can see that under the microscope that the cell that's supposed to be contained to the lung has somehow figured out a way to grow right through basement membranes. So the biopsy says that this cell is not behaving correctly, it's a cancer.

The second part is where has it spread. And the patient has typically gone through a CT scan or a PET scan and draw out a picture that says these are the places where your cancer is present. Knowing where the cancer has gone and that it is a cancer helps the patient explain in their own mind or understand what their symptoms are and why they're feeling the way they're feeling. It may be cancer-related or it may not be. But as we then start to treat these symptoms, it gives the patient the understanding to say, "I can treat this as an arthritis or I can treat this with my as-needed medications they have at home as a cancer."

Interviewer: What else do you try to explain to a patient?

Dr. Wallace: So the next thing is to understand what made the cancer the cancer and so the old world, we looked at a biopsy and said, "This is what the cancer cell looks like." The new world is taking it one step further and we are now doing gene studies. Genes of the cancer that tell the cancer what to do and we can find which of these genes is responsible in very many cases for making the cancer the cancer. So a cancer is our normal cells, except that one part of our normal function has been hijacked and is damaged. If I can understand what step it is that's causing that, well, then we can talk about drugs to block that pathway or at least try to blunt it if I can't correct the pathway.

Alternately, I can pick out a pathway and potentially prescribe them a targeted therapy or a specific therapy that makes the cancer the cancer. Surprisingly, these therapies can be much more well tolerated and more active. So everything is a balance of how well does it work, how many side effects does it cause. And these targeted therapies could easily be a pill that one takes at home and can have the side effects of almost taking an antibiotic, something so different than the chemotherapy that we've been giving for 20 or 30 years.

Interviewer: What's the importance of family members in this whole process?

Dr. Wallace: Family is so, so important. It's sometimes harder on the family than it is on the patient. The family tends to have to keep stiff upper lip and say they'll be strong for the patient so matter what. And yes, it's hard for the patient, but the family suffers with this too so I think it's very important to have family members there. They hear the same background information that the patient hears and their role is to listen and try to understand it as well as the patient because the patient, very commonly, is just overwhelmed by this information.

And even though I write this down and I hand out printed information, people can't always remember it. They sometimes just totally get stuck on the word "cancer." Sometimes they're surprised, but very common they go home that evening and say, "I didn't remember anything that they said," and they look at these handwritten notes we pass out and they say, "Jeez. This note says this," and they can then remember with that trigger what it was that we talked about.

We typically talk about standard treatments. "We'll do this and see how it goes," but everything is simple in cancer. We measure something, we give a treatment, we measure it again. If the cancer has gotten smaller, we're doing the right thing. If the cancer hasn't gotten smaller, we need a new plan. And so we will list the number of potential treatments we have and we usually end off with where do we think the world is going because the first thing the family does and the patient does when they get home is they get on the internet and they look around.

Interviewer: Sure.

Dr. Wallace: So it's important they understand, "This is where I am. This is how I'm going to cope with it. This is how my nurses and social workers and physician are going to support me as I get through this. This is my team that will educate my family members so they will help support me," and we'll run through these therapies as appropriate. We'll balance the benefit versus the side effects. And if possible, we'll try to get them involved with therapies that might be available in two to three years.

Interviewer: So it sounds like it's not just a diagnosis of a physical ailment, there is also treatment for the mental and the spiritual and there is a lot of supporting roles involved other than just you telling somebody, "I'm sorry. You have lung cancer. Let's go do this treatment."

Dr. Wallace: That's so correct. We treat as a team. No one person stands alone. We have many expertises. We have surgeons, radiation therapists and pathologists and so on in the physician group that is interested in the cancer. But we care about so much more than that. It's important to have social workers in the cancer wellness center and the cancer learning center and all of these other things to give the patient the strength to be able to get through this. It's a terrible diagnosis, but there is hope and there are many new therapies. In the last couple of years, there have been a number of drugs approved. In my disease, for lung cancer, there have been two new therapies approved that work by completely different mechanisms. Very, very promising.

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Interviewer: What's the difference between using chemotherapy or targeted therapy for treating lung cancer? We're going to find out next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: Dr. Wallace Akerley is at Huntsman Cancer Institute. He's a lung cancer expert and we're going to talk today about some new, exciting, targeted therapies, and how that differs from chemotherapy, something that a lot of people are familiar with. So how do they differ?

Dr. Akerley: Chemotherapy is a broad therapy. It works on anything that grows fast. Cancers grow fast, so it's a great idea. In that sense, it's the best therapy possible. The problem is, part of us grow fast also. Any wet membrane in our body grows fast. We have wet membranes in our mouth, and it might give us mouth sores. We have a stomach that's a wet membrane. We could get nausea. My hair grows fast. I could easily lose my hair with most chemos. Most important, my white cells in my body that protect us from infection grow fast, so chemotherapy can take away my ability to protect myself from infection.

Interviewer: Those are all the side effects you hear associated with chemotherapy. I never realized that's why. It's the stuff that grows fast that you lose. The sores in your mouth, your hair . . .

Dr. Akerley: As well as the cancer. So that's where the treatment helps in terms of treating the cancer. It's uncontrolled, it grows quickly. It can make the cancer go away. We'd love to give a bigger dose of chemotherapy to get rid of that last bit of cancer. The big problem is, my body has parts of it that grow fast, and we can't handle it. So it's that differential between what the body can tolerate versus what the cancer can tolerate.

Interviewer: It's kind of a brute force attack, chemotherapy is.

Dr. Akerley: Absolutely.

Interviewer: Unfortunately there's collateral damage, which in a lot of cases is the person.

Dr. Akerley: Yes.

Interviewer: So targeted therapies, how do they differ?

Dr. Akerley: Targeted therapies are the new world. We actually look at cancers and try to understand what makes the cancer different from us. In the laboratory, if we can understand what particular pathway made the cancer the cancer, we can give a drug that blocks only that pathway. So now the treatment doesn't care about growing fast. It cares about what makes the cancer the cancer. In that case we can give a treatment that hurts the cancer selectively and has a whole different set of side effects. With chemotherapy, we mentioned just earlier, there can be risks to life and limb at any time. With these targeted therapies, there may be no side effects whatsoever. That's fantastic. Alternately, we may get lesser side effects, typically a skin rash or something, but nothing that's life-threatening like a pneumonia or an infection in the absence of white cells.

Interviewer: And do these targeted therapies actually do a better job of getting the cancer as well?

Dr. Akerley: They do a much better job in taking care of the cancer. The challenge is all cancers aren't the same. So lung cancer that I take care of was once called non-small cell lung cancer. If you listen to that word it says it's just anything that's not the small cell type under the microscope. We actually know that there are probably 50 cancers there. At this time we've picked out at least six, and the interesting part is those specific six cancers we used to say all behaved the same. Now that we've looked at their genes that make them the cancer, we can see that each of these behave a little bit differently.
More importantly, we have a therapy that can go after exactly what that gene is changing in our body. And the therapies aren't necessarily interchangeable, so at one time we looked at cancers and said, "The book says lung cancer should get this chemotherapy." Now we've completely reversed that. We look at the genes of the cancer and explore those, and if a lung cancer gene says take an EGFR inhibitor, then you get a standard lung cancer therapy. But if that lung cancer says you have a melanoma gene, a different kind of cancer, you can actually use a melanoma therapy that will treat that lung cancer in a way that has limited side effects and greater effectiveness.

Interviewer: That's exciting. Is that exciting for you? Did you ever dream of a day like this?

Dr. Akerley: It's completely changed everything that I was taught. We were always taught you do what the book says. What we've found now is you can let the cancer tell you what makes the cancer, and treat the cancer the right way. These things were promised to us to some degree in medical school, for me, 30 years ago, but we had no idea what tools we'd have at this point.
It is amazing. It's completely changed the way I practice, especially just in the last two years. These concepts are taking all the old dog physicians and asking us to retrain. Clinical research is the area where we are. We're probably trying to stay ahead by two years at any time, if we can, before these medications make it to practice. We're getting to use them in clinical trials at least two years early.

Interviewer: And seen a lot of success.

Dr. Akerley: Dramatic success. Better than anything I had hoped for.

Interviewer: If somebody wanted more information on targeted lung cancer therapies, where would you recommend that they go?

Dr. Akerley: There are some fabulous resources at the Huntsman Cancer Institute. The Cancer Learning Center is the place to go. They'll help you in person. HuntsmanCancer.org is another net-based resource.

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Dr. Jones: The number one cause of cancer deaths in women? Most women would say breast cancer, but its lung cancer, and although the rate of lung cancer in men is falling, lung cancer deaths in women is rising. This is Dr. Kirtly Jones from the Department of Obstetrics and Gynecology at University of Utah Health Care and November is Lung Cancer Awareness Month. Lung cancer in women, today on The Scope.

Announcer: Medical news and research from University Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Dr. Jones: The white ribbon. We see pink ribbons everywhere for breast cancer, teal ribbons for ovarian cancer, but where are the white ribbons for lung cancer? The CDC reports that more women die of lung cancer than breast, uterine, and ovarian cancers combined. Twenty-seven percent of all cancer deaths in the US are caused by lung cancer. The five year survival rate for those diagnosed with lung cancer is 16%, which makes it a particularly deadly cancer. Now, the lung cancer rate has fallen 21% among men, but for reasons that remain unclear, the rates have risen 116% among women. Of course, we all know that smoking is the major risk factor. Since 1960, the rate of smoking in men has gone down, but for women, not so much.

Lung cancer develops differently in women than men. Women who have never smoked have a greater risk of developing lung cancer than men who've never smoked. Go figure. Worldwide, 53% of women with lung cancer were never smokers. They could have been exposed to more indoor air pollution related to cooking and heating, and that may be the risk factor for women in Asia and in China and somewhat in the United States. Women tend to develop lung cancer at a younger age than men, too. The good news is women are more likely than men to be diagnosed in early stages of lung cancer, because women probably get more health care, and women tend to live longer than men after treatment for lung cancer. So, that's the good news.

Well, I'm thrilled to live in Utah where smoking is so uncommon, and where it's against the law to smoke in enclosed public places. However, a notable trend in the increase in lung cancer among healthy non-smokers is known primarily in women. If lung cancers in non-smokers were its own category, it would rank among the top 10 of fatal cancers in the US. Lung cancer can result from factors other than smoking. Genetic mutations, as well as exposure to radon gas, secondhand smoke, air pollution and asbestos, among some other things. In Utah, we have particular geographic risks related to radon and air pollution.

So, what to do for this largely preventable, common cancer? If you're a smoker, you should stop smoking. Ten years after quitting, your risk of lung cancer is half of what it would have been if you didn't quit. If you're a heavy smoker over 50, talk to your doctor about the pros and cons of low dose CT scans for screening. If you aren't a smoker, don't start. If you're an adolescent or the parents of one, starting smoking is especially bad, as you're more likely to be addicted to nicotine, and have your developing brain wired for risky behavior, like alcohol.

Lowering your risk of secondhand smoke. If someone in your family smokes, no smoking in the house or in the car. Check your home for radon. Now, radon is a naturally occurring radioactive gas that results from the breakdown of uranium and soil and rocks. It cannot be seen, tasted, or smelled, and according to the EPA, radon is the second leading cause of lung cancer in this country, and it's the leading cause among non-smokers. Outdoors, there's so little radon that it's not likely to be dangerous, but indoors, radon can be more concentrated. When it's breathed in, it enters the lungs and exposes them to radiation. Homes in some parts of the US, like Utah, which are built on soil with natural uranium deposits can have high indoor radon levels, especially in basements. My basement is ventilated and has a fan in it specifically for that reason, and I live here in Salt Lake City.

If you are concerned about radon exposure, you can use a radon detection kit. State and local offices of the EPA can give you the names of reliable companies who can test your home. So get it checked and get it fixed. Limit your time on the freeway and be an advocate for clean air. Eat your fruits and vegetables. Antioxidants in your diet is associated with lower risk of lung cancer. Vitamin pills won't do the trick. So, ladies and gentlemen, put on your white ribbons this month. Lung cancer is largely a preventable disease. Think about the air you breathe and what's in it. Protect yourself and the people around you. This is Dr. Kirtly Jones and thank you for joining us on The Scope.

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Announcer: Examining the latest research and telling you about the latest breakthroughs. The Science and Research Show is on the Scope.

Host: Only 15% of patients with squamous cell lung cancer survive to five years past their diagnosis. It is a difficult cancer to treat. My guest, Dr. Trudy Oliver has developed a new tool for understanding the disease and developing targeted therapies.

Dr. Oliver, you've developed a mouse model for lung squamous cell carcinoma. Why is this important?

Host: Did you know even if you're a non-smoker, just because you live in Utah you have an increased chance of getting lung cancer? We're going to talk with Dr. Shamus Carr of Huntsman Cancer Institute about what's causing that coming up next.

Announcer: Interesting, informative, and all in the name of better health. This is The Scope Health Sciences Radio.

Host: Lung cancer, what causes it? I think everybody thinks it's only smoking.

Dr. Carr: Well, 90% of patients who get diagnosed with lung cancer, it is related to smoking. However, what's interesting is that there's 10% who do not. More interesting is here in the state of Utah 30% are non-smokers.

Host: Really? What's the cause of that?

Dr. Carr: There's a lot of things that have been proven to be the cause. Radon, which is a colorless, odorless gas which is in the basement of pretty much everybody's home here in the state of Utah, is a risk factor.

Host: Why is it so predominant here?

Dr. Carr: It's the geology, so it just comes up through the ground and here it is. Additionally, we make homes so well today, they are air tight. They keep the cold out. In the winter they keep the heat in. In the summertime they keep the heat out and they keep the cool in. If you have a colorless, odorless gas that's coming up through your basement it's not going anywhere. You run your air conditioner all summer, that air doesn't go anywhere. It just keeps recirculating in your house.

Host: What about the inversions that we get?

Dr. Carr: That's a great topic, and I think we're going to learn a lot more about that here in the coming years, pollution in general. In fact, there was just a recent study that just came out of China where they looked at the incidence of smoking over the last thirty years, and it hasn't changed. They smoke a lot over there, but the amount of smokers hasn't changed by percentage.
However, as we all know, you always see in the papers the pictures of Beijing in the summertime. They even pushed the Olympics off and didn't allow people to drive because of air pollution. The air quality there is horrible. What's interesting is the incidence of lung cancer has doubled in Beijing in the last 30 years. Pollution? I think so. However, we're still working on that issue.
I believe the inversion definitely definitely plays a role here in health issue here in the valley in the Great Salt Lake Basin, but time will tell.

Host: We talked about radon. We talked about air pollution, not necessarily proven yet, but likely.

Dr. Carr: Very likely.

Host: What are some other reasons we've got this 30% incidence of lung cancer in non-smokers here in Utah?

Dr. Carr: I think there is also, believe it or not, we're going to find that there's going to be a genetic component. I think there are people out there whose bodies are essentially predestined for this. I've met a number of families, non-smokers, dad died of lung cancer and they said, "Oh, well he worked in the mines," so they kind of attributed it to something else. Then all of a sudden there's somebody else who's got lung cancer, then somebody else. We're starting to see that kind of issue.
I think the state of Utah's really well set up for that because we keep such amazing genealogical records here in this state that we're starting to mine this kind of data, no pun intended, and see if there's something to this. We think that there is going to be.

Host: Is there research currently going on looking into this?

Dr. Carr: Yes.

Host: When do you think we'll see some results? Do you have any idea?

Dr. Carr: As soon as the person who's pulling the data gives it to me. We had a meeting just recently about this. The preliminary data is very striking, very striking that there's going to be a genetic component that we can start talking about in lung cancer, but not yet published.

Host: You're saying that 30% of people who get lung cancer in the state of Utah are not smokers, so even though I don't smoke I've got an increased chance just because I live here. Is there a stigma attached to people who get lung cancer in general because for so many people it is because of smoking?

Dr. Carr: Yeah, you know, I think there is. It's a shame because it's like, "Oh, they did this to themselves. They were bad people. They smoked cigarettes. They weren't healthy." I think that we need to get beyond that. I think this is a multifactorial problem. The incidence of smoking in the United States continues to decrease, in fact, nationally we're under 20% for the second year in a row.
Here in the state of Utah we're only at 10%, so I think we need to realize that there are a lot of other factors that we aren't controlling, like air pollution, they have to work in a mine because they need a job as an environmental hazard, and the radon. The best thing you could do, honestly, the one take home message is go get a radon testing kit for your house, simple. You can go to, I think it is, radon.utah.gov, and for $7 they will send you a testing kit and you can get your own house tested.

Host: We're your daily dose of science, conversation and medicine. This is The Scope, University of Utah Health Sciences Radio.