Yeah, this title for the article is really terrible. The "why" that scientists are investigating is not why many lung cancers aren't in nonsmokers. The "why" they are investigating is "why are these non smokers getting cancer?". Once smoking stops being such a dominant cause, you put more energy into the other cases.
I can’t find any complete numbers (most prevalent factors after smoking would be environmental, and therefore underreported, especially when as hard to detect as radon), but national health agencies tend to put the Radon section second, after Smoking [1,2]. An uncited figure on a Hopkins webpage suggests 30% of non-smoking lung cancer cases are caused by Radon [3]. Among the well-known environmental factors (asbestos, secondhand smoke), it seems to be about equal for risk increase [4]. Given that asbestos and secondhand smoke are on the decline, it stands to reason that radon will tend toward being the top cause, barring a rise in prevalence of one of the disease risk factors (asthma, pneumonia, HIV, tuberculosis).
Of course this is all moot because vaping will be revealed to be the current #1 cause of lung cancer in the coming decades, by a long shot. No citation necessary.
> Of course this is all moot because vaping will be revealed to be the current #1 cause of lung cancer in the coming decades, by a long shot. No citation necessary.
That isn't obvious or apparent to me at all so I do think a citation would be good to see. Nicotine is definitely a culprit in a lot of cardio-related issues for sure. I think some flavoring agents are the more questionable thing and would be curious to hear about those specifically in relation to lung cancers.
Fair enough. Cancer causation is just so weird, I'm going off the heuristic that stuff in your lungs that your lungs aren't prepared for is probably not great, especially with chronic exposure. And your lungs are really only prepared for air (which includes many things within certain tolerances [0]). The "not great" => "cancer" pipeline is really where the hand-waving comes in, and mostly far too early to tell whether the parts of vaping that are "not great" for your lungs will in fact be carcinogenic for your lungs.
So that being said, I'm mostly going to offer citations for "vaping is not great for your lungs." And that being said, I'm just going to offer citations for "specific parts of vaping are not good for your lungs." But my broader argument is that putting stuff in your lungs is going to be bad for your lungs, and these are just the most obvious ones we've found so far. Unfortunately I won't be able to find a citation for that argument.
So, first, the most recent: a study showing disposable vapes had incredibly high level of toxic metal emissions [1]. The non-disposable Juul et al variously have some concerning levels, but the insane numbers are on disposables, which are largely (entirely?) illegal in the US, at least. Still, they're not illegal everywhere, they were used heavily for several years in the US, and several of the top Google results were redditors complaining about the stupid ban and talking about how to get around it. All of this combines to lung damage down the line, and several of the toxic metals are outright carcinogenic, so lung cancer as well.
A more particular example: popcorn lung is a terrifying name, but pretty restricted risk, given the causing chemical is only in certain flavors, and those have supposedly stopped using it [2]. But again, an example of weird chemicals in your lungs cause weird things, and it'll be decades til we figure out all of them.
And finally, a study showing that vaping plus smoking leads to a four-fold higher risk of lung cancer over smoking alone (yes, they adjusted for age, gender, race, location of residence, prevalent comorbidities, and pack-years of smoking) [3].
[0] I was hoping to make a glib point about even high enough pollen concentration being bad for your lungs, but in fact a recent study suggests that allergies reduce risk of lung cancer! I'm chalking that up to allergies being your body's way of keeping non-air particulates from your lungs, but who knows. https://www.frontiersin.org/journals/medicine/articles/10.33...
Except reducing the first cause does nothing about whether air pollution is a nontrivial factor. And nonsmoker cancers are a nontrivial proportion since they account for 10-25 percent of lung cancer worldwide, please just read the article.
Besides the base rate fallacy there is the fallacy of assuming only the biggest factor is what matters, when other factors are nontrivial weights already. Another fallacy is the fallacy of relativizing a problem framing by insisting on comparison with an obsolete problem --campaigns against smoking have done a lot, so why are we still comparing today's problems against the problems of the 20th century. It smacks of "well, things were even worse back then", which surely the base rate fallacy is not trying to suggest.
> And nonsmoker cancers are a nontrivial proportion since they account for 10-25 percent of lung cancer worldwide, please just read the article.
I read the article, but I can't tell if there's a real problem or not. Having "nonsmokers accounts for 10% - 25% of lung cancer worldwide" doesn't leave me any wiser or more informed. Maybe I missed it in the article, so the rest of my comment is pointless, but ...
What's the percentage of lung cancer in nonsmokers? 10% of the pop? 1%? 0.00001%? Whatever the answer is, why isn't it in the article? Then we can see what "10% - 25% of $BASE_RATE" actually is. If we're seeing "10%-25% of 0.0001%", then that sorta tracks as fine, TBH.
The article seems almost designed to mislead: What's the base rate of lung cancer in nonsmokers? What's the base rate of lung cancer in smokers?
For example, if the base rate of lung cancer in smokers is 25% and the base rate of lung cancer in nonsmokers is 0.1%, then I don't see a problem here; funds directed to eliminating the remaining causes of lung cancer will be better spent on other research.
OTOH, if the base rate of lung cancer in smokers is 25% and the base rate of lung cancer in nonsmokers is %15, then I see a real problem here: maybe we need to direct more research funds towards lung cancer[1].
My expectation is that, with smoking so rare, lung cancer in the combined population must be very low, compared with the time when smoking was not rare.
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[1] Actually the problem is worse than that: if there was a singular cause for that 15% in my example, then we it would have been cheaper to target that cause instead of spending dollars reducing smoking.
I do wonder if non-smokers are segregated based on second hand exposure: have a parent/spouse who smokes. Casino employees may have to spend a full shift bathed in smoke.
Yes, also, the base rate of smoking in different groups is important to take into consideration to prevent the base rate fallacy.
Very few Chinese American women smoke (~2%), so if smokers and non-smokers have the same chance of getting lung cancer not caused by smoking, then the number of non-smokers with lung cancer will be a larger proportion.
If 100% of some group would be non-smokers, then obviously 100% of lung cancer cases in that group will be in non-smokers.
It's similar to misinterpreting the fact that most people that were hospitalized from Covid-19 were vaccinated.
Let's start with an extreme example: each day more people die in traffic accidents, than by falling from a 10-story building. But still, we all can agree that driving a car is safer than falling from a building.
Why? Because driving a car you get more chance to get to your destination safely than falling from a building. ChatGPT estimates 0.01% chance to die in car accident per year, when driving every day, and 90-99% to die when falling from a building, once.
However, since there are many millions of people who drive a car every day, multiplying very little chance to die in car crash by millions of people, we get thousands of traffic-related death per day. Compare that to single-digit number of people falling from buildings, even if all of them die from it.
Back to Covid, let's imagine a village with simple numbers like this:
10 people were NOT vaccinated,
100 people WERE vaccinated.
Of 10 people who were NOT vaccinated, all 10 got hospitalized.
Of 100 people who WERE vaccinated, 20 got hospitalized.
_Correct_ way to look at this village would be:
ALL people who were NOT vaccinated, got hospitalized - 100% hospitalization rate.
But among those who WERE vaccinated, only 20% got hospitalized.
Hence, it's better to be vaccinated - this way you'll get 80% chance of not being hospitalized :)
I'm not a real statistician, and don't have actual numbers on hand, but situation with real world numbers is similar: among people who were vaccinated, less percent were hospitalized than among those who were not. It's just that we had so many many vaccinated people, that their small hospitalization rate, when multiplied by total number of vaccinated people, outweighs number of not-vaccinated and hospitalized people.
Cool. I didn't know the effect of the vaccine is so poor, that you now need to account for statistical biases to see its effect at all. That's less than what i was told, and I'm not happy.
Honestly what a shit vaccine. Measles and Tetanus vax did better.
Cool, so your question was in bad faith, you were not at all prepared to learn, have wasted our time, and you still don't understand anything about the base rate fallacy.
You must be a liar or willfully ignorant to say that after the entirety of 2019-2021 happened. The efficacy of vaccines in general and specifically of the various Covid-19 vaccines have been talked about ad nauseam. No even merely scientifically literate person has said that the Covid-19 vaccines (or any vaccine for that matter) are 100% effective.
It's so weird how people will close their eyes for basic science to virtue signal to their group. I sincerely hope you open your mind and prevent your virtue signaling from killing you (or anyone you know) in the next pandemic.
> If i quote the WHO[1] on this, you might just say they are not literate enough.
This is a page primarily about herd immunity, not about vaccine efficacy. You had to dig to find this (or somebody dug for you).
Having said that, even though they added several sentences on how certain things are unsure or need more research, I will admit that they worded this specific sentence badly: "Vaccinated people are protected from getting the disease in question and passing on the pathogen, breaking any chains of transmission."
It is clearly overstated and does not match the careful wording later on: "We are still learning about immunity to COVID-19. Most people who are infected with COVID-19 develop an immune response within the first few weeks, but we don’t know how strong or lasting that immune response is, or how it differs for different people. There have also been reports of people infected with COVID-19 for a second time."
> The rest of your post are personal attacks that do not add to your point.
They do, because you clearly have a bone to pick that is preventing you from rationally approaching the matter and discussions in general. Think about what point you're actually trying to make and what that has to do with the base rate fallacy. Really, verbalize it. What is it? Why did you feel the need to inject that into the discussion, even though it doesn't belong here at all?
The WHO did not word it badly, it was the accepted knowledge back then.
You previously accused me of somehow missing the 2019-2021 timeframe, but that the vaccine doesn't really protect you well from infections was not established until autuum 2021. Consequently, as the scientific data to show it was not collected yet. Either you got the year numbers wrong or there is some retcon happening.
> Why did you feel the need to inject that into the discussion, even though it doesn't belong here at all?
Why is that on me? You tried a stab at antivax whackos and it backfired.
> Really, verbalize it.
I got vaccinated with the belief that it would reliably keep me from the hospital. Because it "prevents severe causes of the sickness" (translated from german). We blamed and shunned unvaccinated people because they were an unreasonable burden to the hospitals, and now you casually remark that its the low efficacy of the vaccine, not being unvaxxed, that causes the majority of people who end up hospitalized. For how long has that been?
Maybe we should have worked on a vaccine with better efficacy (hey, let me dream up the impossible, maybe immunity like with the measles vax where 99% ppl actually can't get sick at all) instead of harassing unvaccinated people?
> The WHO did not word it badly, it was the accepted knowledge back then.
Bullshit. I already showed how they were careful in the rest of their wording in your own source. 100% efficacy was never 'accepted knowledge'.
> Why is that on me? You tried a stab at antivax whackos and it backfired
Bullshit. The base rate fallacy was and is very present. The misinterpretation I referred to made sense to mention: It is a very commonly known recent and relatable example of the base rate fallacy. You made it a tribalistic ad hominem in your own head.
> you casually remark that its the low efficacy of the vaccine, not being unvaxxed, that causes the majority of people who end up hospitalized.
I did not say this at all and you still do not understand the base rate fallacy. A larger percentage of the unvaccinated people were hospitalized than of the vaccinated. There were just generally way more vaccinated people.
> Maybe we should have worked on a vaccine with better efficacy (hey, let me dream up the impossible, maybe immunity like with the measles vax where 99% ppl actually can't get sick at all) instead of harassing unvaccinated people?
See, now there we go. The mention of the Covid-19 vaccination triggered this frustration and made you decide to inject it where it did not belong and keep your mind closed to the math and science surrounding this. The math does not care about your feelings and is what it is. Accept it.
It’s difficult to give any accurate interpretation of, because it’s not a meaningful statistic.
For example, every person hospitalised from COVID-19 had consumed water at some point in preceding months. It’s not evidence that water causes severe complications from COVID-19.
> In and of itself own, as quoted by OP, it’s not meaningful.
This is an overly literal, pedantic, and ungenerous interpretation of what I said.
Clearly the actual numbers as well as the base rates for the relevant groups are necessary to meaningfully interpret the statistic, but I was hinting at a similar case after describing the logic for the original case, not exhaustively describing the similar case.
