How many scientists does it take to find a gene? If it’s a gene as
important as one that raises your risk of lung cancer, at least 142—the
number of researchers who conducted three separate studies being
published today which all identify the same stretch of chromosome 15 as
containing genes linked to lung cancer.
How many scientists does it take to figure out what the genes do and
how important they are? More than 142, apparently, for the three groups
have reached dramatically different conclusions about exactly how the
genes function to make you more likely to develop lung cancer. Two
conclude that the genes directly raise your risk of developing lung
cancer whether or not you smoke, while one concludes that the genes
make you more likely to smoke and only through that effect on behavior
raise your risk of lung cancer.
The discrepancy gets to the heart of a longstanding debate about the
value of genetic discoveries. Whenever scientists discover a gene “for”
some disease or normal trait, it leads to the question of whether the
gene causes that disease or trait directly, or is instead a bystander.
(The classic here is the hypothetical chopsticks gene. Some genes are
more common in Chinese people than in westerners, and Chinese use
chopsticks more than Europeans do, but it would be a laughable mistake
to conclude that the genes cause people to use chopsticks: the genes
are merely markers for certain ethnic groups which, because of culture
alone and not genetics, use chopsticks.) Now that debate has erupted in
the clash of lung-cancer papers.
All three of the papers agree that the genes that increase the risk of lung cancer lie on chromosome 15, one of 23 (each part of a pair) in every human cell. The technique that each team used, called a genome-wide association study,
cannot pinpoint which gene or genes on the chromosome is the culprit;
all it can do is say the suspect gene lies in a certain region of the
chromosome. Earlier studies have shown that among the five genes in the
suspect region of chromosome 15 are three for parts of what is called
the nicotinic acetylcholine receptor. All three groups agree that these
nicotine-receptor genes are almost certainly the genes responsible for
the elevated cancer risk. That is striking: it suggests that nicotine,
long known to be what makes cigarettes addictive, might also cause lung
cancer. And finally, all three groups agree that the dangerous gene
variant is quite common: about half of people of European descent carry
at least one copy, having inherited it from mom but not dad (or vice
versa). About 10 percent to 15 percent carry two copies, inheriting it
from both parents.
It is no surprise that there is a genetic component to lung cancer
and smoking. Smoking causes an estimated 5 million deaths a year, but
while many of those deaths are from lung cancer, not all of them are:
only about 15 percent of smokers develop lung cancer, of which there
are 1 million new cases worldwide every year. (In the United States,
there are about 160,000 deaths from lung cancer every year.) The fact
that relatively few smokers develop lung cancer strongly suggests that
there is something inherently different between smokers who do and
those who do not.
Two of the new papers conclude that the now-suspect nicotinic
acetylcholine receptor gene is a large part of that difference. As its
name suggests, this receptor acts as a docking port for nicotine
molecules. In a study led by Paul Brennan of the International Agency for Research on Cancer
and published today in Nature, the scientists conclude that the gene
raises the risk of lung cancer directly: people who have this gene (to
be precise, everyone has the nicotinic acetylcholine receptor gene;
what matters is which variant, or chemical spelling, you inherited from
mom and dad, since only some spellings raise the risk of lung cancer)
have a greater risk of the disease even if they do not smoke.
So, too, concludes the study by Christopher Amos of the M.D. Anderson Cancer Center,
published online in Nature Genetics. If you have ever smoked and have
one or two copies of the gene variants, your risk of developing lung
cancer is about 30 percent to 80 percent greater than if you do not
have these variants, the researchers found. Putting actual numbers on
that, the risk rises from about 15 percent to about 27 percent at the
high end.
The extra risk of lung cancer conferred by these gene variants is
unrelated to whether or how much you smoke, both the Amos and Brennan
teams conclude. “What we do not understand is why some long-term
smokers develop lung cancer and others don’t,” Amos said. “There are so
many different cancer-causing compounds in tobacco smoke that it’s hard
to separate them and we don’t fully understand the mechanisms that
cause lung cancer.”
The third group reaches a strikingly different conclusion: that the genes affect how much you smoke, and only through that mechanism
do they raise your risk of lung cancer—more cigarettes, more cancer.
Each copy of the gene variant increases the risk of developing lung
cancer 30 percent, they estimate. “This is a genetic predisposition to
seek out a certain environment, to smoke,” said Kari Stefansson, CEO of
the genomics company deCode who led the latter study,
during a recent visit to Newsweek. “We know that complex diseases have
both genetic and environmental components, and the challenge has always
been to figure out their relative contributions. But if this gene
causes you to seek out a ‘smoking environment,’ then it’s as if both
gene and environment contribute 100 percent to the development of lung
cancer.”
Scientists not connected to the new studies are scratching their
heads over how the teams could come down on opposite sides of the
question of whether the gene variants raise the risk of lung cancer
directly (and therefore make you more likely to develop it whether or
not you smoke) or indirectly (making it more likely that you will
smoke). In the latter case, if you have these “lung cancer” genes and
do not smoke, you’re fine—no extra risk of lung cancer. In the former,
even non-smokers have cause for concern if they carry these gene
variants.
“The extent of the disagreement in the conclusions of these studies
is remarkable,” write Stephen Chanock of the National Cancer Institute
and David Hunter of the Harvard School of Public Health in a commentary
on the trio of studies. “They signal the need for greater
methodological rigour in attempts to account for both the genetic and
the environmental causes that we think underlie most diseases.”
Until that disagreement is resolved, don't rush to get tested for
the nicotine-receptor genes. For one thing, even if you turn out to
have the "good" gene variant and therefore to be resistant to
developing lung cancer from smoking, you can't smoke with impunity:
you’re unlikely to also be protected against emphysema, heart disease
and other often-fatal consequences of lighting up. “I try to make a
living by marketing genetic tests,” said Stefansson in a telephone
briefing, “but I am not a proponent of this one.”
At least not yet. But if Stefansson’s interpretation turns out to be
right, and the gene variants increase your risk of smoking but not of
lung cancer otherwise, it will be one more piece of evidence that genes
are not destiny: all you have to do to keep your risk of lung cancer
near zero is to resist the urge to smoke. But you knew that already.