Dustin Diamond, 'Saved by the Bell' star, R.I.P.

Those of us watched Saturday morning TV as kids in the ‘90s were saddened to see that one of the medium’s most recognizable stars, Dustin Diamond, passed away of “stage 4 lung cancer” at the tender age of 44.

Dustin Diamond Never Smoked; Neither Did An Increasing Number of People Being Diagnosed with Lung Cancer

The first thing most people wondered was whether Diamond was a smoker. According to him, he never smoked. Unfortunately, the incidence of lung cancer among never smokers has risen precipitously in the United States. We don’t know why this is. Diamond reportedly said, according to his representatives, that he believed the cancer was caused by working in buildings and staying in hotel rooms that had mold and asbestos. While mold can cause lung lesions that resemble and masquerade as lung cancer, a condition known as aspergillosis, mold does not actually cause lung cancer. However, asbestos is well known for causing lung cancer, although the type of lung cancer seen in asbestos-exposed patients is most often pleural mesothelioma, as opposed to the small-cell lung cancer (SCLC) that Diamond was diagnosed with. Notably, most never-smokers are diagnosed with ­non-small-cell lung cancer (NSCLC), while SCLC is very much considered a smoker’s type of lung cancer. If asbestos was the causal factor, why Diamond developed SCLC and not mesothelioma is not known; some SCLC cases do occur in never-smokers, although it is an uncommon presentation.

SCLC has an extremely poor prognosis, as it is often diagnosed very late. This is what happened in Diamond’s case. In fact, when Diamond’s cancer was originally diagnosed, the origin of the cancer was not initially known: This is called “carcinoma of unknown primary” (CUP). Indeed, the first tumor that Diamond reported was in his throat, but that was not the primary organ where the tumor started. Often, with CUPs, cancer is discovered in a widely metastatic setting, with scans showing tumors throughout the body, so it is not always simple to determine where the primary tumor started. It takes biopsies of the tumors to see if there are certain characteristics that differentiate a lung cancer, for example, from a prostate tumor that has metastasized to the lung. Blood and tissue tests for biomarkers, such as certain antigens, can help make such diagnoses. In this way, in addition to lung imaging, it was determined that Diamond’s throat tumor was not a primary throat cancer, but rather metastatic SCLC. SCLC often spreads up the airways, as well as to the bones, liver, and brain.

What Can You Do If You Are a Never-Smoker Worried About Lung Cancer?

If you are a never-smoker but have been exposed to industrial chemicals and/or asbestos in your work, or have been exposed to secondhand smoke, you may have reason to be concerned about developing lung cancer. Also, if you have lived or worked in buildings made of certain kind of stone materials that emit radon, this is a risk factor as well. Talk to your physician about getting a chest X-ray, and ask if low-dose spiral CT screening might be appropriate for you.

Author

Arash Bereliani, M.D., M.S., F.A.C.C. Beverly Hills Institute For Cardiology & Preventive Medicine