I've never smoked, but I worked with people who did for eight years. I developed squamous cell carcinoma of the throat. It was surgically removed and I had 38 radiation treatments. I tried to get workman's compensation, but the insurance companies are fighting it. They say that the secondhand smoke can't cause cancer. How can I find a doctor who is an expert in this field to help me with my case? I can no longer do my job, and I feel that workman's comp should cover this, especially since this was in a medical building, and by law smoking was forbidden.

D.M.

This question raises an interesting set of issues regarding environmental (secondhand) smoke, policies related to smoking in the workplace, and the relationship between the presence of environmental smoke and a particular case of cancer.

It is well established in the medical community that environmental smoke can cause a whole host of health problems, including cancer (especially lung cancer). Numerous studies show that healthy adults and children can develop many ailments from repeated exposure to someone else's exhaled smoke or smoke from a burning cigarette. The following paragraph is from an article by the American Cancer Society about the dangers of smoking:

"Smoking not only harms your health but the health of those around you. Exposure to environmental tobacco smoke (also called passive smoking or secondhand smoke) includes exhaled smoke as well as smoke from burning cigarettes. Studies have shown that environmental tobacco smoke can cause lung cancer in healthy nonsmokers. It is also associated with sudden infant death syndrome (SIDS), and low-birthweight infants. Babies and children raised in a household where there is smoking have more ear infections, colds, bronchitis and other respiratory problems than children from nonsmoking families do. Environmental smoke can also cause eye irritation, headaches, nausea and dizziness."

Does this apply in this case? Should workers compensation insurance provide benefits? These are tough questions. Certainly, the insurance carrier cannot deny, based on the available medical evidence, that secondhand smoke can cause lung cancer. The carrier may, however, deny that the secondhand smoke you experienced caused a particular case or type of cancer. Squamous cell carcinoma is basically skin cancer. A workers compensation carrier might maintain that the workplace conditions did not cause this case of cancer.

The best place to start is with your personal physician or the specialists who have treated you. If, in their opinion, there is a relationship between the workplace condition of secondhand smoke and your particular cancer, you may have a case to make with your insurance carrier.

Neither smoking nor environmental smoke is the sole cause of lung cancer. My mother-in-law died last year of lung cancer. She never smoked, and as a lifelong homemaker was rarely exposed to environmental smoke. Finding the source of her cancer is impossible. The same may be true of other types of cancer. For more information about cancer, the causes and the treatments, consult the web site of the American Cancer Society.

There is another issue here. If a law or building policy clearly prohibits smoking in a building or relegates smokers to designated areas, and workers are openly smoking, a person may be able to bring a complaint to the building or public authorities. Again, however, it may be difficult to prove that this smoking caused a particular case of cancer. In order to determine your rights and any legal remedies available in this instance, it is best to contact an attorney.