Detecting, treating and lowering your risk of lung cancer
Lung cancer is the leading cause of cancer deaths in the United States. The National Cancer Institute estimates that 236,000 Americans will be diagnosed with this disease in 2022.
Smokers are more likely to develop lung cancer than nonsmokers. Dr. Andrew Meyer, an oncologist with the LMH Health Cancer Center, said 80% of diagnosed lung cancers in the U.S. are related to smoking.
“Lung cancer typically isn’t a genetically inherited condition. Smoking is the biggest risk factor by far,” Meyer said. “Other factors depend on environmental exposure like asbestos and second-hand smoke.”
If you’re worried that you might develop lung cancer, Meyer said there are several characteristic symptoms you should watch for: a persistent cough that gets worse over time, shortness of breath, wheezing, hoarseness, constant chest pain or coughing up blood.
If you have these symptoms, it doesn’t mean that you have lung cancer, but you should check in with your primary care doctor. You may need to undergo testing to determine whether the problem is cancer or something else.
Dr. Rashid Riaz, a pulmonologist with Lawrence Pulmonary Specialists, said if you’re worried that something may be wrong and you’re scared to find out, it’s important to overcome that fear.
“The likelihood is that there isn’t something wrong, but if you’re concerned, go ahead and get checked out,” he said. “The earlier we can find something, the higher the chance of the treatment being effective.”
One commonly used test is a low-dose CT scan, or LDCT, which can help detect the disease at early stages. The U.S. Preventative Services Task Force recommends annual screening for lung cancer with an LDCT for certain adults. To qualify, you must be:
• Ages 50 to 80
• Have a 20 pack-year smoking history. A pack-year describes how many cigarettes you’ve smoked over a certain period of your life. If you’ve smoked a pack a day for the past 20 years or two packs a day for the past 10 years, you have 20 pack-years.
• Currently smoke or have quit within the past 15 years
It’s important to talk with your primary care provider to determine your eligibility.
An LDCT is quick and painless and you may even be able to stay in your regular clothes.
The technologist will have you lie down on a table and the machine will slide you in and out of the scanner. The whole process generally takes less than 30 minutes.
Meyer said there are a couple of things that a radiologist looks for when reading your scan that would indicate something might be wrong.
“We mainly look for nodules, which are growths in the lung that shouldn’t be there,” he said. “Normal lung tissue looks homogenous if it’s healthy. We’re looking for nodules or any densities in the tissue.”
Other concerning findings can include enlarged lymph nodes in the middle of the chest or fluid around the lungs. If something worrisome is revealed through the LDCT, your primary care provider may refer you to a pulmonologist.
“When you come in to see one of our pulmonologists, we’ll thoroughly explain the finding from the scan and give you the risks that may be associated with it,” Riaz said. “Many of the things we find aren’t cancerous. If there is a concern that it is cancer, we’ll go over what the next steps for evaluation should be.”
If your scan shows something that’s not large enough to biopsy, Riaz said his team will repeat CT scans in three to six months to see if it enlarges. If it doesn’t, expect to return in another six months for a repeat scan. The hope is that the area remains stable, which generally means it’s not lung cancer.
More concerning findings may mean that further testing is needed to provide an accurate diagnosis. This could be done using a CT-guided biopsy, where you’re lightly sedated and an interventional radiologist uses the scanner to insert a needle into the nodule and retrieve a sample. Other patients may undergo an endobronchial ultrasound (EBUS), a minimally invasive procedure using a flexible tube that goes through your mouth into your windpipe and lungs. Both procedures are done on an outpatient basis, meaning that you’ll be in and out of the hospital the same day.
The samples collected during the biopsy are sent to the lab and examined by a pathologist. They will check the samples for cancer, inflammation, infection and other lung problems. If cancer is detected, you’ll typically meet with a medical oncologist within a day or two of the diagnosis to talk about treatment options.
There are a variety of treatments for lung cancer, and which one is used often depends on how advanced the cancer is when it’s caught.
“Patients may undergo radiation, chemotherapy, immunotherapy or targeted therapies,” Meyer said. A pulmonologist will also remain involved, continuing to provide treatment for co-existing conditions patients may have, such as chronic obstructive pulmonary disease or emphysema.
“Some patients may experience side effects from the chemo or radiation that can cause inflammation in the lungs. We can help diagnose and treat those conditions as well,” Riaz said.
At LMH Health, Meyer said patients may also be eligible for clinical trials through a partnership with the Masonic Cancer Alliance.
When lung cancer is caught early, the survival rate is relatively high. Meyer said that stage one cancers are cured 80% to 90% of the time.
“We’ve made advancements in treatment over the past decade with immunotherapies and other treatments. Our goal is to catch cancers earlier when the survival rates are much higher,” he said.
The five-year relative survival rate drops dramatically for patients diagnosed with stage two or three cancer. Meyer said that with stage three lung cancer, the five-year relative survival rate is probably in the range of 20% to 40%.
According to the American Lung Association, Black patients are more likely to develop lung cancer and to die from it than any other racial or ethnic group. Meyer said statistics like these are due mainly to disparities and inequities in health care.
“People may not get recommended health care services like cancer screenings for a number of reasons, so cancers are more likely to be caught later when cure rates are lower. It just speaks to the importance of getting the low-dose screening CTs if you qualify,” he said.
Lowering your risk
If you do smoke, now is the time to quit, because the biggest risk factor for developing lung cancer is smoking. Even if you’re vaping instead of smoking cigarettes, you could still be in danger.
“We know there are many carcinogens in the vaping oils being used, including heavy metals. If you continue to vape over time, it’s going to lead to lung cancer,” Riaz said. “It’s still too early to tell what the concrete evidence is, but the same was true when cigarettes first came out. Vaping is going to cause lung cancer.”
When you’re ready to quit smoking or vaping, talk with your health care provider. They can explain options that can make it easier for you to kick the habit for good.
“We’re lucky to have a pharmacist in our clinic to help patients with options to help them quit,” Riaz said. “Whether it’s nicotine replacement therapy or another pharmacotherapy, they can talk with you about barriers to quitting and order medications that will help.”
— Autumn Bishop is the marketing manager and content strategist at LMH Health, which is a major sponsor of the Journal-World’s Health section.