Lung cancer causes about 160,000 U.S. deaths a year, more than the toll of the next three most common cancers — colon, breast and prostate — combined. Yet only about 30% of lung cancer cases are diagnosed early. Most patients are diagnosed at a far less treatable, later stage of the disease.
Since about are preventable, evidence-based screening recommendations for high-risk patients offer the best hope to catch the disease early and provide the best chance for effective treatment.
The American Medical Association recommends that and that screening low-dose computerized tomography (CT) scans for patients at high risk for lung cancer by Medicare, Medicaid and private insurance be a required covered benefit. AMA policy also aims to raise awareness of lung cancer screening with low-dose CT scans in high-risk patients to improve screening rates and decrease the leading cause of cancer death in the U.S.
Understand what lung cancer is
“Lung cancer is a malignancy of the airways or the lung tissue that is the No. 1 leading cause of cancer deaths in the United States,” , chief of the Division of Thoracic Surgery at ֱ told the AMA for its “What Doctors Wish Patients Knew” series.
The two main broad categories are small cell lung cancer and non-small cell lung cancer, he said. The most common type is non-small cell lung cancers, which he said are primarily made up of adenocarcinomas as well as squamous cell carcinomas.
Smoking is the leading risk factor
What causes lung cancer?
“The No. 1 environmental exposure that will surprise no one is smoking,” Seder said. “We do know that 80% of people who have lung cancer were regular smokers at one point in their life, so this is an extraordinarily strong association.”
But smoking isn’t the only factor.
“Nobody refutes the association between smoking and lung cancer anymore, not even the tobacco companies,” he added. “But you can never smoke and get lung cancer, or you can smoke your entire life two packs a day and never get lung cancer. So there are other components that go into it other than just the environmental exposure.”
A genetic mutation may be present
Although there are other environmental exposures such as radon and various toxic chemicals and fumes that have combustion products that have been associated with lung cancer, Seder said, doctors are increasingly seeing young patients who have never been smokers presenting with lung cancer.
“And when that happens, that’s probably not an environmental exposure over time issue, but instead a genetic issue that that person has a mutated gene in their lung making it grow,” he said. “It’s not a genetic component in the sense that it’s passed from generation to generation, but a genetic component meaning there are specific gene mutations that we see within lung cancers that predispose people to early cancers without the typical exposure to carcinogens.”
Most lung cancers are asymptomatic
What are some lung cancer signs and symptoms people should watch for?
“Unfortunately, most lung cancers are asymptomatic until the lung cancer has spread somewhere else,” Seder said. “Once the lung cancer spreads somewhere else, it oftentimes becomes incurable or more difficult to treat.”
But symptoms may include cough, chest pain and coughing up blood. “If it has spread somewhere else, such as their bones,” he said, “they may present with a broken bone because the cancer has eaten away that part of the bone and it fractures.
“If it spreads to their brain, they may present with double vision or other neurologic symptoms,” he added. “Once the cancer is spread distantly, it becomes significantly more difficult to cure.”
If eligible, get yearly screenings
The recommends that anyone between ages of 50 and 80 who has a 20-pack year history of cigarette smoking be screened every year with low-dose CT scans. That means a pack a day for 20 years, or a half a pack a day for 40 years, or two packs a day for 10 years and quit within the last 15 years,” Dr. Seder said, emphasizing that “those patients should all be screened.”
“If you qualify, you get your first screening and then based on that, if there’s nothing found, you would come back in a year for a repeat screening as long as you still meet those criteria of between 50 and 80 years old and quit within the last 15 years,” he said. “If there’s something abnormal that’s identified, those patients will then be asked to come back at a shorter interval.
“It may be six months or three months or if there’s a really concerning finding and it looks like the patient might have a cancer, there may be a biopsy or additional imaging suggested for the patient,” Dr. Seder added.
ҳܾԱ say that how long ago you quit smoking should not be a factor in whether you get screened for lung cancer.
Follow up will be needed
If doctors find something on a scan, they’ll order further testing like a PET scan or biopsy.
If you’re lucky enough to find a lung cancer at a very early stage… then you have the opportunity to undergo a surgery that has a high risk of curing that lung cancer.
The good news about lung surgery today, he said, is that it’s all minimally invasive, “meaning with cameras and a robot and we’re taking out big lung cancers through an inch and a half incision.
“So, there’s less pain, quicker recovery, less complications, less pneumonia.”
Make the decision to quit smoking
So what can you do to keep from getting lung cancer?
“Outside of the cardiovascular issues that smoking predisposes people to, we do know that if you stop smoking today your risk of lung cancer will begin to drop,” he said. “It will never get down to the point of a person who's never smoked, but it will certainly be less than if you continued to smoke.”
Although it doesn’t hurt to also avoid marijuana, e-cigarettes and vaping.
“The data we have are still too preliminary to link vaping to lung cancer,” Seder said. “We do know that vaping is for sure not healthy for you, but does that lead to an increased risk of cancer? Time will tell.”
This article is adapted from a story originally run on the .
