Although it’s been well documented that smoking is deadly, more than 30 million people in the United States still smoke. It’s one of the leading causes of death, yet also one of the most preventable. The Centers for Disease Control and Prevention says, “Cigarette smoking kills more than 480,000 Americans each year. Cigarette smoking cost the United States more than $600 billion in 2018, including more than $240 billion in healthcare spending and nearly $372 billion in lost productivity.”
An estimated 238,340 new cases of lung cancer (117,550 in men and 120,790 in women) will be diagnosed this year, according to the American Cancer Society and over 123,000 people will die. The ACS states, “Lung cancer is by far the leading cause of cancer death in the US, accounting for about 1 in 5 of all cancer deaths. Each year, more people die of lung cancer than of colon, breast, and prostate cancers combined.”
The biggest risk factor for lung cancer is smoking. The CDC says, “In the United States, cigarette smoking is linked to about 80% to 90% of lung cancer deaths. Using other tobacco products such as cigars or pipes also increases the risk for lung cancer. Tobacco smoke is a toxic mix of more than 7,000 chemicals. Many are poisons. At least 70 are known to cause cancer in people or animals”. Even if you’re not a heavy smoker and light up a pack a day, you’re still at risk. According to the CDC, “People who smoke cigarettes are 15 to 30 times more likely to get lung cancer or die from lung cancer than people who do not smoke. Even smoking a few cigarettes a day or smoking occasionally increases the risk of lung cancer. The more years a person smokes and the more cigarettes smoked each day, the more the risk goes up.”
Jyoti Malhotra, M.D., M.P.H, is director of thoracic medical oncology at City of Hope Orange County Lennar Foundation Cancer Center in Irvine, California tells us, “As a lung cancer specialist, I see patients every day who are living with – not defined by – lung cancer. Precision medicine, the combination of molecular testing and targeted drugs, has been a game changer in our efforts to fight this aggressive form of cancer. We have made monumental advances in immunotherapy, which used alone or with conventional therapies can offer patients better outcomes. This is good news for people with lung cancer. There are two main types of lung cancer — small cell and non-small cell. Most lung cancers are non-small cell, which is less aggressive than small cell.
The Mayo Clinic says, “Lung cancer is a type of cancer that begins in the lungs. Your lungs are two spongy organs in your chest that take in oxygen when you inhale and release carbon dioxide when you exhale. Lung cancer is the leading cause of cancer deaths worldwide.
Doctors believe smoking causes lung cancer by damaging the cells that line the lungs. When you inhale cigarette smoke, which is full of cancer-causing substances (carcinogens), changes in the lung tissue begin almost immediately. At first your body may be able to repair this damage. But with each repeated exposure, normal cells that line your lungs are increasingly damaged. Over time, the damage causes cells to act abnormally and eventually cancer may develop
Dr. Malhotra explains, “While many cases of lung cancer can be attributed to tobacco smoking, anyone with lungs can get this disease – and we’re seeing an increasing number of patients who never smoked at all. In addition to tobacco use, the disease can be caused by breathing secondhand smoke, exposure to substances such as radon, and having a family history of lung cancer. Knowing the facts and seeking care early are important.”
Manuel Villa Sanchez Chief Thoracic Surgery at Staten Island University Hospital adds, “It is most commonly seen in smokers but non-smokers can get it as well known risk factors are: tobacco smoke, second-hand smoke, exposure to radon, exposure to asbestos, personal or family history of lung cancer.”
The CDC says, “Adults who do not smoke and are exposed to secondhand smoke increase their risk of developing lung cancer by 20–30%. Secondhand smoke causes more than 7,300 lung cancer deaths each year among U.S. adults who do not smoke.”
Another myth is only older people get lung cancer, but according to John Hopkins Medicine that isn’t true. “The average age of a lung cancer patient in the United States is 70. However, about 30,000 people under the age of 50 will be diagnosed with lung cancer each year, and about 21,000 of them will die from the disease. Your risks of getting lung cancer at a young age may be determined in part by factors such as radiation therapy for a childhood cancer, or a genetic predisposition to lung cancer.”
Dr. Malhotra shares, “Signs to look for are a cough that may be associated with blood or red-colored phlegm (hemoptysis), chest pain or painful breathing, difficulty breathing or shortness of breath, and fatigue or a feeling of being unusually weak or tired. See a doctor if you experience these symptoms. The earlier lung cancer is detected, the better your chances for a successful outcome.”
According to Dr. Sanchez, “Most of the time lung cancer is asymptomatic, for it is usually detected in advanced stages with symptoms such as: shortness of breath, bloody sputum, chest pain, among others. Screening programs with low dose CT (LDCT) on patients deemed at higher risk have shown benefit in early detection and treatment with survival advantages.”
Dr. Malhotra states, “The bottom line is that we don’t always catch lung cancer in its earlier stages. This is primarily because the lungs are internal organs, and it is hard to know if cancer has formed. Sometimes, people do not feel symptoms until the cancer has advanced. Also, lung tumors often spread rapidly (metastasize) to other body parts, including the brain, liver, and bone.
It is challenging to catch lung cancer at its earlier stages because symptoms may not appear until the tumor grows. Additionally, it’s common to fear a cancer diagnosis, which means people tend to put off seeing their doctor or getting screened. The good news is that we are getting better at diagnosing lung cancer much earlier than before. A low-dose CT scan is a quick, painless, and non-invasive approach to screening for lung cancer. We know that only a small percent of people who are eligible to be screened for lung cancer get the screening. Early detection is key to surviving lung cancer.”
Dr. Malhotra suggests, “If you receive a lung cancer diagnosis, seek out a consultation at a National Cancer Institute- designated cancer center where there are experts who specialize in lung cancer and who can help you access the latest therapies. There is new hope for people with this disease and it starts with getting the right diagnosis and the best treatment plan for you from the beginning.”
Dr. Sanchez explains, “There are two main types of lung cancer: Non-small cell lung cancer NSCLC (80-85%) and small cell lung cancer SCLC (10-15%). At SIUH we fight lung cancer with a multi-disciplinary approach, a team composed of specialists from thoracic surgery, medical oncology, radiation oncology, pulmonary medicine, interventional and diagnostic radiology. This team approach allows us to formulate a comprehensive approach aimed at achieving the best outcomes. We also have a lung cancer screening program focused on early diagnosis and treatment of lung cancer for the local community of Staten Island.
The mainstay of treatment for lung cancer is surgical resection, at SIUH we have the resources and technology to deliver state-of-the-art treatment. We perform minimally invasive robotic surgery on our lung cancer patients which is associated with less postoperative pain, faster recovery, and discharge home and excellent oncological outcomes. The role of medical oncology is treating lung cancer patients with standard chemotherapy as well as with immunotherapy and targeted therapy. Radiation oncology intervenes with standard radiotherapy and stereotactic body radiotherapy (SBRT) as standalone treatments or as part of multi-modality therapy. Interventional radiology offers radiofrequency ablation (RFA) as another therapy that has shown benefit in the treatment of lung cancer.”