Each year, more people die of lung cancer than colon, breast and prostate cancers combined.
Lung cancer is often found late because symptoms don’t usually appear in its early stages. It often spreads before a persistent cough, chest pain or other warning sign alerts patients to a possible problem.
That helps explain why lung cancer remains the leading cause of cancer deaths in the United States,
“Two-thirds of cases are found late, when it’s hard to treat,” said Dr. Philip Ong, an interventional pulmonologist and medical director of bronchoscopy at University Health. “But, when it’s found early, the survival rate can be as high as 90%.”
Although no strategy can eliminate every risk, people can take steps to protect their lungs and determine whether screening is appropriate for them.
Lowering lung cancer risks start with tobacco
Cigarette smoking is the leading risk factor for lung cancer. The most important preventive step is not smoking -- or quitting, if you are a current smoker. Avoiding secondhand smoke at home and in vehicles is also important.
Quitting can be difficult, but people do not have to do it alone. Counseling, medication and other forms of smoking cessation support can help people manage cravings and kick the habit.
People who have never smoked can still be at risk
While smoking is the biggest risk, people who have never smoked can also develop lung cancer. Family history can contribute. Exposure to radon gas found in some homes or buildings, secondhand smoke and air or workplace pollution can also be factors.
“If you have a pair of lungs, you are at risk to get lung cancer,” Dr. Ong said. “About a quarter of people who have lung cancer have never smoked.”
Current screening recommendations focus primarily on age and smoking history. However, everyone should report persistent respiratory symptoms and follow up if an unexpected spot is found on a scan.
Who should ask about lung cancer screening?
Unlike a diagnostic test that’s ordered when someone is showing symptoms, screening looks for signs of disease in at-risk people who may feel well.
The American Cancer Society recommends yearly lung cancer screenings with a low-dose CT scan for adults ages 50 to 80 who smoke now or used to have at least a 20-pack-per year smoking history.
During the low-dose CT scan, the patient lies on a table that moves through the scanner taking images of the lungs. The scan is painless and only takes a few minutes.
Because screening guidelines and insurance coverage may differ, people with a significant smoking history should review their eligibility with a healthcare provider.
Know the symptoms of lung cancer
Screening is designed to find cancer before it causes symptoms. Warning signs include:
- A persistent cough
- Coughing up blood
- Chest pain, shortness of breath or wheezing
- Unexplained fatigue, weight loss, pneumonia or another respiratory illness
“When you have things like this happening, don’t ignore them,” Dr. Ong said.
An unexpected lung nodule should not be ignored
A lung nodule -- sometimes described as a spot on the lung -- may be discovered during screening or on a CT scan performed for another reason. This can be especially important for people who have never smoked and do not meet current screening criteria.
Most lung nodules are not cancer. Depending on a nodule’s size, appearance and the patient’s risk factors, a provider may recommend monitoring it with another scan or examining it more closely.
“The good news is that 95% of these nodules are benign, but we need to find which one is cancer and which one is not,” Dr. Ong said. “If you have a spot, make sure that you know it’s being monitored.”
Robotic technology can help doctors investigate small nodules
When a nodule looks suspicious, a biopsy may be recommended to determine whether it is cancer. University Health uses ION robotic bronchoscopy, a thin, flexible tube the physician inserts through the patient’s mouth and into the windpipe and airways of the lungs. When it reaches the nodule, it removes a small tissue sample for testing.
It is often a safer process than a traditional needle biopsy where the needle is inserted through the chest wall. That process increases the risk of puncturing the lung and causing it to collapse.
Dr. Ong says robotic bronchoscopy -- performed under general anesthesia -- is also very precise, allowing physicians to more easily obtain tissue from small or difficult-to-reach spots.
Early diagnosis saves lives
Early diagnosis through scans and robotic bronchoscopy can help a multidisciplinary care team determine the cancer’s stage and identify options that may include lung-preserving surgery, immunotherapy or medications targeted to specific features of a tumor.
“In the past, lung cancer was a depressing line of work,” Dr. Ong said. “Now it’s full of hope.”
You can learn more about lung care and treatment at University Health.