Lung cancer is the leading cause of cancer deaths worldwide.1 In the United States, more people die from lung cancer than any other type of cancer.2 November is Lung Cancer Awareness Month, and to help us gain a better understanding of the condition, the screening process, and treatment options, we sat down with Chakravarthy Reddy, MD, pulmonologist at the University of Utah Huntsman Cancer Institute in Salt Lake City, UT.
What Is Lung Cancer?
Lung cancer occurs when cells in the lungs change or mutate, resulting in abnormal cell growth. These cells multiply uncontrollably, forming a tumor and spreading to other parts of the body.
“Stage one or stage two, where patients are potentially curable, have almost no symptoms at all; it’s always incidentally found,” Dr. Reddy explains. “A patient has a scan for some other reason, and the cancer is detected in the lungs.”
When lung cancer symptoms do manifest, they can include a cough that worsens or does not resolve, chest pain, shortness of breath, coughing up blood, wheezing, weakness or fatigue, and weight loss.4 “Unfortunately, by the time a patient presents with symptoms, they’re in advanced stages, and their survival is not as good,” says Dr. Reddy.
What Are Risk Factors for Lung Cancer?
Smoking is by far the leading cause of lung cancer, putting people who smoke at a significantly higher risk of developing lung cancer compared to non-smokers.5
In addition to smoking, breathing secondhand smoke is also dangerous, increasing the risk of lung cancer.6 “We always talk about smokers, but there is a correlation between people who live with smokers and their risk for developing lung cancer,” Dr. Reddy adds. “Secondhand exposure does increase the risk of developing cancer.”
The American Cancer Society lists other risk factors for lung cancer, which include:5
A naturally occurring radioactive gas, radon is the breakdown of uranium in soil and rocks. Potential risk areas are homes with basements.
Asbestos is a mineral fiber that occurs in rock and soil.7 People who work with asbestos (e.g., in mines, mills, textile plants, shipyards, and where insulation is used) are several times more likely to die of lung cancer.
Exposure to cancer-causing agents, such as uranium, arsenic, beryllium, cadmium, nickel compounds, coal products, and diesel exhaust can increase lung cancer risk.
Personal or Family History
If an individual has lung cancer, there is a higher risk of developing another lung cancer. Brothers, sisters, and children of people who have had lung cancer may have a higher risk.
Previous Radiation Therapy to the Lungs
People who have had radiation therapy to the chest for other cancers are at a higher risk of lung cancer, particularly if they smoke.
In cities, air pollution can increase the risk of lung cancer, with some research suggesting approximately 5% of all deaths from lung cancer may be due to outdoor air pollution.
Who Should Be Screened for Lung Cancer?
The recommended screening test for lung cancer is a low-dose CT scan.8 According to the United States Preventive Services Task Force, those eligible for screening must meet the three-pronged criteria:9
Age ǀ Adults aged 50-80 years
Smoking History ǀ Individuals with a 20 pack-year smoking history
Tobacco Exposure ǀ Current smokers or those who have quit within the past 15 years
Age is a straightforward benchmark, but calculating a pack-year may seem foreign to most. “Multiply the number of packs of cigarettes you smoke per day by the number of years you’ve smoked. This gives you the value, which we call pack-years,” Dr. Reddy explains. An example would be if a person has smoked a pack of cigarettes for 20 years or two packs for 10 years, each of these instances would calculate a 20 pack-year history.
The third criterion addresses tobacco exposure—but what is the significance of a 15-year time span? “It takes about 15 years for the risk [of lung cancer] to normalize,” Dr. Reddy says. “If it’s been less than 15 years since the patient quit, then the third criterion for lung cancer screening is met.”
This also means if a patient does not meet the criteria, screening will not happen. Dr. Reddy encourages people who are under 50 who have a 20 pack-year history to speak with a physician about any concerns, personal risk factors, and the benefits of being screened.
What Lung Cancer Treatment Options Are Available?
When lung cancer is caught early, there are more curative options. Unfortunately, as Dr. Reddy mentioned, lung cancer is normally caught in late stages. A surgery called a lobectomy, which removes one of the lobes in the lung, is only an option for stage 1 or 2 cancer. “Patients who come in with lung cancer don’t have healthy lungs to begin with,” Dr. Reddy says. “It’s more likely they also have emphysema from smoking, and they probably won’t tolerate removal of even a lobe.”
If a patient’s lung function is borderline, Dr. Reddy suggests another surgical option called a wedge resection, where the lobe is spared, and only the cancer is removed. “It’s not preferred, but if that’s the only option, it’s better than not doing anything,” Dr. Reddy says. “If their lung function is any worse than that, then we clearly cannot do any surgery at all. We have to think of second-line approaches, such as radiation therapy.”
According to Dr. Reddy, lung cancer that spreads first to the lymph nodes in the chest is still potentially curable. However, once it leaves the chest and invades the chest cavity and other parts of the body, such as the adrenal glands, the brain, or bones, it is potentially no longer curable. When this occurs, palliative care is the only option, relieving symptoms and mitigating suffering while optimizing patient quality of life.
To relieve common lung cancer symptoms, such as shortness of breath or a persistent cough, there are options. “One of the things we do is use balloons to dilate [the airway passages],” Dr. Reddy explains. “Merit makes Elation® balloons, which we find extremely useful, especially because they are available in short, two-centimeter balloon configurations.”
A second approach is to stent the tumor in the lung to maintain the patency of the airway. An option for this line of treatment would be Merit’s AERO® Tracheobronchial Stents. “Patients notice an improvement immediately, almost right after they wake up from the procedure,” Dr. Reddy says. “The radial force of the AERO stent actually keeps the airway open, and that improves shortness of breath.”
Lung Cancer Awareness Resources
As lung cancer awareness is heightened this month, it is critical to share facts about the importance of screening with loved ones and encourage those who smoke to quit.
Knowledge is power, and having health resources to help understand lung cancer better is important. In addition to information about the disease, the below organizations provide a wide range of topics, including survivor stories and ways to get involved throughout the month, helping patients and families in their battle against lung cancer:
Support for Merit EmployeesIf you smoke and need help quitting, sign up for our Employee Smoking Cessation program. Contact Dr. Priest for more information.
Merit Medical is dedicated to improving the lives of people, families, and communities worldwide. Learn more about the trusted interventional and palliative treatment options we offer to help physicians care for lung cancer patients.
- World Health Organization. 2021. “Cancer Key Facts.” https://www.who.int/news-room/fact-sheets/detail/cancer
- Centers for Disease Control and Prevention. 2021. “Lung Cancer Statistics.” https://www.cdc.gov/cancer/lung/statistics/
- American Lung Association. 2021. “Lung Cancer Basics.” https://www.lung.org/lung-health-diseases/lung-disease-lookup/lung-cancer/basics
- Centers for Disease Control and Prevention. 2021. “What Are the Symptoms of Lung Cancer?” https://www.cdc.gov/cancer/lung/basic_info/symptoms.htm
- American Cancer Society. 2019. “Lung Cancer Risk Factors.” https://www.cancer.org/cancer/lung-cancer/causes-risks-prevention/risk-factors.html
- Centers for Disease Control and Prevention. 2021. “Health Effects of Secondhand Smoke.” https://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/health_effects/index.htm
- United States Environmental Protection Agency. n.d. “Learn About Asbestos.” https://www.epa.gov/asbestos/learn-about-asbestos
- Centers for Disease Control and Prevention. 2021. “Who Should Be Screened for Lung Cancer?” https://www.cdc.gov/cancer/lung/basic_info/screening.htm
- United States Preventive Task Force. 2021. “Lung Cancer: Screening.” https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/lung-cancer-screening