“We’ve made tremendous strides in treatment and diagnosis of lung cancer and, in many cases, it can be more akin to a chronic illness like hypertension, diabetes or congestive heart failure,” said Dr. Michael Layton, a pulmonologist with HCA Florida St. Lucie Hospital.
“Our ability to recognize and treat lung cancer in its early stages has increased survival rates substantially … [in fact], it’s not uncommon to see the five-year survival rate of stage 1 disease in excess of 80 percent,” Dr. Layton added. “Twenty years ago, if someone had stage 4 lung cancer the most appropriate care was palliative care, and while the survival rates remain low in that advanced stage, it’s still a lot better than 20 years ago when no one survived.”
All of that is very good news, since lung cancer remains the most common form of cancer, according to the American Cancer Society. An estimated 236,740 people will be newly diagnosed with lung cancer in 2022 and an estimated 130,180 people will die from the disease. That’s more than any other type of cancer and more than breast, prostate and pancreatic cancers combined.
Despite those grim numbers, the outlook for lung cancer patients is more promising than ever for all stages of the disease – primarily because more people are with diagnosed when the cancer is at an early stage and living longer as a result. A decline in smoking also plays a part.
The rate of localized, early-stage disease diagnosis increased by 4.5 percent yearly from 2014 to 2018 while there were steep declines in advanced disease diagnoses. The result was an overall increase in three-year survival rates. In 2004, 21 out of 100 people diagnosed with lung cancer were living three years after their diagnosis. By 2018 that number had risen to 31 out of 100 people – a 50 percent increase.
“Tobacco abuse causes 90 percent of lung cancer, but it can also be caused by secondhand smoke, exposure to radon and asbestos, radiation, air pollution including diesel fumes, arsenic and other chemical products that are found in the workplace,” Dr. Layton continued. “But as smoking becomes more socially unacceptable and more people are aware of its dangers, more smokers are quitting, resulting in a significant drop in the number of new cases.”
In fact, the American Society states that from 2009 to 2018 the rates of new cancer cases dropped almost 3 percent a year in men and almost 1.5 percent in women. The differences between men and women reflect historical patterns of tobacco use. Women began smoking in large numbers years later than men and were slower to quit.
Perhaps the best measure of progress against cancer is the trend in cancer death rates. Lung cancer death rates declined by 56 percent since 1990 in men and 32 percent since 2002 in women. These improvements in lung cancer mortality are due to a decline in smoking and advances in early detection and treatment.
But many of those former smokers turned to vaping as an alternative and the question now is: Will there by an uptick in lung cancer due to the new addiction?
“We really don’t know what is in the vape,” warned Dr. Layton. “Companies are not bound by the FDA to have any specific components. We know there are carcinogens in there, but we don’t know what else there is. There is vape-associated acute lung injury, probably as a result of vitamin E, which is in some the materials, but because lung cancer takes a long time to develop it’s difficult to make that association. E-cigarettes haven’t been around long enough to make a conclusive association.
“Marijuana is another substance that is inhaled into the lungs,” Dr. Layton added. “Changes have been identified in the epithelia lining cells of airways that are similar to changes you see when patients smoke cigarettes, but there haven’t been any studies that have made that association.
Many people who smoke marijuana also smoke cigarettes, so trying to isolate the cause and effect of each one of those may be more difficult because there’s a lot of bias introduced into the studies.
Clearly any time you inhale hot gases into the lungs, it can potentially harm or change the function of the lung.”
Both the amount and how long someone smokes increase the risk of dying from lung cancer.
That’s why the American Cancer Society recommends yearly lung cancer screening for anyone between the ages of 50 and 80 who has a 20-pack-year history and is still smoking or quit within the previous 15 years. Pack years are calculated by multiplying the number of cigarettes smoked per day by the number of years smoked.
“Unfortunately, fewer than 5 percent of those who qualify in the United States get screened,” said Dr. Layton. “It’s a simple, low-risk procedure done with a low-dose CT scan rather than a full CT scan. There are no needles involved, it only takes minutes to do and it’s covered by most insurances.
“If it’s done annually, those high-risk patients can reduce their risk of dying from lung cancer by 20 percent. If they quit smoking and get annual low-dose CT screening they can reduce the risk of dying by 40 percent. Those numbers are huge. These screenings should be done yearly for 15 years past the time they quit smoking or until they reach the age of 80.”
Doctors would like to see lung cancer screening become as common as mammograms for breast cancer, pap smears for cervical cancer, and colonoscopies for colon cancer. Simply put, quitting smoking and getting annual screening can make the difference between living with or dying from lung cancer.
Dr. Layton completed his medical school, internship and residency at Creighton University. He went to University of Florida for his fellowship in pulmonary medicine. His office is located at HCA FL St. Lucie Medical Specialists-Hillmoor, 1700 Hillmoor Dr., Suite 505, Port St. Lucie. Call 772-398-7826 to schedule an appointment.