At last, there is a growing grassroots effort to increase the public and medical profession’s interest in lung cancer. Lung cancer is by far, the most common fatal malignancy in both men and women in the United States today. As a matter of fact, lung cancer kills more women than breast, ovarian, and uterine cancer combined. We know exactly what causes lung cancer, but we are not making much progress in dealing with it. Smoking, which is responsible for at least 90% of lung cancer, continues in about 25% of our population with 47 millions smokers at risk. Even former smokers remain at risk for at least twenty years or more after stopping smoking. Since there are approximately 45 million former smokers, over a hundred million people in this country are at risk of developing lung cancer sometime in their lifetime.
Unfortunately, no physicians’ organization, or even the American Cancer Society recommend screening for early diagnosis. The reason is that studies sponsored by the National Institutes of Health more than twenty years ago, did not show a great improvement in lung cancer mortality in a large, screened population. When screening was done, more early cases were found, and survival was actually improved. These studies are now believed to be inadequate, because they did not screen the patients at highest risk. In a study conducted recently in Colorado where we did sputum pap tests, which look for malignant cells in sputum that is coughed from deep portions of the lung, we have found a large number of hidden cancers in early stages of disease. The population screened smoked a pack a day or more for more than thirty, or in most cases, forty years. These individuals were also selected because they had some degree of airflow obstruction, as measured by spirometry. In this group of people, we found 2% lung cancer. Subsequent studies are revealing additional hidden tumors. We estimate that 4% to 5% of those screened will be found to have lung cancer in early and curable stages. Mammo-graphy only yields .4% to .5% positive results in women in the highest risk age group. Why do we continue to ignore lung cancer in the light of this new information? Unfortunately, lung cancer is not a man’s or a woman’s issue. Prostrate and breast cancer, though far less of a problem, receive most of the attention.
A new Association, the Alliance for Lung Cancer Advocacy, Support, and Education, (ALCASE), is developing a tour of regional workshops entitled, “Lung Cancer: A Revolution in Care”. The purpose is to increase the public’s and profession’s awareness of the fact that lung cancer can be identified early, and cured. People should be identified and diagnosed early, and treated by pulmonologists, oncologists, and surgeons when the chance of cure is high. In response to the pleading of experts in lung cancer identification, including myself, the American Cancer Society has agreed to rethink their position on screening. But even before we get their blessing, patients who are heavy smokers and have airflow obstructions, and particularly those with a family history of lung cancer, should ask their doctor for a sputum pap test, chest x-ray, or CT scan to be able to diagnose lung cancer early and treat it effectively.
I will be in touch next month.
Thomas Petty, MD