What Is My Risk of Getting Lung Cancer?

It was estimated by the American Cancer Society that there would be 161,840 deaths from lung cancer in 2008 (90,810 among men and 71,030 among women), accounting for about 29% of all cancer deaths. Additionally, it was estimated by the American Cancer Society that there would be 215,020 new lung cancer cases diagnosed in 2008 (114,690 among men and 100,330 among women), accounting for about 15% of all cancer diagnoses.  More women die each year from lung cancer than from breast, uterine, and ovarian cancers combined. Every hour of every day, 19 people die from lung cancer and at least 15-percent never smoked. Lung cancer is considered a silent killer, since the disease is most often not detected until it is in a terminal stage. (Source: American Cancer Society)

Approximately 90% of all lung cancers occur among smokers and approximately 10% occur among non-smokers. (MLF Note: Some recent research indicates that approximately 8% of men and 20% of women diagnosed with lung cancer were never-smokers--see High Rates of Lung Cancer Found for Female Non-smokers). Passive smoking contributes to the development of lung cancer among non-smokers and certain occupational exposures such as asbestos exposure are also known to cause lung cancer. (Source: National Cancer Institute)  "Although cigarette smoking is the most common cause of lung cancer, other risk factors include industrial exposures to agents such as asbestos, arsenic, uranium, nickel, and chromates as well as exposures to the indoor air pollutants such as formaldehyde and radon gas. There are a significant number of patients who do not have the risk factors outlined above. Lung cancer is not necessarily a self-inflicted disease by smoking. The incidence of lung cancer in women without a history of prior smoking has increased in recent years.  Histologic types of lung cancer are different between smokers and non-smokers. The majority of patients with no prior smoking have a histologic type of adenocarcinoma as opposed to either squamous cell carcinoma or small cell carcinoma, common in patients with prior smoking. Estrogens are known to act as tumor promoters through a receptor-mediated mechanism in reproductive organs. There are some reports of estrogen receptor expression in lung cancer, and it is possible that the lung is an estrogen-responsive organ and that women are more susceptible to lung cancer than men, suggesting a role for estrogen in the development of this disease." (Source: Noah C. Choi, M.D., Distinguished Scholar in Thoracic Oncology, Director of MGH Thoracic Oncology Center, Head of Thoracic Oncology Unit,  Massachusetts General Hospital) 

How Can I Find Out If I Have Lung Cancer?

Early Detection Low-Dose Spiral CT Scan Screening

"How do you discover a lung cancer while it is curable?  Doctors no longer rely nearly as much on routine annual chest X-rays in smokers, because there are better diagnostic techniques. In my own practice, I send everyone at special risk-particularly cigarette smokers, past or present, for a low-dose helical CT scan of the chest every year or two. This scan has detected several small cancers among my patients, who subsequently were cured." (Source: Face The Facts About Lung Cancer, by Dr. Isadore Rosenfeld, Boston Sunday Globe, 11/9/03)

"The best hope of curing lung cancer is finding it as early as possible. If you are at risk, this new test (CT scan) can detect tiny spots on your lungs years before they would even be seen on a regular chest x-ray. These tiny spots, or nodules may be signs of early lung cancer." (Source: The New York Early Lung Cancer Action Program)

"Lung cancer results in more deaths in the United States than any other malignancy, and accounts for more cancer deaths than breast, colon, and prostate cancer combined. Lung cancer causes no symptoms in its earliest stages. Moreover, the five-year survival rate for lung cancer is only 14 percent, a number that has not changed significantly in many years. These statistics underscore the dire need for the earliest detection possible. An effective screening technique that detects the cancer in its initial stages may help prevent death in the nearly 170,000 individuals diagnosed with this disease each year." "CT screening transforms the prognosis for lung cancer, just as mammography did for breast cancer and the PAP test did for cervical cancer." "The current five-year survival rate for lung cancer is only 14 percent But that could soar to 80% if all smokers and ex-smokers received annual CT exams and early treatment" (Source: Claudia I. Henschke, M.D., Ph.D., Professor of Radiology and Division Chief of Chest Imaging at the New York Weill Cornell Center of New York Presbyterian Hospital)

Spiral computed tomography (CT) of the chest performed in middle-aged smokers can help identify two to four times more lung cancers than chest x-rays, with more than 70 percent of the tumors still in Stage 1, according to an article on lung cancer in the first issue for November (2002) of the American Thoracic Society's peer reviewed journal, the American Journal of Respiratory and Critical Care Medicine. (Source: Intelihealth. com [a subsidiary of Aetna]).

The Early Lung Cancer Action Project.  Study population was 1,000 symptom-free volunteers of whom 46% were female and 54% were male.  The median age of this study was 67, the median pack years smoking was 47 and asbestos exposure was 14% of cohort.  The volunteers were considered medically able to have thoracic surgery.  Both chest x-ray and low-dose CT scan were utilized in the study.  The results of the study were as follows: (1) the low-dose CT scan detected nodules in 233 volunteers; the chest x-ray detected nodules in 68 volunteers.  (2) High Resolution CT scan evaluation of the volunteers in foregoing (1) showed that 27 of the 233 volunteers (2.7%) with CT scan detected nodules had Stage 1 resectable lung cancers, whereas 7 of the 68 volunteers (0.7%) with x-ray detected nodules had Stage 1 resectable lung cancers.  Study Conclusion was that low dose spiral CT scan is a useful way to identify early stage lung cancer in populations at high risk for developing lung cancer.  (Source: Lancet, July 10, 1999)

Early Lung Cancer Detection and Treatment Strategies. "Lung cancer is the leading cause of cancer deaths in both men and women in the United States. The majority of lung cancer patients will present with advanced disease with a very poor overall survival.  Although prior screening trials have shown no benefit from screening, there is renewed interest in low-dose CT screening as a screening modality for lung cancer. A high proportion of screen-detected cancers are early stage and resectable for cure. For the majority of these early stage patients, standard lobectomy is the treatment of choice. New options to potentially detect and treat early stage lung cancer will increase dramatically in the future." (Source: Port JL, Kent M, Altorki NK, Surg Oncol. 2002; 11:191-199)

In the June 24, 2003, Personal Journal section of the Wall Street Journal, Spiral CT Scan for early stage lung cancer detection was listed in an article entitled: "Five Tests Worth Paying For--Health Insurance Usually Won't Cover Them, but They Could Save Your Life"


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