What are the chances that you will develop lung cancer? That depends primarily on whether or not you smoke or have ever smoked. It also depends on how much you smoke, how long you have smoked and how young you were when you started. If you have never smoked, you have only about a one percent chance of developing lung cancer in your lifetime.
“Ninety percent of males and 80 percent of females with lung cancer are smokers,” says John Sprandio, M.D., a medical oncologist in the Crozer-Keystone Health Network. “People who have been very heavy smokers for 30 years have almost a one in three chance of developing lung cancer. For others who have smoked less than a pack a day for a shorter period of time, such as 10 years, the risk is lower at five or six percent. No matter how long you have smoked, quitting will reduce your risk of lung cancer to some extent.”
What about the one percent of non-smokers who develop lung cancer? Research studies suggest that exposure to secondhand smoke causes about 17 percent of these cases. “Secondhand smoke is especially detrimental to infants and young children,” Dr. Sprandio advises.
Genetic predisposition and environmental factors such as exposure to radon or asbestos are also known to increase the risk of lung cancer for non-smokers and smokers. “Pennsylvania sits on a radon belt,” notes Dr. Sprandio. “So it’s important for residents to have their houses tested and remediated if the radon level is found to be high.”
People who smoke and have worked around asbestos have an extremely high risk of developing lung cancer, especially a type called mesothelioma. “We see a fair amount of this in Delaware County because of past industry located in this area,” Dr. Sprandio says.
Most people are diagnosed with lung cancer in advanced stages because the disease has no early symptoms. The classic warning signs – chronic cough, shortness of breath and blood in the sputum – don’t occur until the later stages. In 2004, the American Cancer Society recommended that physicians should consider chest X-ray screening for people who smoke even if they don’t have symptoms, weighing the potential risks and benefits on an individual basis. “This recommendation is opening the door for potential widespread screening for lung cancer in the near future,” says Dr. Sprandio.
Studies have also shown that low dose CAT scans can detect more lung cancer at earlier stages than a chest X-ray. “When people are diagnosed earlier, they quit smoking at a higher rate and survival rates improve,” notes Dr. Sprandio. Patients diagnosed at Stage I have a 60 percent chance of survival. At Stage II, survival is cut roughly in half to a range of 25 to 35 percent.
Through Crozer-Keystone’s affiliation with the nationally renowned Fox Chase Cancer Network, Dr. Sprandio and his colleagues discovered the value of ordering annual PET scans for patients with a history of lung cancer. “If these patients develop a second lung cancer and we find it in the early stages, we treat them with chemotherapy and we’ve been able to cure them of the second lung cancer,” he says. “Working with Fox Chase, we were nine years ahead of everyone else in doing this. I think annual screening will eventually become standard practice as an increasing number of studies prove the benefits.”
New Staging Techniques
Correctly diagnosing the patient’s stage of lung cancer is essential to providing the most effective treatment. About two years ago, Crozer-Keystone acquired an advanced combination CT PET scan machine that enables physicians to see metabolic activity in the body. This helps them determine the likelihood that cells are cancerous as well as the stage of cancer. Dr. Sprandio says that the combination of a low dose CT scan and PET scan is so effective that he expects it to replace biopsy as the standard for lung cancer diagnosis in the very near future.
New Treatments Improve Survival
Research has shown that a patient with Stage III lung cancer treated with surgery alone has a 25 percent chance of survival. When four cycles of chemotherapy are added, the survival rate increases significantly to 41 percent. This combination of surgery and chemotherapy holds promise for patients with Stage I, II and III lung cancer, improving their chances of survival by 10 percent or more. “We find that this combination improves the patient’s quality of life and either prevents or delays complications of cancer,” says Dr. Sprandio, also noting that patients benefit by receiving chemotherapy prior to surgery.
“Giving chemotherapy before surgery gives physicians the opportunity to assess how well the tumor is responding to the drug so we can refine treatment if necessary postoperatively,” Dr. Sprandio explains. “Choosing the proper chemotherapeutic drugs for lung cancer is more complex today because we have a much wider variety. Fifteen years ago, we had only two.”
New drugs developed over the past decade are making chemotherapy more effective and more easily tolerated by patients. Side effects such as fatigue and nausea have significantly decreased in many cases. A relatively new drug called Avastin®, which prevents the development of new blood vessels, has been shown to significantly improve survival rates for those with advanced lung cancer when combined with chemotherapy. Dr. Sprandio is using another newer drug, Tarceva®, to treat women with lung cancer who are nonsmokers. “I have patients who have been stable to improving for the past two years by taking this one pill a day without a drop of chemotherapy.”
Dr. Sprandio uses a combination of Avastin and Tarceva with patients for whom chemotherapy was unsuccessful; overall 80 percent of these patients benefit from this combination.
When patients can’t undergo surgery because of age or other medical problems, stereotactic radiation is often used. This advanced treatment involves the use of a cyber-knife, an instrument that concentrates radiation to a very well-defined tumor area.
Another advanced tool is radiofrequency ablation. “Essentially, we microwave the tumor,” says Dr. Sprandio. “It gives the patient a break from chemotherapy. In some patients, the disease is arrested by this technique and they don’t need chemotherapy again for years.”
“We’re encouraged by these new developments,” he concludes. “Even when patients are not cured, we can often help them enjoy a better quality of life.”