Lung Cancer: Latest on Screenings, Vital Facts for Smokers and Non-Smokers

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February 18, 2021

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Lung cancer remains the leading cause of cancer deaths among both women and men. Smoking is by far the leading risk factor for lung cancer, causing more than 80 percent of deaths.

This month, the deaths of two celebrities from advanced lung cancer – actor Dustin Diamond, 44, and radio talk show host Rush Limbaugh, 70 — have put a fresh spotlight on this deadly disease, and the screenings that can detect it in its early stages.

Watch now: Hear from  Mark Dylewski, M.D., chief of general thoracic surgery at Miami Cancer Institute, about lung cancer risk factors and screenings. Video by Anthony Vivian.

About 25,000 people who have never smoked die of lung cancer each year. If counted as a separate category, lung cancers not caused by smoking would rank among the top ten causes of cancer deaths, says the American Cancer Society (ACS).

The radio host, Mr. Limbaugh, was famous for smoking cigars. He had announced in February 2020 his diagnosis of advanced lung cancer.  The actor, Mr. Diamond, 44, known best for his portrayal of Screech on “Saved by the Bell,” died only weeks after being diagnosed with stage 4 small cell carcinoma, or lung cancer. Almost all cases of small cell lung cancer are a result of smoking, the ACS says. But the actor had said he never smoked.

Mr. Diamond’s diagnosis puts a fresh focus on rare cases of lung cancer that are not tied to smoking. But it is current and former smokers who are at the highest risk for lung cancer, said  Mark Dylewski, M.D., chief of general thoracic surgery at Miami Cancer Institute.

“With lung cancer, there’s two primary risk factors that we look at: family history and then the use of tobacco,” says Dr. Dylewski. “So, that’s very different than other cancers like breast cancer, where family history plays a role in screening– but there’s nothing in particular that people do or ingest significantly that we can identify puts them at risk for breast cancer. That’s different for lung cancer. We know that smoking causes lung cancer in the majority of people.”

Dr. Dylewski emphasizes that Baptist Health South Florida, through Miami Cancer Institute and other facilities, has one of the largest lung cancer screening programs in the U.S.

“We screen nearly a thousand or more patients a year,” Dr. Dylewski says. “Baptist Health has multiple centers where individuals can go in and receive the appropriate screening CT scan. It’s very easy to access and it’s low cost. Anybody who feels that they have a significant risk for the development of lung cancer should really pay attention to this information and seek out an opportunity to get a lung screening CT scan.”

Overall, the chance that a man will develop lung cancer in his lifetime is about 1 in 15; for a woman, the risk is about 1 in 17. These numbers include both smokers and non-smokers. “From 15 to 17 percent of people that we treat for lung cancer in any given year have not been exposed to significant tobacco use, and it tends to be more commonly seen in women between the ages of 50 and 70 who are non-smokers,” says Dr. Dylewski.

The recommended screening test for lung cancer is low-dose computer tomography (also called a low-dose CT scan, or LDCT). Such a test involves an X-ray machine that scans the body and uses low doses of radiation to make detailed pictures of the lungs.

“Historically, the majority of patients that were diagnosed with lung cancer in the U.S. were at Stage Three and Four,” said Dr. Dylewksi. “That used to be about 60 to 70 percent of patients, and that is changing with the implementation of screening with CT scans. And we’re catching more and more patients in the earlier stages — Stage One and Stage Two — where surgery can have an impact at curing those patients.”

Cancer screening with LDCT are recommended for people who:

  • Have a history of heavy smoking (average of one pack of cigarettes per day), and
  • Smoke now or have quit within the past 15 years, and
  • Are between 55 and 80 years old.

The ACS recommends yearly lung cancer screening with a low-dose CT scan (LDCT) for people at higher risk for lung cancer. Screening can detect lung cancer early, when treatment is more likely to be effective. “If you currently smoke or previously quit, are age 55 or over, and in fairly good health, talk with your healthcare provider about your risk for lung cancer, what to expect from screening, and if screening is a good option for you,” the ACS states.

According to the ACS, regardless of whether you have ever smoked, the most common symptoms of lung cancer are:

  • A cough that does not go away or gets worse
  • Coughing up blood or rust-colored sputum (spit or phlegm)
  • Chest pain that is often worse with deep breathing, coughing or laughing
  • Hoarseness
  • Weight loss and loss of appetite
  • Shortness of breath
  • Feeling tired or weak
  • Infections such as bronchitis and pneumonia that do not go away or keep coming back
  • New onset of wheezing

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