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Q&A: Screening, Treating, & Surviving Lung Cancer

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Tuesday, August 09, 2005

By Miranda Hitti

Lung cancer is the No. 1 cause of cancer deaths for U.S. men and women. Health professionals agree that smoking greatly raises the risk of lung cancer and that quitting smoking can have major health benefits. But all smokers don't get lung cancer, and all lung cancer patients aren't smokers.

WebMD spoke about lung cancer and lung cancer survival with Jay Brooks, MD, chief of hematology and oncology at the Ochsner Clinic in Baton Rouge, La.

Q. Dana Reeve, widow of actor Christopher Reeve, has announced that she has lung cancer. A spokeswoman for the Christopher Reeve Foundation reportedly said that Dana Reeve didn't smoke but didn't elaborate on that. How many people get lung cancer who do not smoke?

A. Less than 5 percent of people who get lung cancer have a history that [doesn't include] tobacco. That is either directly smoking cigarettes or cigars, or they do not work in a smoking-related environment. What that means is either in a home with a smoking spouse or having tobacco exposure in a workplace.

Q. So you're talking about heavy tobacco exposure?

A. Well, there is no safe level of tobacco exposure. No one has ever calculated a dose that is a safe level.

Q. What do we know about the people who are in that less-than-5 percent group?

A. They're a group of patients that we don't completely understand why they develop lung cancer. There are some unusual types of lung cancer that they could [have].

(WebMD received a news release on that topic from the American Cancer Society. The news release states, "A spokesperson is quoted as saying Ms. Reeve is not a smoker. Lung cancer does occur in people who have never smoked, even though cigarette smoking is by far the biggest risk factor for lung cancer in the U.S., causing an estimated 80 percent of lung cancers in women and 90 percent in men. Known risk factors that may affect never-smokers include exposure to secondhand smoke and radon, as well as occupational exposure to asbestos and certain chemicals and metals. Genetic susceptibility is thought to play a greater role in people who develop lung cancer at an early age. Fewer than 3 percent of lung cancers occur in people under the age of 45.")

Do Any Treatments Work?

Q. Some people say they've heard that even if lung cancer is flagged early, there are no good treatments.

A. I'm not going to say that. I think that's a very fatalistic approach. We desperately need ways of detecting early lung cancers. But I think there is a group of patients who are diagnosed with lung cancer in whom surgery can effectively cure them of their lung cancer. The use now of chemotherapy after lung cancer has been operated on definitely can improve the chances of being alive. The use of combinations of chemotherapy and radiation therapy can also improve the chances of patients who have more advanced stages of lung cancer.

Q. If there are benefits to early detection, why isn't everybody getting an annual lung X-ray?

A. For someone like myself -- I'm 51 years old, I've never smoked a day in my life, my father smoked when I was a child -- I don't consider lung cancer a very high priority in my health screening. I take care of some physicians in our organization. Some of them have had a smoking history in the past and they've asked about doing CT [scans] of the chest. Some of them have had CAT scans done, and what I've told them is, "Understand that if we do this test, we may be detecting something that we don't know quite what to do with yet." I've explained that the information is still out on that.

(Previously, Brooks told WebMD that a large study has just been done on using CAT scans to screen people at high risk of lung cancer. The results of that study aren't in yet. Chest X-rays "have not really been shown to be completely beneficial" for lung cancer screening, Brooks told WebMD recently.)

The Success Stories

Q. Some people have commented that ABC News anchor Peter Jennings had stopped smoking for 20 years and still got cancer. The question they ask is, why should they quit?

A. The same argument you can make [is], "I drive in my car for 20 years, I never wear a seatbelt, and I go 20 miles over the speed limit. I've never had a problem." That's a true statement. But if you do that long enough, statistically, something bad is going to happen. It's never too late to stop smoking, but you have to understand that the effects in terms of lung cancer linger much longer than that of [heart] disease.

Q. What success stories come to your mind from patients you've treated?

A. I have a patient today who's 60 years old. I treated her 14 years ago. She presented with a lung cancer that had spread to her brain. She was operated on, had brain surgery, had the lung cancer removed, was then treated with chemotherapy and radiation. Five years ago, I think, [she] developed a second lung cancer which was successfully operated upon, and [she] is doing well today. That's a very unusual situation, but it's a real situation.

The statistics are, unfortunately, that 90 percent of people who are diagnosed with lung cancer will die of lung cancer. But there's a 10 percent group of people who don't.

Q. Once someone has been diagnosed, besides quitting smoking, are there other things that can be done?

A. I think if they were diagnosed with a lung cancer, I think they should be seen by an oncologist, because I think that individual will have the expertise to give them the very best in terms of all the latest treatment options that are available. I truly encourage patients to participate in research trials, which allows patients to be exposed to the latest therapeutic advances.

By Miranda Hitti, reviewed by Brunilda Nazario, MD

SOURCES: Jay Brooks, MD, chief of hematology/oncology, Ochsner Clinic, Baton Rouge, La. Reuters. News release, American Cancer Society. Reuters.

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