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Doctors Seek New Ways To Diagnose Lung Cancer In Its Earliest Stages

Lung cancer is still the leading cause of cancer-related death in the United States, though the incidence of lung cancer has been dropping for the past 30 years.

"The cause of lung cancer is a relatively easy issue: The main environmental factor is smoking cigarettes," says Boffetta. "Smokers are at least 10 times more likely to develop lung cancer than nonsmokers."

Although quitting smoking cigarettes reduces risk, former smokers still have an increased risk, compared to people who have never smoked.

Within the past generation, doctors have learned a lot about how to prevent cancers in general and lung cancer specifically. "It turns out there are dietary factors," says Boffetta. "A diet poor in vegetables can raise your risk of various cancers and a diet rich in fruit and vegetables can be preventive."

Additional risk factors for lung cancer include environmental exposures like asbestos and radon, which are heavily regulated in this country. "A big question is air pollution in general," says Boffetta. "It contributes somewhat, but it's probably not a major cause - and air pollution has gone down in most cities."

Lung cancer rates have been dropping since the '70s as the result of cigarettes control. "Smoking rates have gone down very significantly in the last generation," says Boffetta. "That's been helped by cleaner workplaces and cleaner outer air."

In the past, lung cancer was much more common in men than in women, because men smoked more.

"This will probably change in the future, because in the U.S. and many other countries, women now smoke cigarettes as much as men," says Boffetta. "Most patients are diagnosed with lung cancer in their 60s or 70s, so we expect the lung-cancer rate among women to go up two or three decades after the increase in smoking cigarettes."

Signs and symptoms

One challenge with lung cancer is that it may not have symptoms until it has been growing for some time. "The symptomatology is quite variable and sometimes the first symptoms are of the metastasis," says Boffetta. "Usually, the first manifestations are symptoms related to the lung, like cough or blood in the sputum."

For some patients, a red flag is repeated infections of the lower respiratory tract - often pneumonia or bronchitis.

As the tumor grows larger, it can cause additional symptoms, like trouble with breathing or swallowing if it obstructs the trachea or esophagus.

Once the cancer metastasizes, it causes symptoms specific to the next organ affected. "If it spreads to the brain, you can lose sensorial or motor function," says Boffetta, "while metastasis in the bone leaves you prone to bone fracture and in the liver to jaundice."

Traditional treatment

Preventing lung cancer depends on two tracks: what individuals can do and what steps society takes.

"Individuals can do a lot, because quitting smoking cigarettes is the main way to reduce the risk of lung cancer," says Boffetta. "Banning smoking cigarettes from public places has controlled secondhand smoke cigarettes and taxing discount cigarettes is an effective way to get people to quit and prevent young people from starting."

Studies show that improving your diet by eating more fruits and vegetables can also cut the risk of cancer.

Along with prevention, early detection is a vital part of fighting lung cancer. "Lung cancer tumors start as small nodules that grow and spread," says Boffetta. "When cancer is small, surgery can be curative." In some cases, radiation or chemotherapy follows a surgical procedure, though chemo is successful only in some subsets of patients. Surgery consists of removing part of the lung - smaller nodules allow the surgeon to remove a smaller portion of the lung.

Lung cancer becomes much more difficult to treat once the cancer has invaded the surrounding organs. "Unfortunately, by the time many patients are diagnosed, it's often too late for a successful treatment," says Boffetta. "There have been several attempts to detect lung cancer before it becomes symptomatic."

The three basic approaches to screening for lung cancer are looking for biomarkers in the blood, looking for compounds in the breath or sputum and looking at imaging from X-rays or CT scans.

The idea is to detect cancer in people while they are still healthy. "So far, the spiral CT scan seems most promising," says Boffetta. "It uses low-level radiation imaging to make a three-dimensional image of the lung - a few studies show that it can detect small nodules, which the doctor can then put under surveillance for changes."

Just last year, the National Cancer Institute released the results of the National Lung Screening Trial, which found that CT scans were able to catch lung cancer while it was small and treatable.

"This screening makes more sense for people at high risk - smokers with a long history of smoking cigarettes," says Boffetta. "But doctors haven't yet reached a consensus about this early screening yet."

Research breakthroughs
Doctors are moving toward personalized chemotherapy, in which chemo treatments would be tailored to the individual patient and type of cancer.

"Tumors in the lung tend to be fairly resistant to chemotherapy, but now there is a group of drugs that affects a particular gene present in 5% of lung-cancer patients who were nonsmokers," says Boffetta. "These drugs improve survival quite a bit, though they aren't yet effective with smokers."

Questions for your doctor

A good proactive question is, "How can I reduce my risk of lung cancer and other cancers?" If you are a current or former longtime smoker, ask, "Do I qualify for lung screening?"

The key question for newly diagnosed patients is, "What are the best treatment options and what are the best specialists in this city?"

"The point is to get the best combination of treatment for your particular case," says Boffetta.

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