By Cindy Dashnaw Jackson
November 1, 2023
Screening could stop lung cancer in its tracks, especially for women
By Cindy Dashnaw Jackson
Lung cancer leads to more deaths of women than cervical and ovarian cancers combined and kills twice as many women as breast cancer. The good news? Getting a lung scan could save many of these lives.
November is Lung Cancer Awareness Month, a good time to remind eligible women that getting a lung scan is every bit as important as a mammogram, colonoscopy or Pap test.
“Screening works because it finds lung cancer at an earlier stage, and finding cancer early decreases the risk of death by at least 20 and maybe as high as 40 percent,” said Catherine R. Sears, M.D. “A lot of what I work on, both with lung cancer screening and my research, is trying to diagnose lung cancer as early as possible so we can cure it.”
She and Nasser Hanna, MD, who founded and chairs End Lung Cancer Now, are two of the many doctors and researchers at the IU Simon Comprehensive Cancer Center who speak passionately about preventing lung cancer deaths in women.
“We don’t have to discover anything new,” Hanna said. “We just need to implement what we know works.”
Cigarette smokers and non-smokers are at risk.
“One in 17 women in the United States will develop lung cancer. That means you or someone around you will get lung cancer,” said Sears. “The way to end lung cancer is to find it early. The earlier the better! That’s why screening is so important.”
Between 80 and 90 percent of lung cancer cases stem from cigarette smoking, and Indiana ranks high for females who smoke cigarettes. According to American Health Rankings, 18 percent of Indiana women ages 18-44 smoked cigarettes almost daily in 2020, notably higher than the national 12 percent. Though smoking cigarettes has declined nationally, truth.org writes that women aren’t quitting as quickly as men: “Smoking rates among women have dropped by about 59 percent since 1965, compared with a 66-percent drop among men.”
The slow decline in cigarette smoking coincides with another statistic: a slower decline in lung cancer diagnoses for women than men. (Lung Cancer Research Foundation) If the trend continues, warn researchers Christina R. MacRosty and M. Patricia Rivera in Lung Cancer in Women: A Modern Epidemic, “Lung cancer mortality rates in women are estimated to exceed those in men by 2045.”
Patients who quit smoking cigarettes before starting cancer treatment have a 45-percent higher survival rate than those who continue to smoke. Watch It's Never Too Late to Quit Using Tobacco, Even After a Cancer Diagnosis.
Cigarette smoking is the No. 1 risk factor for developing lung cancer but not the only one; those who do not smoke cigarettes get lung cancer, too. Up to 20 percent of those diagnosed have never smoked cigarettes—and they are nearly twice as likely to be women as men. (John Hopkins Medicine)
Women may have other risk factors for lung cancer, too—more than men, even after controlling for smoking history. Cancer.org cites studies like this one:
“Women between the ages of 30 and 49 are being diagnosed with lung cancer at higher rates than men, at the same age and in many high-income countries [including the U.S.], according to a new study published in the International Journal of Cancer ... [and] the authors said that differences in smoking between men and women do not completely explain the pattern.”
This higher risk for women may be related to how cigarettes are made now compared to in the past or the way women respond to agents in tobacco, “such as not being able to repair damaged DNA or having abnormal genes related to cancer development.”
Yet, multiple studies suggest that women benefit more from lung cancer screenings.
Don’t wait. Ask your doctor.
Lung cancer screening is painless. After answering a few questions, completing the low-dose CT scan takes less than three minutes.
“You do what’s called a shared decision-making visit with your doctor first that includes talking about your habits and your health. You make the decision whether to get a scan together,” said Sears. “It is a low-dose CT scan, so it’s lower radiation than a normal CT scan. You can schedule it for whenever it’s convenient for you. The scan is then read by a radiologist who is experienced in looking for signs of lung cancer.”
Annual lung cancer screenings are recommended for women (and men) ages 50 to 80 with a smoking history of at least 20 pack-years and who smoke now or quit within the past 15 years.
A pack-year describes how many cigarettes a person has smoked in their lifetime at 20 cigarettes per pack. For example, smoking an average of one pack per day for 20 years equals 20 pack-years, two packs per day for 20 years equals 40 pack-years, a half pack per day for 20 years equals 10 pack years. Calculator
Women who meet the eligibility criteria above should not wait for their doctor to bring up lung cancer screening. They should advocate for their own health. As recently as May 2020, a study in the Journal of Thoracic Oncology found that “one-half of primary care physicians (PCPs) were not familiar with [current lung cancer screening] recommendations,” and enrollment among eligible patients was as low as 2 percent to 4 percent.
“Lung cancer screenings will help diagnose more Stage I non-small cell lung cancers that can benefit from curative treatment,” said Sears. “Screenings have been endorsed in this country for more than a decade now, yet the medical industry is still debating whether everyone who’s at high risk for lung cancer is properly identified for screenings. Unfortunately, this debate hits women the hardest.”
The result, said Hanna, is that few women eligible for lung scans ever get them.
“While 75 percent of women regularly get mammograms, just 7 percent of eligible women get lung scans. Why? Because they don’t know they need them,” he said. “Right now, women rely on their healthcare providers to tell them what they need, but primary physicians are asked to do so many things already. This is just another one, and they don’t all do it or even know they should do it.”
Hanna believes the electronic medical record (EMR) is an excellent place to start increasing the number of lung cancer screenings for women.
“The EMR is a powerful tool for all sorts of things: tracking smokers, flu shots, colonoscopies, blood pressure trends, etc. Implementing a scan trigger within the EMR is an easy programming thing to do.”
When a woman comes in for a mammogram, for instance, the system EMR would automatically check for other actions that are due: COVID vaccination, lung screen, colonoscopy, etc.
Further, making this more of a routine touch-base could start softening another stumbling block to women getting lung cancer screenings: The stigma surrounding the disease.
Lung cancer stigma can be a roadblock to treatment.
A significant factor in whether a woman will address the potential for lung cancer, said Hanna, is fear of society’s reaction: If she smokes tobacco products, getting cancer is too often viewed as her own fault.
“Lung cancer is the one cancer in particular where there’s a stigma, and when you feel guilt and shame for having the diagnosis, you’re less likely to advocate for yourself or want advocacy on your behalf,” Hanna said.
The consequences of these negative attitudes are far-reaching, affecting everything from care and treatment to research funding. In reality, lung cancer research holds infinite promise for treating and curing so many other types of cancer.
“The lung cancer stigma is so counterproductive. In cancer research, there’s no other solid-tumor cancer that gives us more information about how to attack the overall cancer problem—cancer of all types—than studying lung cancer,” Hanna said. “Lung cancer is the result of decades of continuous exposure to carcinogens that cause tens of thousands of genetic alterations, so we learn a tremendous amount about cancer just from researching lung cancer.”
Women are already benefiting from this type of crossover research. For example, in his lung cancer studies, John Turchi, Ph.D., received a National Cancer Institute grant in 2021 to develop a drug that could make radiation therapy far more effective for lung cancer and also for head and neck cancers—which have been rising among women for decades.
Knowledge is power. Take control.
Both Drs. Hanna and Sears believe that the more women know about the life-saving benefits of lung cancer screening, the more women will advocate to get them.
“Women in general are more participatory in their own health and the health of others. They’re more likely to be advocates and fundraisers, get their screenings and engage in health prevention, be trusting and engage in the health system than men,” Nasser said.
Lung cancer screening could save your life or significantly improve your quality of life after a diagnosis. Talk to your doctor about lung cancer screening today. If you smoke cigarettes and can consider quitting, help is out there. If you have stopped smoking cigarettes, you may still qualify for lung cancer screening. And if you are ever diagnosed with lung cancer, know that you don’t deserve it. Anyone with lungs can get lung cancer.
About the Author
Cindy Dashnaw Jackson finds and tells nonprofit stories that inspire audiences to share, show up and support. She honed her ability to craft a message that fits an audience during 20 years in nonprofit PR and communications. Now a freelancer and founder of Cause Communications LLC, she's a copywriter and storyteller for nonprofits across the United States. And she earned her degree at IUPUI.