Lung cancer remains leading cause of cancer deaths

By Brian Hartz

Tuesday, November 5, 2019

The most common and consistently fatal form of cancer is also the one that’s most easily preventable: lung cancer.

Yet in the Hoosier state, the leading cause of the disease — smoking — is on the rise again after years of decline.

Dr. HannaHanna

“We are falling back in some areas,” Dr. Nasser Hanna, the Tom and Julie Wood Family Foundation Professor of Lung Cancer Clinical Research at Indiana University School of Medicine and a physician scientist at the IU Simon Cancer Center, said. “We’ve always been one of the five to 10 heaviest-smoking states in the country.”

According to America’s Health Rankings, in the past two years, more Hoosiers have been lighting up. It’s estimated that nearly 22 percent of Hoosier adults smoke, which is above the national average of 17.1 percent.

In 2015, the most recent year in which data is available, approximately 4,932 Hoosiers were diagnosed with lung cancer and 3,858 died as a result of the disease, according to the Indiana State Department of Health.

“Lung cancer kills more people every year than breast cancer, prostate cancer and colon cancer combined,” Hanna said.

Lung cancer kills more people every year than breast cancer, prostate cancer and colon cancer combined.”Dr. Hanna

Teen smokers

Cigarette smoking among teens has decreased in recent years, Hanna said, only to be replaced by the rise of e-cigarettes, vaping devices and increased use of marijuana. Therein lies the problem: Young people who smoke become adults who smoke, and even products like Juul, which are marketed as “safe” alternatives to cigarettes, still deliver carcinogens to the body.

“Eighty percent of people who are adult smokers began smoking before the age of 18,” Hanna said.  

To address that problem, the Indiana House of Representatives is due to consider legislation that would raise the legal age of smoking from 18 to 21.

“If we can get people to age 21 without smoking, they're very unlikely to smoke,” Hanna said. “This is a very important piece of legislation.”

Lung cancer detection, treatment

lung cancerIn the meantime, there is some good news when it comes to lung cancer detection and treatment. The National Lung Screening Trial, a nationwide study of 50,000 smokers with no history of lung cancer, found that a screening process that involved low-radiation CT scans, as opposed to standard chest X-rays, reduced lung cancer deaths by 15 percent to 20 percent because the cancer was detected before it had a chance to metastasize (spread).

But in Indiana, Hanna said there has been “relatively low interest” in lung cancer screening that involves CT scans, despite the cost of the scans being covered by Medicare.

“We need to be doing this more,” Hanna said. “Lung cancer screening is a really important new aspect of prevention that needs to be more widely incorporated.”

The people who are most likely to develop lung cancer — smokers — aren’t getting screened, he adds, because they are accustomed to experiencing a “smoker’s cough,” shortness of breath or wheezing and don’t realize they could actually have early-stage lung cancer, whose symptoms are similar to bronchitis or emphysema.

“And so oftentimes, the first symptom a patient develops is the symptom of metastatic disease,”  Hanna said. “They have a headache because the cancer has spread to the brain. They have back pain because the cancer has spread to bones. They have substantial weight loss because the cancer is widely metastatic in the liver. The symptoms that will really get their attention are the symptoms of advanced disease. This is why it's critical for people who are at risk to get a screening CT.”

For people who are given an early-stage lung cancer diagnosis, treatment — and their odds of survival — has improved thanks to recent advances in medicine.

“We have better surgical and radiation interventions that are more effective than they used to be and that carry fewer risks to the patients,” Hanna said. “For patients who have more locally advanced disease but not yet metastatic, the recent implementation of immunotherapy has substantially improved a patient's ability to be cured compared to the era before immunotherapy.”

Even patients with more advanced, metastatic lung cancer are living longer in some cases. “We are making strides and there are subsets of patients for whom our therapies are becoming much more effective,” Hanna said.

Despite the advances, people who smoke should schedule an appointment with a physician to discuss their medical history, undergo a physical exam and learn about screening tests that are best for them.