This column originally appeared at Times-Herald.com on Wednesday, November 20th, 2013 by Dr. Saeid Khansarina. Board certified in thoracic surgery, Piedmont Newnan Hospital’s Dr. Saeid Khansarinia has special interests in robotic surgery and thoracic oncology. A graduate of the University of California in San Diego, he received his medical degree from St. Louis University and completed his internship and residency in general, thoracic and cardiovascular surgery at the University of Florida. He is a Fellow of the American College of Surgeons.
When you hear someone has lung cancer, what is the first thing you do? If you’re like the majority of people in the general population, you’ll ask the person who has been diagnosed with this deadly disease whether or not they have smoked. Contrary to the popular belief, lung cancer is not exclusive to smokers
. While smoking certainly increases a person’s risk of developing lung cancer, it is not the only factor to consider. Lung cancer can affect just about anyone. In fact, studies show that the rate of lung cancer in younger, non-smoking women is actually on the rise
The trouble is: medical experts aren’t sure why more non-smoking women are being diagnosed when the number of new lung cancer cases seems to have plateaued in men. Secondhand smoke and radon exposure
can play a role in the development of lung cancer, but plenty of patients who have rarely been exposed can still have lung cancer, too. Early detection
, the key to beating lung cancer, remains a challenge for healthcare providers because patients rarely present symptoms until it is too late.
The common stereotype that lung cancer is a “smoker’s disease” continues to plague the ability to raise widespread awareness and fundraising efforts for the disease that is second only to heart disease as the largest killer in the United States. Those with known risk factors for lung cancer, including family history and people who have smoked for a long time, are encouraged to get screened and take advantage of Piedmont Newnan Hospital’s discounted, low-dose computed tomography (CT) lung cancer screenings. (For more information, visit piedmont.org/lung
Lung cancer is responsible for claiming the lives of more people than colon, breast and prostate cancer combined
. Yet, so few know about it or think it cannot affect them because they don’t smoke. This year, 159,480 Americans with lung cancer will die. Approximately 16,000 to 24,000 of these people who died never even smoked, according to the American Cancer Society. Symptoms can be as vague as coughing, shortness of breath, wheezing, recurring lung infections and hoarseness.
While screening mechanisms are still being developed for younger, non-smoking men and women, it is always important to pay attention to what your body is telling you about your health. If you notice symptoms such as those listed above, it is best to seek help from a medical expert.
The following was originally published at DukeHealth.org
by Dr. Thomas A. D’Amico on June 21st, 2011. Thomas A. D’Amico, MD, is a professor of surgery and director of the Duke Cancer Institute’s lung cancer program. He was elected chair of the National Comprehensive Cancer Network board of directors in 2010.
Lung Cancer: Is “The Blame Game” Hurting our Progress? Thomas A. D'Amico, MD
As a thoracic surgeon, I operate on lung cancer patients every day. We discuss life-and-death issues regarding their surgeries, but we don’t usually talk about how they feel about their disease.
At a recent lung cancer advocacy event, I had the opportunity to hear one of my patients tell her story. A former Division I soccer player for East Carolina University, 24-year-old Taylor Bell
was diagnosed with lung cancer two weeks after her 21st birthday. She puts a very different face on lung cancer than most people expect.
She’s very grateful for her survival, but she says that, even when she’s talking to survivors of other types of cancer -- to anyone, really -- when she tells people she has had lung cancer, inevitably everyone asks the same thing: “Did you smoke?”
Her point of view is, “Why is that the most important thing you want to know about me?” It’s offensive to her because, number one, she didn’t smoke, and number two, what if she did? Would that mean that she deserved the disease?Assigning Blame for Lung Cancer
That is the underlying assumption when many people think about lung cancer: In an international survey commissioned in 2010 by the Global Lung Cancer Coalition
, 22 percent of U.S. respondents admitted they feel less sympathy for lung cancer patients than for patients with other types of cancer, because of the link to smoking.
The reality is that 15 to 20 percent of folks who get lung cancer have no personal firsthand experience with tobacco. Some, like Taylor Bell, are complete non-smokers. Some have been exposed to secondhand smoke, which certainly is not their fault.
If you counted just deaths from lung cancer among nonsmokers, lung cancer would still be the sixth leading cause of cancer-related deaths in the United States.
But no one should be blamed for getting cancer, regardless of their smoking history. Most smokers first start the habit as teenagers, and by adulthood it becomes entrenched; nicotine addiction is among the hardest to overcome.
The real issue is not the smoker who develops cancer; it’s how we as a society assign blame for disease. If we are to measure our sympathies for the ill by the behaviors that may have contributed to their illness, what about the patients with debilitating heart disease who have led high-stress, low-exercise lifestyles, or people with type 2 diabetes who had poor eating habits?
What about the smokers who didn’t develop lung cancer but developed breast cancer, heart disease, or stroke?
Would you have more sympathy for a smoker with lung cancer if you knew he had grown up with little education about the dangers of smoking?
What about if the individual had a strong genetic predisposition to nicotine addiction?Stigma Slows Progress in Fight Against Lung Cancer
The truth is, it’s rare that we can draw a straight line from a person’s disease to their lifestyle choices, and applying moral judgments to the ill is not only a waste of energy, but also a slippery moral slope.
I believe the public-health campaign against smoking and tobacco use has had unintended consequences: not only stigma for the victims of diseases associated with smoking, but actually slowing our progress in the fight against those diseases. And that is something we need to pay attention to.
The fact is that lung cancer is the most important cancer disease in our country, and indeed among all developed countries, in terms of its impact. In 2010, lung cancer caused 157,300 deaths in the United States, more than breast, prostate, and colon cancer combined, according to estimates from the American Cancer Society
In 2006, the most recent year for which we have estimates, we spent $10.3 billion in care for lung cancer patients, and the estimated loss of economic productivity due to lung cancer is $36.1 billion -- far higher than the next-highest figure (which is breast cancer, at a $12.1-billion loss).
The burden of this disease to us as a society should be, in itself, enough to compel us to do everything we can to improve diagnosis and treatment. Yet lung cancer receives much less research funding than other types of cancer that cause fewer deaths.
The stigma associated with lung cancer definitely takes its toll on survivors personally, and it’s possible that it also affects research funding for the disease. Using the most recent available data on National Cancer Institute
research funding, lung cancer received only $1,875 per death, compared to $17,028 per breast cancer death, $10,638 per prostate cancer death, and $6,008 per colorectal cancer death.
It’s impossible to read the minds of people who make decisions regarding funding for lung cancer research, but I think funding disparities can be attributed partly to a combination of the smoking stigma and ageism. If a 73-year-old person has a life-threatening disease, that’s not perceived as being as important to society as a disease that affects younger people. And an older patient population also means less patient advocacy.
The fight against breast cancer, for example, has been promoted successfully because many young women who are survivors have their life to give to raising awareness. The cure rate for lung cancer is much lower than for breast cancer. So there are fewer advocates.Need for New Screening Methods and Biologic Therapies
There is a need for greater research funding to advance two priorities that could make a significant difference for patients with lung cancer -- perfection of screening methods to catch more cases in the early stages, and stepped-up evaluation of biologic therapies, which can be equally as effective or more effective than chemotherapy without the overall toxicity.
Improved screening is an urgent need. Today, only about 20 percent of lung-cancer cases are caught at stage one. If we could increase that to 40 percent, we would improve survival dramatically.
Spiral computed tomography (CT) scan screening is a promising technique that’s being tested for patients known to be at high risk, but as a widespread tool, even CT has a drawback: the high chance of false positives.
Your CT scan might show a little nodule, but that does not necessarily mean you have lung cancer, and follow-up testing for lung cancer is invasive: if you have a positive screening for a mammography, you get a needle biopsy, but a positive screen from a CT scan might lead to a surgery.
We would like to be able to determine your true cancer status without having to do additional CT screens on you for the next five years or subjecting you to an unnecessary lung biopsy.
A line of research that holds much promise is perfecting a method for combining CT scans with a serum or urine test that detects a protein or other biomarker.
Even if we improve diagnosis, we’ll always have people who present with advanced disease, and the cure rate for those people is, frankly, dismal. One way to improve that rate is with better targeting of biologic therapies.
Industry is producing these agents faster than we can test them. We need to put more effort into testing and enhancing these agents -- which could improve treatment for others cancers as well. For instance, Avastin (bevacizumab) is now known to be successful against lung cancer, but it wasn’t originally conceived as a lung cancer agent.
To carry out these research priorities, we must erase the stigma that accompanies lung cancer and give the disease the full research support that its sufferers and their families deserve.
In the meantime, we will count on survivors such as Taylor Bell, who handles the smoking question with grace. After she tells people that no, she never smoked, the second question usually is: “Well, how did you get it?” Her response: “Why does anyone get cancer?”
Lung cancer survivor & Jill's Legacy
advisory board member, Taylor Bell, was featured in the August 2013 issue
! Congratulations, Taylor! You can read the Cosmopolitan article HERE.
The International Association for the Study of Lung Cancer (IASLC) finds that much more research needs to be done on treatment given to non-smoking women for lung cancer.
An estimated 516,000 women worldwide are affected by lung cancer and 100,000 of these women are from the United States
. Up until now, women with lung cancer have been given the same treatment as men. However, numerous studies have highlighted different characteristics of lung cancer in women. Hence, there is a need for more research to be done on lung cancer treatment given to women, especially those who don't smoke, states the International Association for the Study of Lung Cancer (IASLC)
Researchers from the University of Toulouse III in France looked into the clinical, pathological and biological characteristics of lung cancer in 140 women. They found that 63 participants had never smoked in their lives
while 77 were either former or current smokers. Researchers compared the findings of both groups and found differential genetic alteration repartition in women according to their tobacco status
Around 50.8 percent of women who had never smoked displayed an EGFR mutation while only 10.4 percent of current/former smokers showed the same mutation. However, 33.8% of current/former smokers showed K-Ras mutation while only 9.5 percent of women who had never smoked showed this form of mutation. The researchers also observed a higher percentage of estrogen receptors (ER) α expression in patients who never smoked when compared with smokers.
This led researchers to conclude that lung cancer in women who have never smoked is more frequently associated with EGFR mutations and estrogen receptor (ER) over expression.
"These findings underline the possibility of treatment for women who have never smoked with drugs to target hormonal factors, genetic abnormalities, or both," the authors say.
The study is published in the July issue of the Journal of Thoracic Oncology.
Originally published at medpagetoday.com
by Charles Bankhead
, Staff Writer, MedPage Today
on April 05, 2013.
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner
All patients with advanced lung adenocarcinoma should undergo testing forEGFR
mutations to determine their eligibility for targeted therapies, according to a jointly developed guideline from three organizations.
Patients should undergo EGFR
testing at diagnosis of advanced disease or at recurrence or progression if they were not tested at earlier disease stages. ALK
rearrangement testing is suggested by the International Association for the Study of Lung Cancer, the College of American Pathologists, and the Association for Molecular Pathology.
Patients should not be excluded from testing because of smoking status or clinical characteristics, the guideline authors said in an article published online in the Journal of Thoracic Oncology
"It was recognized by each of these three organizations that there was a gap in knowledge, a gap in communication, and variance around the world in how this testing ought to be done," first author Neil I. Lindeman, MD, a pathologist at Brigham & Women's Hospital in Boston, said in video statement.
"We decided collectively ... that these three voices should come together in order to make a consensus guideline."
The consensus opinion of the guideline panel is that EGFR
testing should be encouraged for patients with stage I, II, or III disease at diagnosis.EGFR
testing should have priority over all other genes, followed by ALK
"Any oncologist should be able to provide this testing and should do this testing to give their patients optimal care," Gregory Riely, MD, a medical oncologist at Memorial Sloan-Kettering Cancer Center in New York city, said in the video.
"With a proper biomarker, I can tell patients that they have a 70% to 80% chance of responding to a treatment rather than saying that they have a 1 in 10 chance of responding to treatment," he added.
Other points made in the guideline include:
The guideline addresses a variety of other issues related to testing techniques and processes, quality control, testing for secondary mutations and for other genes, and reporting results.
- Primary and metastatic lesions are equally suitable for testin
- Test results should be available within 10 working days and labs that cannot keep that turnaround schedule should take steps to keep the schedule -- either in-house or at a reference lab (consensus)
- KRAS testing should not be used as the sole determinant of a patient's eligibility for anti-EGFR therapy
- Specimens from patients with acquired resistance to EGFR inhibitors can be tested for the secondary EGFR T790M mutation with as few as 5% of specimen cells
- Reverse transcriptase polymerase chain reaction is not recommended as an alternative to fluorescence in situ hybridization assay for selecting patients for ALK inhibitor therapy
- In the setting of fully excised lung cancer specimens, EGFR and ALK testing is not recommended in lung cancers that lack any adenocarcinoma component, such as "pure" squamous cell carcinomas, "pure" small cell carcinomas, or large cell carcinomas lacking any immunohistochemistry (IHC) evidence of adenocarcinoma differentiation.
The broad recommendations for testing and the guideline's emphasis on urgency in obtaining test results reflect practices already in place at leading cancer centers, according to Edward Kim, MD, of Carolinas HealthCare System's Levine Cancer Institute in Charlotte, N.C.
"Testing should be based on type of patient (i.e. histology) and not clinical characteristics (i.e. smoking status or ethnicity)," said Kim, who was not involved in writing the guideline. "Both tests (EGFR
) are recommended to be ordered at diagnosis, which is our current practice at Levine Cancer Institute.
"Although 'within 2 weeks' for results is recommended, I hope that the turnaround time can be shortened in the near future. Patients with lung cancer are anxious to begin therapy, and longer delays will preclude the use of these molecular agents in the front-line setting."
The guideline authors disclosed relationships with Novartis, Millennium, Arqule/Daiichi Sankyo, NanoString, Genzyme, Infinity, Sequenom, Remedica Medical Education, Abbott, Existence Genetics, CymoGen Dx, Applied Spectral Imaging, Parteq-Queen's Commercialization Office, Merck, Eli Lilly, Pfizer, OSI/Genentech/Roche, AstraZeneca, Boehringer Ingelheim, Amgen, GlaxoSmithKline, Bristol-Myers Squibb, and sanofi-aventis. Several authors disclosed royalties related to publications and fees received as expert witnesses.
Leading magazine downplays value of lung cancer screenings, to the detriment of advances in early detection research.
SAN CARLOS, Calif., March 20, 2013 /PRNewswire
-- The following statement was issued by Bonnie J. Addario regarding the March cover article in Consumer Reports: The cancer tests you need--and those you don't:
"I am appalled by the March 2013 Consumer Reports
cover story (The cancer tests you need--and those you don't
), because of the misleading and misguided message it sends to people who really need life-saving cancer screening tests, and how it discredits the value and importance of proper early detention cancer screening tests.
"The article's irresponsible reporting is best summed up in this statement on page 31: 'But most people shouldn't waste their time on screenings for bladder, lung, oral, ovarian, prostate, pancreatic, skin or testicular cancers.'
is one of the most trusted publications in America. Anyone, whether they know they are low or high risk, will read that statement and walk away believing early detection cancer screening tests are unnecessary. The six-page article mentions only twice that its ratings apply only to asymptomatic, low-risk population.
"Shame on Consumer Reports
. We are talking about people's lives here.
"I myself am a lung cancer survivor. For more than a year I was misdiagnosed and not given an early detection screening test, even though I was in a high-risk category. When I was finally diagnosed I was stage 3B. Unlike so many others, I beat the odds. But my odds would have been better with an early detection cancer screening test. I founded the Bonnie J. Addario Lung Cancer Foundation
seven years ago to advocate and raise money for better research, education, early detection and treatment. Because something must be done.
- Lung cancer kills more people than the next five biggest cancers combined.
- Eighty percent of new lung cancer cases are former smokers or never smokers.
- Yet the five-year survival rate has been unchanged for more than 40 years. Only 15 percent of diagnosed patients live longer than five years.
- More funding and better research will lead to more effective early detection screening, which will save and prolong lives.
"Cancer screening and treatment are certainly at a crossroads, as the article states. This is made clear as well by recent legislation to direct more tobacco settlement money to early lung cancer detection programs. But the article's irresponsible representation of the value of screening tests, I fear, might damage the progress my lung cancer foundation has made over the past seven years - just as we are making great strides.
"People cannot readily see symptoms of lung cancer. Symptoms are deep in the lungs, unlike breast cancer, where lumps can be felt and are visible. When you are diagnosed with lung cancer it is often at stage four, when it's too late.
"The Consumer Reports
article makes only one responsible and thoughtful statement: 'Weighing the risks and benefits of cancer screening is best done in the context of a patient-doctor relationship.'
should stay out of the health care advice business, and stick to writing about toasters and washing machines. I wouldn't approach my doctor about whether I should buy a Honda or a Ford. And likewise, people should not consult Consumer Reports
to help them decide whether or not to have a potentially life-saving cancer screening test."
About the Bonnie J. Addario Lung Cancer Foundation The Bonnie J. Addario Lung Cancer Foundation
is one of the largest philanthropies (patient-founded, patient-focused, and patient-driven) devoted exclusively to eradicating Lung Cancer through research, early detection, education, and treatment. The Foundation works with a diverse group of physicians, organizations, industry partners, individuals, survivors, and their families to identify solutions and make timely and meaningful change. BJALCF was established on March 6, 2006 as a 501c(3) non-profit organization and has raised more than $9 million for lung cancer research.