10 Things You May Not Know About Lung Cancer

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Cigarette smoking was a fashionable habit in the mid-20th century when its harms were not yet known. The popularity of smoking likely contributed to peak death toll rate of lung cancer in 2005, which has since been decreasing. “As education and awareness of the dangers of smoking are becoming more well-known, we’re seeing that rates of smoking are declining and so are lung cancer death rates,” says Konstantin Dragnev, MD, a medical oncologist in Dartmouth-Hitchcock's Norris Cotton Cancer Center’s (NCCC's) Comprehensive Thoracic Oncology Program who sees lung cancer patients daily. Even still, nearly 13 percent of all new cancers are lung cancers. Here are 10 things you may not know about this disease:

  1. Lung cancer is the leading cause of cancer deaths in U.S. for men and women, outnumbering mortality rates of colon, prostate and breast cancers combined. It is also the second most common cancer diagnosed in both men and women in the US.
  2. The American Cancer Society estimates more than 228,000 new cases of lung cancer will be diagnosed in the U.S. in 2019, and more than 142,000 deaths will result from lung cancer. Both rates are slightly higher in men (1 in 15) than in women (1 in 17). “These numbers include both smokers and non-smokers, but people who smoke have about 20 times the risk of developing lung cancer compared to those who have never smoked,” says Dragnev.
  3. Tobacco smoking is the leading cause of lung cancer. The risk of lung cancer increases with the length of time and number of cigarettes, cigars or pipes smoked. Quitting smoking, even after smoking for many years can significantly reduce the chances of developing lung cancer. Studies have shown that smoking low-tar or low-nicotine cigarettes does not lower the risk of lung cancer.
  4. There are two main types of lung cancer:
    • Small cell lung cancer – occurs almost exclusively in heavy smokers and is less common than non-small cell lung cancer.
    • Non-small cell lung cancer – an umbrella term for several types of lung cancers that make up 80 to 85 percent of cases. Each type starts from a different kind of lung cell including squamous cell carcinoma, adenocarcinoma and large cell carcinoma.
  5. There are typically no early symptoms of lung cancer. Once signs and symptoms appear, the disease is usually already advanced. “Symptoms may include a new cough that doesn't go away, coughing up blood, even a small amount, shortness of breath, chest pain, a hoarse voice, weight loss without trying to lose weight, or bone pain,” says Dragnev.
  6. In addition to smoking, other risk factors for lung cancer include:
    • Exposure to secondhand smoke. 
    • Exposure to radon gas. Radon is produced by the natural breakdown of uranium in soil, rock and water. Unsafe levels of radon can accumulate in the air and water in any building, including homes. According to the National Cancer Institute, in people who have never smoked, about 26 percent of deaths caused by lung cancer have been linked to radon exposure.
    • Exposure to asbestos and other carcinogens. Workplace exposure to asbestos and other substances such as arsenic, chromium, nickel, tar and soot also can increase your risk of developing lung cancer.
    • Family history of lung cancer. People with a parent, sibling or child with lung cancer have an increased risk of the disease.
  7. Steps to lower the risk of lung cancer include:
    • Not smoking – NCCC provides dedicated specialists in the Tobacco Cessation Clinic who offer a supportive approach to quitting without judgement or blame, offer motivation and assist in modifying behavior, assessing progress, and coping with withdrawal.
    • Avoid secondhand smoke. Urge smokers in your household to quit, or at least to smoke outside. Avoid areas where people smoke.
    • Test your home for radon. Information about radon testing is available through the Department of Public Health.
  8. And as always, choosing fruits and vegetables, getting regular moderate exercise and maintaining a healthy weight have been linked to reduction in many types of cancer and other health problems.
  9. Many support resources are available close to home and nationwide to help with quitting smoking. Here are just a few:
  10. Major topics in lung cancer research include:
    • Ways to help people quit smoking and stay tobacco-free through counseling, nicotine replacement and other medicines.
    • Ways to convince young people to never start smoking.
    • Inherited differences in genes that may make some people much more likely to get lung cancer if they smoke or are exposed to secondhand smoke.
    • Use of vitamins or medicines to prevent lung cancer in people at high risk. So far none have been shown to clearly reduce risk.
    • New screening methods for earlier detection such as screening with spiral CT, a procedure that uses low-dose radiation to create a series of very detailed pictures of areas inside the body. The National Lung Screening Trial showed that screening with low-dose spiral CT was better than chest x-rays at finding early-stage lung cancer, and decreased the risk of dying from lung cancer in current and former heavy smokers.
    • Precision medicine clinical trials. “We are conducting molecular analyses of lung tumors to guide treatment selection,” says Dragnev.
    • Clinical trials of new targeted treatments for lung cancers with specific genetic changes.
    • Clinical trials of immunotherapy combinations.

Each person’s medical history, genetics, environment and behaviors are different. Your providers can discuss your individual lung cancer risk factors and make recommendations that are appropriate for you.