CNN — The American Cancer Society has recently updated its lung cancer screening guidelines with the aim of improving early detection. The new guidelines recommend annual low-dose CT scans for individuals aged 50 to 80 who have a 20-year or longer history of smoking, regardless of their current smoking status or how long ago they quit. These changes bring attention to important questions about lung cancer. How common is it? What are the different types of lung cancer? Apart from smoking, what are the risk factors? Why does early detection matter? What treatment options are available? And how can people reduce their risk of developing these cancers? To answer these questions, I interviewed Dr. Leana Wen, our CNN wellness medical expert. Dr. Wen is an emergency physician and professor of health policy and management at the George Washington University Milken Institute School of Public Health. She previously served as the health commissioner for Baltimore.
CNN: Dr. Wen, how common is lung cancer?
Dr. Wen: According to the US Centers for Disease Control and Prevention, lung cancer is the third most common type of cancer in the United States. Skin cancer is the most common, followed by breast cancer in women and prostate cancer in men. However, more people in the US die from lung cancer than any other type of cancer. The American Cancer Society estimates that in 2023, there will be approximately 238,000 cases of lung cancer and around 127,000 deaths from the disease.
CNN: What are the different types of lung cancer?
Dr. Wen: There are two main types of lung cancer: small-cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). These names come from the appearance of the cancer cells under a microscope, with SCLC cells appearing smaller than NSCLC cells. Both types have further subtypes. NSCLC includes adenocarcinoma, squamous cell carcinoma, and large cell carcinoma. SCLC tends to spread more rapidly than NSCLC and is usually diagnosed when it has already spread beyond the lungs. The majority of SCLC cases are found in current or former smokers. NSCLC is more common, accounting for 80% to 85% of lung cancer cases. While it is strongly linked to smoking, adenocarcinoma, the most common subtype, can also occur in nonsmokers. This type of lung cancer is more prevalent in young individuals and women. Additionally, cancers originating in other parts of the body can spread to the lungs, but these are not considered lung cancers.
CNN: What are the risk factors for lung cancer, aside from smoking?
Dr. Wen: Smoking is by far the biggest risk factor for lung cancer, responsible for about 80% of lung cancer deaths, according to the American Cancer Society. The risk increases with the duration and intensity of smoking. Some people mistakenly believe that cigar or pipe smoking poses no cancer risk, but this is not true. Smoking “light” or flavored cigarettes also increases the risk. Second-hand smoke is another major risk factor, as individuals living with smokers have a higher chance of developing lung cancer. Other risk factors include environmental exposures like radon and asbestos, a type of lung cancer called mesothelioma is associated with asbestos exposure. People who have undergone radiation therapy to the chest for other cancers, such as breast cancer or Hodgkin disease, are also at increased risk. Having a family history of lung cancer may slightly elevate one’s risk, though it can be difficult to separate this from the effects of second-hand smoke. Finally, outdoor air pollution is estimated to contribute to 1% to 2% of all lung cancer deaths in the US.
CNN: What are the symptoms of lung cancer?
Dr. Wen: Early symptoms of lung cancer can be nonspecific, such as a persistent cough, shortness of breath, fatigue, and general chest discomfort. Some individuals may experience a hoarse voice, coughing up blood, loss of appetite, and unexplained weight loss. As the cancer spreads, additional symptoms may occur, including bone pain, jaundice from liver damage, and symptoms related to the tumor pressing on blood vessels and other structures.
CNN: Why is early detection important?
Dr. Wen: Early detection is crucial because it saves lives. This holds true for all types of cancer, including lung cancer. When cancer is detected at an early stage, before it has spread to the lymph nodes or other organs, it is easier to treat and has a higher chance of successful treatment. Survival rates are significantly higher for early-stage cancers compared to advanced stages. Screening is recommended for individuals without symptoms, and the American Cancer Society has expanded its guidelines to include a larger population due to research indicating more benefits than drawbacks in recommending low-dose CT scans. However, individuals with symptoms should seek medical attention and undergo examination to determine the cause of their symptoms.
CNN: What treatment options are available for lung cancer?
Dr. Wen: The specific treatment depends on factors such as the type and stage of the cancer, as well as the patient’s overall health. Treatment options include radiation therapy, chemotherapy, surgery, and immunotherapy. Surgery may be recommended for individuals with localized cancer, whereas advanced cases may require therapies to manage symptoms and prolong survival.
CNN: How can people reduce their risk of lung cancer and other cancers?
Dr. Wen: The most important step for current smokers is to quit smoking. Numerous studies have shown that smoking cessation reduces the risk of lung cancer, even for heavy smokers. While the risk may not be as low as that of someone who has never smoked, quitting can still help prevent lung cancer. Resources are available through organizations such as the American Lung Association, and individuals can also consult with their healthcare provider for assistance. It is also important to minimize exposure to second-hand smoke. Being aware of occupational hazards and checking for harmful levels of radon in homes is beneficial. Research is exploring the role of factors like diet and exercise in reducing lung cancer risk, although it is not currently clear how much they can impact the risk. Nevertheless, adopting healthy habits can improve overall health.
