Lung Cancer Prevention

Question: Which cancer causes more deaths than any other in the United States?

Answer: Lung cancer.

You're forgiven if you guessed breast cancer, or prostate cancer, since those diseases, with their aggressive campaigns to boost research and treatment, are getting lots of attention. But lung cancer—which accounts for about a third of cancer deaths in men and a quarter of those among women—takes the grim prize.

"The incidence of breast cancer is huge in relation to lung cancer, but 90 percent of people with breast cancer survive, where about 92 percent of people with lung cancer die, most of them within two years of diagnosis," says Dr. Cheryl Healton, president and CEO of the American Legacy Foundation, created with money from the 1998 Master Settlement Agreement between states and the tobacco industry. In fact, lung cancer kills more Americans than breast cancer, prostate cancer and colon cancer combined.

Here's the big irony:lung cancer is to a large extent preventable, which brings us to irony number 2. It's something everyone from Grandma Rosie to your five-year-old nephew knows how: Don't start smoking, and if you do, stop smoking now.* This is what is called in scientific parlance a no-brainer. Some 85 percent of lung cancer is linked to tobacco use.

What's with the disconnect? If lung cancer's so deadly, and the cause and prevention are evident, what keeps smokers smoking? As a former smoker, I can testify that guilt and fear are huge. And that's in addition to the nicotine addiction. Smokers frequently see quitting in black-and-white terms: If they're not 100 percent successful, they feel they've failed.

Yet, research is yielding new insights and treatments. One of the best free quitting programs, based on the latest behavioral research, is QuitNet online.

Smokers deserve to know that quitting is a learning process, says Chris Covert-Bowlds, a family practice physician in Bellingham, Wash., who specializes in helping smokers stop. Quitting takes practice, he says. Falling off the wagon is, for many, one stage in a process whose length varies greatly.

Don't I know it. When someone asks me when I quit smoking, I have to ask, "Which time?" I made many tries before succeeding long-term. Although my last cigarette was in 1993, when I spoke with Covert-Bowlds about smoking, I was amazed to notice that our conversation triggered a cigarette craving.

The new, very effective approach for such hard-core smokers is "combination therapy" in which a quitter combines two or three or more stop-smoking aids—say, nicotine patches or gum with a behavioral regime like the American Lung Association's free online smoking cessation program, and the prescription drug bupropion (marketed as Zyban and Wellbutrin) to cut cravings.

Also new are effective nicotine delivery devices, including a nasal spray and an inhaler. Before long, Healton predicts, “a major drug” will appear in the U.S., “revolutionizing things” by interfering with the desire to smoke. The release of varenicline (marketed as Chantix by Pfizer) in 2006 seemed a step in that direction. It targets the nicotine receptor in the brain and studies showed it helped people to quit smoking and stay quit one and a half to two times more often than buproprion. However, recent reports of an association with suicidal thoughts and aggressive and erratic behavior may send medical science back to the drawing board.  On the horizon, French drug manufacturer Sanofi-Aventis has sought Food and Drug Administration approval for rimonabant (brand name Acomplia).  It blocks a particular receptor (the cannabinoid receptor) in the brain and is approved in Europe to help reduce both the desire to smoke and eat. (Weight gain is a downside of quitting, as nicotine revs up metabolism.) However, the FDA has demanded more safety data before it can be released.

Despite the difficulties, quitting is a far-better strategy for avoiding lung cancer than screening. No technique has been proven, though many tests are used. Chest X-rays are virtually useless, says Healton. Your doctor may be able to examine your sputum under a microscope, but that can't catch most lung cancer varieties.

Since lung cancer can progress without symptoms, when symptoms do arrive, the cancer may be advanced. According to the National Institutes of Health, symptoms include: a persistent cough that worsens over time; constant chest pain; coughing up blood; shortness of breath, wheezing, or hoarseness; repeated bouts of bronchitis or pneumonia; swelling of the neck and face; loss of appetite or weight loss; and fatigue.

To judge your lung cancer risk, use the Memorial Sloan-Kettering Cancer Center online tool. Smoking is the biggest risk, but others include exposure to asbestos, the radioactive gas radon, second-hand smoke and air pollution.

In time, CT (spiral computed tomography) scans may become widely used to spot lung cancer early. But apart from the huge cost are two questions – raised by some physicians and researchers – of whether catching lung cancers early really makes a difference in preventing death, and whether the radiation of CT scans might ultimately cause more cancers than it detects. Healton believes CT screening is valuable and notes that doctors now offer it in many locales. She recommends at least two CT scans before any surgery, and says scans should be read only by radiologists with much experience in this particular work, as the scans are extremely difficult to interpret.

In spite of the progress with CT scans, the bottom line on lung cancer remains simple: Start trying to quit smoking, and keep practicing until you get it right. For help, call 1-800-QUIT-NOW.

Correction, August 22, 2005: This article originally stated that "lung cancer is virtually 100-percent preventable" and the way to prevent it is to "stop smoking," which is inaccurate because nonsmokers can also get lung cancer. This error has been corrected. Return to the corrected sentence.