Susan Watts/New York Daily News
Dr. Raja Flores says, “Only 15% of lung cancer patients are nonsmokers.”
THE SPECIALIST: Dr. Raja Flores
As the chief of thoracic surgery at Mount Sinai, Dr. Raja Flores performs 300 to 400 lung cancer surgeries a year. November is Lung Cancer Awareness Month.
WHO’S AT RISK
Lung cancer is the leading cancer killer in this country, responsible for the death of more than 158,000 Americans in 2010 alone.
“The main reason lung cancer is so deadly is that it’s caught late; 84% of patients are diagnosed only after the cancer has spread beyond the lungs,” says Flores. “Only very recently have studies shown that the key to early detection is using CT scans to screen high-risk patients. If we can start diagnosing and treating patients earlier, we can save thousands and thousands of lives.”
While there are different types of lung cancer, the most common is non-small cell lung cancer. “Lung cancer is a tumor that grows from the lung cells and eventually starts to take over the normal functioning lung,” says Flores. “From there, it often spreads to the bones and the brain.”
Men and women are equally at risk of developing lung cancer. “The number one risk factor is smoking. Only 15% of all lung cancer patients are nonsmokers, and the question remains: were they exposed to secondhand smoke?” says Flores. “Other factors are having a family history or exposure to toxins like radon and asbestos.” For instance, all 9/11 first responders should consider screening because of the toxic exposures near Ground Zero.
SIGNS AND SYMPTOMS
One of the reasons lung cancer is so deadly is that it grows silently. “Basically by the time you develop signs and symptoms, the cancer is advanced,” says Flores. “At that point, people experience cough, coughing up blood, shortness of breath, wheezing and chest pain.”
The best way to prevent these outcomes is to get screened. “A recent, definitive National Cancer Institute trial found that low-dose CT scans radically improve patients’ odds,” says Flores. “If we catch lung cancer early, we can remove it surgically; 80% to 85% of lung cancers caught at stage 1 can be cured.”
Low-dose CT scans are very safe, comparable to a mammogram. “These CT scans offer a huge improvement of value over having an X-ray, but at this point, most high-risk patients are currently receiving neither,” says Flores. “We now recommend that anyone aged 50 or older with a 30-pack-year smoking history should get a CT scan once a year.” A pack-year is considered a year of smoking one pack a day; thus, smoking two packs a day for a year is considered two pack-years.
Lung cancer can be treatable and even curable — if it is caught early. “Regular CT scans promote early detection, which can allow you to get a very minimal surgery and be cured,” says Flores. “If you wait, you’re talking about a major surgery and much worse outcomes.”
Surgery is the first line of defense. “If you find lung cancer early, you can get a smaller surgery — VATS (video assisted thoracic surgery), which allows us to take out a lobe or wedge-shaped section of lung,” says Flores. “We can do this with three little holes in the chest, and the patient has a lot of healthy lung preserved.” Most patients go home in a day or two, and continue to be monitored for recurrences for the rest of their lives.
Larger cancers can also be treated surgically. “Once the tumor is bigger, sometimes we can take it out by itself, and sometimes we have to take out the whole lung,” says Flores. “People can actually live well with only one lung. I have a patient who bikes 15 miles a day with one lung.”
If you’re a current or former smoker or at risk due to other exposures, lung cancer screening is one of the best tools available for protecting your health. “The only thing that results in cures is finding lung cancer early and removing it,” says Flores. “Some people want to stick their head in the ground, but many former smokers are trying to right a wrong they committed in the past. Talk to your doctor about screening.”
Some doctors started pushing for lung cancer screening in the early 1990s, but there was no consensus until recently. “The National Lung Screening Trial was put together to show that screening didn’t bring a benefit, but actually screening turned out to be hugely positive,” says Flores. “Right now we’re working to get the word out to patients and primary-care physicians that the key to surviving lung cancer is early CT screening.”
QUESTIONS FOR YOUR DOCTOR
Anyone with a history of smoking or exposure to other high-risk toxins should ask, “Am I a candidate for lung cancer screening?” If you are diagnosed with an early-stage tumor, ask, “Can this be taken out minimally invasively?”
“If you have the risk factors for lung cancer, you should be screened. Period,” says Flores. “There’s no question about it. We know that screening works.”
WHAT YOU CAN DO
Get informed. Excellent advocacy groups are the Lung Cancer Alliance (lungcanceralliance.org) and the International Early Lung Action Cancer Program (ielcap.org). Mount Sinai also hosts useful patient information (mountsinai.org/lung-cancer).
Stop smoking. No matter how long you’ve smoked, stopping will decrease your risk. “Not to zero, but significantly,” says Flores.
Weigh screening. If you’re at risk, talk to your doctor about whether you’re a good candidate. The decision needs to be made at the individual level. “A CT scan costs as little as $ 300, and that’s well worth it to cut your risk,” says Flores.
Find an expert. Flores recommends that patients look for experienced lung cancer specialists who don’t rush to surgery as the only treatment. Seeking out a second or even third opinion is a good idea before choosing a course of treatment.