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Dr. Royce Calhoun: During Lung Cancer Awareness Month — what to know about the deadliest cancer

November is Lung Cancer Awareness Month. The point of having an awareness month is, of course, to make people aware. The fact is a majority of the population and healthcare community are still unaware of some basic facts regarding lung cancer and lung cancer screening (LCS). Please take a moment to read the following and check what you really know about lung cancer and LCS.

Every cancer can kill but lung cancer is unique in many ways and it’s worth considering:
1. Deadliest Cancer: Lung cancer kills more men and women in the United States than the next three cancer killers combined (breast, colorectal and prostate).  In the state of Kentucky, lung cancer kills more than the next five cancer killers combined.

2. The Stigma: Lung cancer is mostly a self-inflicted cancer with over 80% of lung cancers arising in people who smoke or have smoked cigarettes.  This fact has led to a significant stigma associated with lung cancer and making many patients ashamed of getting lung cancer and at times feeling like they “deserve to die”. This is very different than other cancers like breast, colorectal and prostate.  While the majority of patients with lung cancer are either active smokers or former smokers, almost 20% of lung cancers occur in people who have never smoked making this subset of lung cancer the seventh leading cause of cancer deaths in the U.S. Lung cancer in never-smokers has a female predominance and often occurs in younger patients in their 30s through 60s but with some cases as early as teenagers.  
3. Why So Deadly?: So, why is lung cancer so deadly? The answer is quite simple: by the time most people (70%) find out they have lung cancer; it has spread to either lymph nodes or other distant sites outside the lungs via the blood stream. Despite improvements in therapies, these stage III and stage IV patients have a low cure rate. The overall survival of lung cancer is thus around 15% because the majority of patients with lung cancers are found too late.
4. Changing the Numbers. Saving Lives.: How can we change the dismal stats on lung cancer?  Well to be sure, getting people to quit smoking and to never start in the first place would be the best way, however, we have a tool right now that can save tens of thousands of lives in the U.S. each year if we apply it. Screen at risk patients for lung cancer.   
5. Who Should Get Screened: Who is eligible and how do you screen for lung cancer? Easy peasy. Anyone who is 50-80 years old, current or former smoker (if quit in the last 15 years) with a 20 pack-year history (if you are 50 or older and either smoke or did, there is a very good chance you qualify), qualifies for a LCS which is a low radiation dose, non-contrast (no IV, no dye) Cat Scan (chest CT). It is faster and easier than mammography, colonoscopy or drawing blood for a PSA test.
6. Screening More People: If LCS is a proven good screening tool (it is, better than any other screening for cancer that we have) and it’s so easy, then why is lung cancer still killing so many patients? Great question. Although we have the technology to catch lung cancers early, when it is small, has not spread and very curable (greater than 70% cure rate for stage I usually with a minimally invasive robotic surgical resection), this life saving screening is not being done for the majority of patients who are at risk. At St. Elizabeth, we are screening less than half of all patients that meet criteria mentioned above. Nationally, the LCS rate for eligible patients is estimated to be 6-10%. When at risk patients get LCS, the percentage of stage I and II (early, limited disease), approaches 80% as opposed to 20% in patients who are not screened.  Dramatic difference.
7. Figuring Out Why LCS Isn’t Utilized More: Why are we doing such a poor job of screening for lung cancer compared to breast, colon and prostate — all of which are well over 70%? The short answer is, we don’t really know but have some ideas and we are actively investigating this at St. Elizabeth to try and determine why. Some potential reasons LCS has not been as widely adopted as other cancer screenings could be anything from inaccurate smoking history of the patients to providers not having adequate knowledge themselves about LCS to patient fear.

The good news is that these reasons and many others are all fixable with education and motivation on the part of the providers and patients. If you are not a provider but you, family or friends fit the criteria mentioned in #5, look into LCS.

Information can be easily found at www.stelizabeth.com/lung, including a quiz to find out whether LCS is for you. We are a national leader in screening eligible patients and continue to evolve and refine to offer our patients with lung nodules and lung cancer the best care that can be found anywhere. Click here to find out more about our overall lung cancer program.
St. Elizabeth offers a robust lung nodule and lung cancer program for our immediate community and beyond and one we should all be proud of and trust in.
Royce Calhoun, MD, is Medical Director of Thoracic Surgery at St. Elizabeth Healthcare.

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