Dr. Richard Freeman, Medical Director, St.Vincent Cancer Care
No type of cancer kills more Americans — men or women — than lung cancer. It accounts for 29 percent of cancer deaths in men, followed by prostate cancer at 11 percent. In women, it accounts for 26 percent of cancer deaths, followed by breast cancer at 15 percent.
Despite being the deadliest cancer by a large margin, lung cancer has struggled to garner the advocacy of breast and prostate cancer. Richard Freeman, MD, medical director of St.Vincent Cancer Care, believes this stems from a misguided notion that people who suffer from lung cancer have brought it upon themselves. “There is an old stigma in which people think, ‘It’s your own fault because you smoke cigarettes.’ ”
The truth is more complicated, Dr. Freeman said. Roughly 60 percent of the people diagnosed with lung cancer have already quit smoking — or never smoked. Lung cancer is a disease that can and does affect all types of people, not just smokers.
Whether or not you’ve smoked, it’s important to understand the nature of lung cancer, its signs and symptoms, and what type of care is appropriate if you think you’re at risk for the disease. Here, Dr. Freeman offers answers to these questions and more.
Is lung cancer always caused by smoking or second-hand smoke?
In the vast majority of cases, yes. The spontaneous mutation rate of lung cells is almost zero, so that tells us it’s almost always triggered by an external factor, unlike lymphoma or some other cancers that occur spontaneously. Seventy years ago, lung cancer was almost unreportable it was so rare. Nowadays, it’s primarily caused by smoking or secondhand smoke exposure, or other rarer causes, such as radon exposure. Air pollution can contribute to it, but it pales in comparison to smoking.
How much does quitting smoking reduce your chances of getting lung cancer?
We can’t say for sure. But we can say this much with absolute certainty: no matter how long you’ve smoked — 20, 30, 40 years — if you quit smoking, you are going to reduce your chances of getting lung cancer. It doesn’t go back to zero, but it does increase as soon as you stop. At St.Vincent, we recognize that quitting isn’t a mere matter of willpower. That’s why we offer smoking cessation services to people who are interested in quitting.
Why is lung cancer is so much more deadly than other forms of the disease?
It’s very difficult to detect early. When mammography was introduced, for instance, we gained the ability to pick up breast cancer earlier, and the chance of curing it went up about 20 percent. Until recently, there has been no way to screen for lung cancer, so it’s not generally detected early.
Seventy-five percent of people who develop lung cancer are diagnosed in the late stages of the disease, and when you are detected in the later stages, you are not going to respond to treatment as well. But over the past 15 to 20 years, the three modalities used to treat lung cancer — surgery, chemotherapy and radiation — have gotten better. The survival rates are improving.
Will we eventually see screening opportunities for lung cancer similar to what exists for breast cancer?
There are some exciting screening possibilities on the horizon. The National Institutes of Health has found that low-dose CT scans for people who are at high risk for lung cancer can be a good screening test, and aid in the early diagnosis of lung cancer and help improve survival rates. As of now, it’s not covered by Medicare or private insurers, but it’s something that we’re hoping to move toward.
What symptoms should prompt you to talk to your primary care doctor about lung cancer?
A chronic cough, chest pain, voice hoarseness, shortness of breath or coughing up blood — these could all indicate the presence of lung cancer, but they could be caused lots of other things, too. People who have any of these symptoms persistently should talk to their doctor about getting a chest X-ray. If the X-ray shows anything abnormal, you move on to a CT scan, which usually provides the information we need to proceed to diagnosis.
St.Vincent is home to various lung cancer clinical trials. Could you explain the benefit of this research?
First of all, the presence of clinical trials means there is a great deal of infrastructure and a lot of interest in the type of cancer being studiedbecause it’s a lot of work to get clinical trials open. (Second sentence is repetitive—a lot of people interested) And it means the facility has the latest treatments available, in terms of both clinical trials and non-trial treatments.
People who qualify for and participate in a clinical trial receive the latest, most promising treatments that are in the process of evaluation.. Can we say anything about our lung clinical trials—such as Here at St.Vincent Cancer Care we are studying new drug combinations, radiation therapy protocols, and xxxx (just making this up, but I do think you connect the trials to lung cancer.)
Have you seen clinical trials make a meaningful difference in your patients’ outcomes?
Yes, definitely. When the first line of treatment doesn’t work, second-line therapy gives patients a second chance. That’s where clinical trials can, and have been, really powerful. We have seen very specific instances where patients who did not do well with their first-line therapy went on a clinical trial and did remarkably well, and there was significant improvement in survival.
What should one consider before deciding where to receive lung cancer care?
If you’re suspicious you have a lung cancer or a lung nodule, you really need to go to a medical facility where they specialize in lung cancer. The risk of going to a place where they don’t specialize in the disease is that you could either be under- or over-diagnosed. And if you’re under-diagnosed, they may not find cancer while it’s still growing, and if you’re over-diagnosed you may be subjected to surgery or other procedures unnecessarily, and that can have its own ramifications for your health.
St.Vincent Cancer Care holds multidisciplinary conferences for each patient with lung cancer. How valuable are they to the the treatment of the patient?
They are incredibly valuable. We have published two papers showing how they improve the quality and decrease the time from diagnosis to the end of treatment for lung cancer patients.
In these weekly conferences, all the different doctors — pulmonologists, surgeons, medical oncologists, radiation oncologists and other specialists — share opinions and ideas in one meeting, instead of patients going to four or five different office appointments. We also discuss whether patients are good candidates for clinical trials. It really is extremely important in developing a treatment plan for these patients.
In places that don’t do this, you generally see fragmented care. You may have patients who have never seen a surgeon who are surgically treatable, or people who are operated on when chemotherapy was indicated. So these conferences are vitally important to getting the highest quality and most efficient care.