Thoracic surgeon Dr. Jacques Fontaine at the Moffitt Cancer Center in Tampa believes there is a well-marked path to improving the stubbornly high mortality rate for lung cancer.
The breast cancer community already has blazed the trail.
“Some of the things that really changed the face of breast cancer 20 years ago, are now taking hold with lung cancer,” Fontaine told Asbestos.com. “Hopefully, we’re going to start seeing more progress.”
November is Lung Cancer Awareness Month, a time to focus on what needs to be done, what should be done better, and what breast cancer has taught everyone.
While progress in combating lung cancer has come slowly in recent decades, the fight against breast cancer has been much more pronounced and celebrated.
Breast cancer death rates have dropped almost 40 percent since 1989, according to the American Cancer Society. The five-year survival rate for breast cancer today is 90 percent.
Lung cancer, by comparison, has a five-year survival rate of just 17.8 percent. And the number of deaths annually has increased by 3.5 percent in the last 16 years. An estimated 158,000 Americans are expected to die from lung cancer in 2015, more than breast, prostate and colorectal cancers combined.
Early Screening Is a Big Help
Lung cancer is just entering the age of early screening and earlier detection, more precise, less aggressive surgeries, more refined drug regimens, and improved awareness and research campaigns — elements that led to success with breast cancer.
“The same things that happened with breast cancer several years ago are now happening with lung cancer,” Fontaine said. “And that’s encouraging. There is reason to be optimistic now.”
The medical profession has proven that early diagnosis greatly increases the chances of successful lung cancer treatment. And it has proven that low dose computed tomography (CT) screenings with the latest technology work well to identify early-stage disease.
The problem is that 90 percent of those with stage I lung cancer have no obvious symptoms, which make it difficult to detect without regular screening. Stage I lung cancer has a 70 percent cure rate, but only 15 percent of those with lung cancer are diagnosed that early.
“Most patients who develop symptoms — coughing up blood, chest pain or have difficulty breathing — are diagnosed with advanced disease, where the chance of a cure is much lower,” Fontaine said. “Hence the importance of undergoing screening for lung cancer before any symptoms develop.”
An aggressive early screening campaign that is accepted by the public could change the death rate significantly.
The National Institutes of Health (NIH) found a 20 percent reduction in lung cancer deaths among current and former heavy smokers who underwent CT screenings.
It’s now about raising awareness to these potentially life-saving screenings, much like annual mammograms and regular self-exams became the norm for women as a precaution to potential breast cancer.
More Precise Surgery
Fontaine spoke earlier this month about lung cancer surgery at a conference of medical professionals in Philadelphia. He was surprised by the lack of acceptance or knowledge of early CT screenings.
“They [CT screenings] are changing the way we treat lung cancer,” Fontaine said. “We’re catching it earlier now, which has led to a change in the way some surgeons approach it.”
Decades ago, a lung cancer patient might have his entire diseased lung removed. Then surgeons began doing lobectomies, which involve removal of a major portion (lobe) of the cancerous lung. Now they are doing a segmentectomies, or resections of a segment, a smaller anatomic portion of the lobe where the tumor is located.
“At Moffitt Cancer Center, we are removing a smaller piece of the lung, but it’s a more delicate, precise operation that requires a higher level of expertise,” Fontaine said. “For certain cases, it works every bit as well, but you have to have a surgeon adept at doing it.”
Smoking and Research Funding
The American Lung Association estimates that smoking contributes to 85 percent of lung cancer deaths today.
Fontaine believes a negative stigma attached to smoking, which previously slowed the pace of lung cancer research and advancements, is fading as fewer individuals take up smoking.
Lung Cancer also can be caused by other factors, including an exposure to asbestos.
This year alone, there are 198 different research grants for breast cancer worth more than $110 million that are funded by the American Cancer Society. There are half as many grants and less than half as much money for lung cancer research.
Despite a stagnant past, there is optimism for the future regarding lung cancer. Fewer individuals are smoking today. Dozens of clinical trials involving new immunotherapy drugs are being conducted. Early screening is becoming more accepted. Surgery is becoming more precise. And awareness is growing.
“Progress has been slow,” Fontaine said. “But I think we are now catching up and I am optimistic about the direction we are heading.”