What Are the Deadliest and Fastest-Killing Cancers?
Harvard Health: New Guidelines Aim To Screen Millions More For Lung Cancer
Lung cancer kills more Americans than any other malignancy. The latest American Cancer Society (ACS) updated guidelines aim to reduce deaths by considerably expanding the pool of people who seek annual, low-dose CT lung screening scans.
Advocates hope the new advice will prompt more people at risk for lung cancer to schedule yearly screening, says Dr. Carey Thomson, director of the Multidisciplinary Thoracic Oncology and Lung Cancer Screening Program at Harvard-affiliated Mount Auburn Hospital, and chair of the Early Detection Task Group for the ACS/National Lung Cancer Roundtable. Currently, fewer than one in 10 eligible people in the US follow through on recommended lung screenings.
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What are the major changes in the new ACS lung cancer guidelines?
The updated guidelines are aimed at high-risk individuals, all of whom have a smoking history. And unlike previous recommendations, it doesn't matter how long ago a person quit smoking. The updated guidelines also lower the bar on amount of smoking and widen the age window to seek screening, which aligns with 2021 recommendations issued by the US Preventive Services Task Force.
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"Now that the age requirement has expanded and the amount of cumulative smoking history has dropped, we think this will mean another six to eight million people will be eligible to have screening," says Dr. Thomson.
How many people get lung cancer?
Although lung cancer is the third most common malignancy in the United States, it's the deadliest, killing more people than colorectal, breast, prostate, and cervical cancers combined. In 2023, about 238,000 Americans will be diagnosed with lung cancer and 127,000 will die of it, according to ACS estimates.
What is the major risk factor for lung cancer?
While people who have never smoked can get lung cancer, smoking and exposure to secondhand smoke is a major risk factor for this illness. Smoking is linked to as many as 80% to 90% of lung cancer deaths, according to the CDC.
Indeed, people who smoke are 15 to 30 times more likely to develop or die from lung cancer than those who don't. The longer someone smokes and the more cigarettes they smoke each day, the higher their risks.
Is lung cancer easier to treat if found in early stages?
Yes. As with many cancers, detecting lung malignancies in their earliest stages is pivotal to improving survival.
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Depending on the type of lung cancer diagnosed, up to 80% to 90% of people with small, early-stage tumors survive five years or longer, says the American Society of Clinical Oncology. The number of people who survive long-term becomes smaller as tumors grow larger, and if they spread to lymph nodes or other areas of the body.
Should you consider lung CT screening?
The updated ACS guidelines recommend screening if you:
Before scheduling a low-dose CT lung screening, you'll need to talk to a health professional about your risks and the screening process, either in person or by phone. Previously, an in-person medical appointment was required.
Why did the ACS change the years-since-quitting screening requirement?
Much international research suggests that the number of years since someone stopped smoking has little or no bearing on their risk of developing lung cancer, Dr. Thomson says.
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"You have an equal likelihood of developing lung cancer whether you quit more than 15 years ago or more recently," she says. "The recommendations on the national scene say that we need to be screening more people and make it easier to be screened. One of the ways to do that is to drop the quit history requirement."
If you're eligible for screening, how often should you have it?
Every year, says the ACS.
But why not screen for lung cancer for several years and then take a break, as is done with a malignancy such as cervical cancer? Research hasn't been done to demonstrate that this type of approach is safe, Dr. Thomson says.
"We know that a large percentage of lung cancers identified in people through low-dose CT scans are identified after their first year of screening," she says. "And some forms of lung cancer can move quickly, which is part of the reason it's as deadly as it is."
Did all guidelines organizations drop the years-since-quitting requirement?
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No. The Centers for Medicare & Medicaid Services (CMS) and the U.S. Preventive Services Task Force -- which, along with the ACS and other groups, recommend national standards for screenings -- haven't yet signed on to the ACS approach. These two groups maintain that only smokers who quit 15 or fewer years ago should remain eligible for screening.
However, guidelines issued by the National Comprehensive Cancer Network mesh with the new ACS recommendations by not having a years-since-quitting threshold.
Because Medicare and other health insurers may have slightly different rules to determine payment for lung cancer CT screening, it's best to confirm this with your health care provider or insurer before getting tested.
Copyright (C) 2024 by Harvard University.
I Thought I Pulled A Muscle But I Actually Had Stage 4 Lung Cancer Aged 37 Despite Never Smoking - Here Are The Signs You MUSN'T Ignore
A Texas woman was diagnosed with stage 4 lung cancer at just 37 years old, despite never smoking.
Tiffany Job, a nurse and mother of eight-year-old twin boys, assumed that the pain in her right rib that began in March 2020 was a pulled muscle resulting from a workout.
However, scans would later reveal tumors in her lungs that had spread to her neck, and bones.
'I think I was just in denial, like "This is not happening."' said Tiffany. 'It was shock. A lot of shock.'
Her case comes amid a mysterious rise of cancer cases in people under 40, including colon and appendix cancer.
Lung cancer - the deadliest form of the disease - is also rising, particularly in women, thought to be linked to the fact women are slower to give up cigarettes.
Tiffany Job, 40, was diagnosed with stage four lung cancer after mistaking her symptoms for a pulled muscle
Ms Job's cancer had spread to her pelvis, right femur, and cervical spine
Tiffany's 'pulled muscle' quickly became the least of her problems when a collection of other symptoms cropped up.
On a hiking trip in July 2020, she could barely walk a few feet without her heart rate shooting up and becoming short of breath.
Then, a month later, Tiffany developed a cough that wouldn't subside. Doctors performed blood tests and prescribed a course of antibiotics and steroids.
However, nothing helped.
In September, Tiffany went to her primary care doctor, who ordered a pulmonary function test (PFT). This test measures lung volume and capacity, as well as how air moves through them. 'I failed that miserably,' she told The Patient Story.
Her husband, Nick, said: 'I think they said she had the lung capacity of an 80-year-old.'
'That raised some pretty significant concerns. That was, I think, the first real alarm bell for the primary care doctor.'
'Nobody ever speculated that lung cancer could have even been an option.'
Over the next few weeks, doctors speculated that it could be anything from sarcoidosis - an inflammatory condition caused by an immune overreaction - to Covid to tuberculosis.
Finally, after spending days in isolation, scans revealed that Tiffany had stage four non-small cell lung cancer, which had spread to her pelvis, right femur, and neck.
Ms Job said she was 'in denial' after hearing about the lung cancer diagnosis, especially because she had never smoked
Ms Job posted on Instagram in November that her primary tumor is growing, and her current treatment is ineffective (pictured here with her husband, Nick, and their twin sons)
Lung cancer is the deadliest form of cancer in the US, according to the National Cancer Institute (NCI). It accounts for one in five cancer deaths, followed by colorectal cancer, which causes one in 10 cancer deaths.
About 53 percent of cases are diagnosed when the disease has traveled to multiple other organs.
'The vast majority of lung cancers are diagnosed in the advanced stage because their symptoms don't present until it's moved pretty fast,' Nick said.
The survival rate also drops significantly in these cases, with fewer than 10 percent living for five years.
Only one in four lung cancer patients survive after five years.
There are two main types of lung cancer: small cell and non-small cell.
Non-small cell lung cancer is the most common type, accounting for nine out of 10 lung cancer diagnoses, and typically grows more slowly. It usually doesn't cause any symptoms until it has progressed.
Lung cancer is the deadliest form of cancer in the US, according to the National Cancer Institute (NCI). The survival rate drops sharply as cancer spreads. Advanced lung cancer has just an 8.2 percent five-year survival rate
The above shows lung cancer cases among men and women split by age groups. It reveals the disease is now more common in younger women, compared with other groups
Signs of non-small cell lung cancer, according to the NCI, include chest pain or discomfort, a lingering cough, trouble breathing, wheezing, coughing up blood, loss of appetite, unintentional weight loss, fatigue or lethargy, trouble swallowing, and swelling in the face or veins in the neck.
Cigarette smoking is the leading cause of lung cancer, though Tiffany noted that she never smoked. Exposure to secondhand smoke has also been shown to increase this risk.
Men were nearly twice as likely as women to develop the disease in the 1980s, driven by higher smoking rates and workplace exposure to substances like asbestos.
But with declining cigarette use and increased safety regulations, the pattern has flipped, with young and middle-aged women now being diagnosed with the disease at higher rates than men.
Some evidence suggests this is because women are slower to quit smoking.
Tiffany's tumor had a genetic mutation known as EGFR (epidermal growth factor receptor). This means the cancer causes an excess of the EGFR protein, which can accelerate the growth of lung cancer cells.
This qualified her for a clinical trial of a drug that would specifically target the mutation.
'The prognosis for lung cancer is pretty bad, and chemo doesn't have a good track record, especially for her subtype of cancer,' Nick said.
Tiffany added: 'When we heard "clinical trial," I was very open to it. I think being a nurse, I've always been pretty open to things like that.'
'I feel like that's how we learn. We don't get information if people don't do it.'
However, Tiffany posted on Instagram in November that, despite the novel therapy, the primary tumor in her lung is growing, and her current treatments are no longer effective.
Still, she remains optimistic.
'We don't know what's going to happen to us by the end of the day, so we may as well just live for each and every moment,' she said.
'I'm A Lung Doctor - Here's A Warning Sign Of Lung Cancer Most People Don't Know About'
Lung cancer is the leading cause of cancer deaths worldwide. Most cases are associated with smoking, but not all of them.
Dr Mike Hansen, a lung doctor for almost 10 years, has seen thousands of people with lung cancer.
In a video posted to his YouTube channel, which has more than one million subscribers, Dr Hansen said: "There are actually different types of lung cancer, one in particular is a type that non smokers can get, and that's something called lung adenocarcinoma."
With his experience, Dr Hansen went on to list the warning signs of lung cancer to look out for. Understanding these symptoms is vital and potentially life saving, he said.
"Warning sign number one is an interesting one that most people don't think about or know about," said Dr Hansen, "And that's changes in the fingernails".
Finger clubbingLung cancer can cause clubbing of the fingernails, which is enlargement in and around the fingertips. Dr Hansen said: "It's certainly not the only thing that can cause clubbing of the fingernails, but if you notice this change it's definitely something that needs to be looked at and a potential sign of lung cancer."
Persistent coughA cough associated with a cold or a respiratory infection subsides in a week or two, but a persistent cough that doesn't go away could be a symptom of lung cancer.
Dr Hansen said: "Pay attention to whether your chronic cough is constant, or intermittent, if it's dry or if it's producing mucus, or if it has changed in any way.
"Also, if you are coughing blood, that's a big one. Because even if you're coughing up blood in small amounts, that can be a sign of lung cancer, and that would warrant immediate medical attention."
Shortness of breathMany illnesses can present with shortness of breath, which is a red flag symptom that requires medical attention. But Dr Hansen added: "Experiencing shortness of breath or becoming easily winded could also be a potential warning sign of lung cancer, especially if that tumour is blocking an airway - if it's causing a narrowing airway, that's something that could be causing shortness of breath.
"Or, if that tumour is actually causing fluid build up outside of the lung, known as pleural effusion, that could do it as well. "
Lung cancer can cause chest pain, especially if it metastasizes to the chest wall, or if it causes swollen lymph nodes within the chest.
Dr Hansen said: "The pain can feel sharp, or could feel like a constant pain, it could be a dull pain, or could come and go meaning it's intermittent.
"So chest pain that worsens with deep breathing, or coughing, or even laughing, or sneezing, that could be a sign of lung cancer."
WheezingWhen air passages of the lungs become either blocked or constricted or inflamed, you could experience wheezing or a whistling type of sound when you breathe, particularly on the exhale.
Dr Hansen explained: "While wheezing can be associated with numerous conditions such as asthma or COD, it can also be a sign of lung cancer."
Recurring chest infectionsRecurring chest infections, like bronchitis or pneumonia, can be a sign of lung cancer. Dr Hansen said: "While healthy people can suffer from these conditions, a recurrent pattern might indicate undying issues like a kung tumour that's blocking the airways, and therefore predisposing you to infections."
FatigueLung cancer can also contribute to fatigue, particularly if that cancer is advanced. Dr Hansen said: "Fatigue linked to cancer is usually more intense compared to the typical run of the mill feeling tired. With cancer fatigue it does not improve with rest."
Hoarse voiceIf someone has a hoarse voice that doesn't go away or a significant change in their voice, that could be a sign of lung cancer, and this can actually result from a tumour that presses on a nerve that controls the larynx, the voice box, called the recurrent laryngeal nerve, said Dr Hansen.
Difficulty swallowingLung cancer can sometimes cause difficulty swallowing, often accompanied by pain. Dr Hansen explained: "This happens if a tumour is pressing on the oesophagus, which is the muscular tube that connects from the throat down to the stomach. If that cancer has spread to the lymph nodes, these swollen lymph nodes end up pressing against the oesophagus."
Decreased appetiteMost cancers decrease appetite and therefore have an unexplained weight loss in that person of 10lbs or more, which could be the first sign of cancer. "Lung cancer is no exception," said Dr Hansen.
If you think you have symptoms of lung cancer, speak to your GP.
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