By Gigi Chen, MD
The most effective way to reduce lung cancer is by cancer prevention. Smoking is thought to be the cause in 85% of lung cancer. With our progress in smoking cessation, there is a recent decline in lung cancer rates and mortality. However, there still are 19% of populations in US who are smokers. We also know that the risk of lung cancer still takes many years after smoking cessation before it declines significantly. Therefore, there is a need for an effective screening modality for lung cancer.
Previously, studies using chest x-ray as a screening modality have not shown that it reduces cancer related deaths from lung cancer. More recently, the National Lung Screening Trial conducted by National Cancer Institute, compared annual screening using low dose chest CT scanning with chest x-ray for three years in high risk individuals and found a reduction in lung cancer deaths. Several observation trials including the early lung cancer project (ELCAP) showed that low dose chest CT can identify early asymptomatic lung cancer. This would allow treating lung cancer at early stage and improve overall cure rate.
The CT screening is recommended only for people who are at high risk where benefit would outweigh the risk. High risk is defined as age 55 to 74 with 30 pack year smoking and if no longer smoking, smoking cessation within 15 years. Lung cancer screening should also be done in a multidisplinary program which involves a number of expertise to guide the screening.
There have also been new and exciting advances in the treatment of advanced lung cancer. We now have a better knowledge of the molecular pathways that drive lung cancer growth. In a patient with an identifiable “driver mutation” such as EGFR mutation or ALK rearrangement, we have targeted therapy such as erlotinib, afatinib or crizotinib which are highly active in treating these cancer types. In patients who do not have an identifiable driver mutation, we have a combination of chemotherapy as well as monoclonal antibody that are active in treating lung cancer. Many clinical trials that use new targeted agents as well as immunotherapy are being studied in the area of lung cancer.
Gigi Chen, MD is a Medical Oncologist and Hematologist practicing at Diablo Valley Oncology, located in the California Cancer and Research Institute, Pleasant Hill.
Join an engaging panel of lung cancer experts as they cover the most current information regarding early detection, new screening recommendations, clinical trials, treatment options, surgical techniques, and survivorship issues. November 16, 2013, 3–5 PM at the Walnut Creek Library. Register by calling 925-677-5041 x272 or online at: www.shinealightonlungcancer.org