For Dignity Health's Hello Healthy podcast, Eric Peck, MD, cardiothoracic surgeon with Dignity Health Medical Group — Bakersfield discusses recent research that explains a rise of lung cancer in women under 50 years of age and the surgical treatment options available for lung cancer patients. Read the interview transcript below.
Caitlin Whyte (Host): Over the past several years, research shows that rates of lung cancer have been rising sharply in women. A recent study from the American Cancer Society reported women between the ages of 35 and 54 are being diagnosed with lung cancer at higher rates than men in that same age group. Dr. Eric Peck, Cardiothoracic Surgeon with Dignity Health Medical Group, joins us today to discuss this new research and the surgical treatment options for lung cancer patients.
Well, doctor, let's talk about this lung cancer research study. Can you briefly tell us what the evidence suggests?
Eric Peck, MD: Well, yes, I would like to first of all state that I think it is not well known that lung cancer is actually the highest cause of cancer deaths in both men and women. Um, Even for women, uh, something like breast cancer is not the highest cause of death, it's actually lung cancer. So I think that's important to start with.
In fact, every day there are hundreds of women who are dying of lung cancer around the country. This study in particular, has demonstrated that there is a higher rate of lung cancer in women between the ages of 35 and 54, which is a new finding. We haven't seen that before. And in fact, 15 to 20 percent of women who get lung cancer have never smoked, which is another interesting finding. So that's what this study is really all about.
So what are some common misconceptions about lung cancer then?
Eric Peck, MD: Well, I think again, first of all, I don't think many people appreciate that it is the number one cancer cause of death, and so I think it needs to take a highlight in everybody's mind. Um, I think also because of that, there aren't as many research dollars put into lung cancer as there are for other types of cancer, and so I think the more the public is made aware of this, hopefully we can get increased funding so that we learn more about some of these things that we're noticing in the studies.
And lastly, I'd also like to say that I think a lot of people assume that you must be a smoker in order to get lung cancer, and in fact, what this study and many other studies have shown is that people who don't smoke can get lung cancer as well.
Are there any possible explanations for this, people getting cancer without having smoked?
Eric Peck, MD: There are a couple of things that have been proven. That includes uh, exposure to second hand smoke. Also, there is a chemical called radon. It's a gas, and it, in some locations, can accumulate inside somebody's home. And that has been proven to cause lung cancer as well. There, and then there's some other hypotheses as to why maybe people who don't smoke get cancer. One of them may be air pollution that people are breathing all the time. And in particular, with regard to women and lung cancer, people are starting to wonder if maybe women, their bodies metabolize these carcinogens in a different way that makes them more likely to get cancer from a certain exposure more so than a male of the same age.
What are some early warning signs of lung cancer? Who should be getting screened and when?
Eric Peck, MD: Well, that's a great question. I'll first of all state that, of course, people who smoke are at the highest risk and so anybody between the ages of 50 and 80 who has smoked on average a pack a day for 20 plus years, even if they've quit within the last 15 years, they are considered at high risk, and there are many programs now available for these patients to get a lung cancer screening test, which is a CAT scan, to identify nodules when they're small. Unfortunately, lung cancer often doesn't cause symptoms until it's very advanced, and that's why, historically, lung cancer outcomes have not been very good, cause patients didn't get identified until the cancer was advanced or had spread. But certainly, any cough that persists for more than, let's say, six weeks, if you have pain in the upper back, shortness of breath, unexplained weight loss, coughing up blood, those are all things that should prompt an evaluation by your doctor.
Also, it's important to know that if someone has a family member who has a history of lung cancer not related to smoking, that also puts them at higher risk and they would be eligible for lung cancer screening tests as well.
With the focus on women in particular, if they find themselves with a lung cancer diagnosis, what are their treatment options?
Eric Peck, MD: Hopefully if it's diagnosed early, the treatment option that is preferred is surgery to remove the cancer and hopefully cure the patient. Usually at that same time, lymph nodes will be sampled to really identify for sure whether the tumor has started to spread or not. Other treatment options that are available include chemotherapy, newer immunotherapies that modulate the patient's natural immune system to help fight cancer cells and radiation therapy.
What are some common procedures used to treat lung cancer?
Eric Peck, MD: So the goal with surgery and lung cancer is to cure the patient. If patients have advanced lung cancer then the treatment usually is more chemotherapy or immunotherapy or radiation therapy. If someone is fortunate enough, however, to be a candidate for surgery, then the procedure includes an incision between the ribs and then to remove the lung where the tumor is growing and that procedure is called a thoracotomy. That's the incision between the ribs, and a lobectomy, removing the lobe of the lung that contains the cancer.
At the same time that we're in there, we will do a lymph node dissection, again, to identify any early spread of the cancer. There are other procedures that some lung cancer patients may also be candidates for. There's a procedure called a mediastinoscopy. That is an incision that's made in the notch right above the breastbone. It's done under anesthesia, and that is to sample lymph nodes around the windpipe if there's a suspicion that it may already have spread there. And the patient is undergoing that procedure to really determine, did it spread, so that we know whether they're a candidate for surgery or whether the treatment's going to be chemotherapy or radiation therapy.
The last procedure I'd like to mention is for patients who, unfortunately, the cancer has already spread. And oftentimes it spreads to the lining outside the lung and that causes fluid to build up in the chest cavity and compress the lung and make those patients very short of breath. There's a procedure, it's a minimally invasive telescope procedure called pleurodesis where we basically get the lung lining and the rib lining to fuse together so there's no space there anymore for the fluid to reaccumulate. It's very effective in improving those patients quality of life.
For patients who undergo this procedure, what should they expect? What is recovery like?
Eric Peck, MD: Most of these chest surgeries, the patients will require drain tubes to be placed during the surgery and those drains are usually in the patient for three or four days after the procedure. They have to be in the hospital during that period of time, but we'll have them up walking around with physical therapy, managing their pain. Typically they'll go home the day after the chest tubes are removed, uh, pretty functional. They'll have some pain where the incision is located. And typically it takes about six to eight weeks to completely recover from that procedure.
Is there anything else women should know about their lung health?
Eric Peck, MD: Well, obviously you're talking to a doctor and the first thing I got to say is please don't smoke. And that includes vaping as well. Vaping does avoid um, tar being deposited in the lungs. But the chemicals that they use to aerosolize the nicotine and the flavors that are in that, are equally harmful to the lung and carcinogenic.
So please don't smoke, don't vape. Also, that includes being around other people who smoke because we know secondhand smoke exposure also increases your risk for cancer. Please know your family history of anybody who's had lung cancer, especially if they didn't smoke. Be aware of symptoms that you may have, such as a persistent cough, coughing up blood, unexplained weight loss.
And if you're eligible, talk to your doctor about these lung cancer screening tests, because it really can make a difference between catching that lung cancer when it's curable, or unfortunately, when it's too late.