Vim & Vigor - Fall 2018 - University of Virginia - 19

Other Causes of
Lung Cancer

The second-leading cause of lung
cancer is secondhand smoke. Living
with a smoker or being exposed to
secondhand smoke at work raises an
individual's risk of developing lung
cancer between 20 and 30 percent,
according to the Centers for Disease
Control and Prevention. But even brief
exposure can increase risk, albeit by a
small amount.
Another risk factor for lung cancer
is harder to detect: Radon gas is invisible, odorless and naturally occurring.
It forms as uranium and radium decay
in the ground and exists in low levels
in air everywhere. But about 1 in 15
homes in the U.S. has unsafe levels of
radon gas, and radon is responsible
for an estimated 15,000 to 22,000 lung
cancer deaths per year.
Other exposure-based risks include
working around asbestos, airborne
chemicals and diesel fuel; air pollution; and previous radiation therapy
to the lungs.
Genetics also play a role.
"A small percentage of families have
a genetic mutation called T790M,"
Walia says. "If you have this mutation, there is a very high likelihood
that you will develop lung cancer in
your lifetime."

Limited Screening
Guidelines

What makes lung cancer so deadly is
it's often diagnosed at later stages,
when the cancer has already metastasized-that is, spread to other parts
of the body.
Only in the last five years has the
U.S. Preventive Services Task Force
recommended annual lung cancer
screening for high-risk patients using
low-dose CT scans. The task force
defines high-risk patients as smokers
or former smokers with a smoking
history of 30 pack years. Thirty pack
years means smoking a pack a day

for 30 years or two packs per day for
15 years.
There are currently no screening
guidelines for nonsmokers. It's best to
talk to your doctor about your individual risk. People with strong family
histories of lung cancer may want to
meet with a genetic counselor about
being tested for T790M.

Know the Signs

Because lung cancer screening is still
in its infancy, it's important to familiarize yourself with the early symptoms of the disease.
Cough that doesn't go away
Coughing up blood
Chest pain that's worse with
coughing or laughing
Hoarseness
Shortness of breath
Persistent bronchitis or
pneumonia
New wheezing
Walia recommends mentioning lung
cancer when talking to your healthcare
team about your symptoms.
"Tell your doctor about any symptoms, like persistent cough, shortness
of breath and fever that's not going
away," she says. "And bring up the
possibility of lung cancer, because it's
certainly possible your doctor isn't
thinking lung cancer if you don't have
obvious risk factors."
The sooner you can get a diagnosis,
the better off you'll be. ■

ONE SIZE
DOESN'T
FIT ALL
Whether you're a smoker or not,
lung cancer is lung cancer, right?
Not exactly.
"At the biological level, lung cancer
in smokers is different than lung cancer
in never-smokers," says Guneet Walia,
PhD, senior director for research and
medical affairs at the Bonnie J. Addario
Lung Cancer Foundation.
Because smokers are exposed to
more carcinogens in cigarettes than
nonsmokers, more of their genes are
altered, whereas nonsmokers might
have one or two mutated genes driving
their cancer.
With differences at the cellular level,
lung cancer in nonsmokers must be
treated differently.
"Immunotherapy-recently
approved drugs that use your own
immune system to fight your cancer-
work better for treating lung cancer
in smokers, because their genes look
so abnormal the immune system is
able to identify them more easily and
kill them," Walia says. "Cancer cells in
nonsmokers don't look as abnormal, so
targeted chemotherapy tends to be a
better option for them."
Researchers are rapidly improving
both types of drug therapy.
"We are constantly identifying new
genes and developing new drugs in
response," Walia says. "In the past few
years we've had more drugs approved
for lung cancer than over the past
few decades."

WEBSITE

Who Needs a Lung Cancer Screening?
Get the answer to this and other frequently asked questions from the
Lung Cancer Screening Program at UVA Cancer Center. Go to
uvahealth.com/lungcancerscreening.

FALL 2018

http://www.uvahealth.com/lungcancerscreening

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