SMOKING : SLOWLY TAKING YOUR BREATH AWAY
( continued from page 9 ) In 2018 the Nobel Prize in Medicine was awarded to Dr . Tasuko Honjo ( Univ . of Kyoto ) and Dr . James P . Allison ( UCLA / MDA ) for discovering immune checkpoints and their inhibitors . These checkpoint inhibitors have unleashed not only the cellular host defense against cancer cells , but have given a new lease on life for many patients with cancer .
We are curing more lung cancers than we have ever before . Newer surgical tools , minimally invasive and video / robotic assisted , allow easier surgeries . Stereotactic radiation puts early lung cancers in a cross hair of bundled radiation beams and has become a standard for nonsurgical patients . We are also making cancer treatments better tolerated by integrating palliative care early on and quality of life measurements have become part of clinical trials .
So what is still missing ?
The holy grail of caring for lung cancer patients is to prevent lung cancer altogether . Remember , it used to be a very rare cancer 100 years ago .
Since Surgeon General Dr . Luther Terry ’ s report in 1964 , it has been glaringly clear that smoking is the main cause of lung cancer . Unfortunately , the pandemic of cigarette smoking has slowed only little since it began in the early 1900s . 24 % of adults still smoke in Kentucky , today and every day .
Kentucky also has high radon levels due to the porous limestone underground . Radon is the second most common cause of lung cancer and can be easily tested in the living area and mitigated . Free tests and information are available at the Kentucky Cabinet for Health and Family Services website ( https :// chfs . ky . gov / agencies / dph / dphps / emb / Pages / radon . aspx ) and often also from your local public health department .
Air pollution is more and more recognized as another significant contributor to lung cancer risk . Kentucky is among the states with a high amount of toxic waste released into air and water ( 24,286,737 pounds in 2019 , epa . gov / trinationalanalysis ). secondhand smoke and radon accounting for many , and genetic bad luck for others . The US Preventive Services Task Force recommends annual lung cancer screening with low-dose CT chest for those 50- 80 years old , with 20 pack / year or more history , either still smoking or had quit fewer than 15 years prior .
Lung cancer is primarily man-made . It could become rare again if physicians would stand up to it . It would be more survivable if all primary care doctors and APRN / PA staff would screen for it . Ask your patients about smoking . Ask about radon . Ask about quitting , and impress on them that screening reduces death from lung cancer .
References
Sung H , Ferlay J , Siegel RL , Laversanne M , Soerjomataram I , Jemal A , Bray F . Global Cancer Statistics 2020 : GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries . CA Cancer J Clin . 2021 May ; 71 ( 3 ): 209-249 . doi : 10.3322 / caac . 21660 . Epub 2021 Feb 4 . PMID : 33538338 .
Siegel , R . L ., Miller , K . D . and Jemal , A . ( 2020 ), Cancer statistics , 2020 . CA A Cancer J Clin , 70 : 7-30 . https :// doi . org / 10.3322 / caac . 21590
Bianconi E , Piovesan A , Facchin F , Beraudi A , Casadei R , Frabetti F , Vitale L , Pelleri MC , Tassani S , Piva F , Perez-Amodio S , Strippoli P , Canaider S . An estimation of the number of cells in the human body . Ann Hum Biol . 2013 Nov-Dec ; 40 ( 6 ): 463-71 . doi : 10.3109 / 03014460.2013.807878 . Epub 2013 Jul 5 . Erratum in : Ann Hum Biol . 2013 Nov-Dec ; 40 ( 6 ): 471 . PMID : 23829164 .
Countercurrents Series , & Narod , S . A . ( 2012 ). Disappearing breast cancers . Current oncology ( Toronto , Ont .), 19 ( 2 ), 59 – 60 . https :// doi . org / 10.3747 / co . 19.1037
EPA . EPA Assessment of Risks from Radon in Homes . EPA 402-R-03-003 . Washington , DC : U . S . Environmental Protection Agency , Office of Radiation and
Indoor Air ; 2003 .
Dr . Kloecker , MD , MPH , MBA practices thoracic medical oncology and is the author / editor of “ Lung Cancer : Standards of Care ” McGraw Hill , 2021 . He is a Professor , Gratis Faculty , at the UofL School of Medicine and works currently at St . Elizabeth Healthcare in Edgewood , Kentucky . ( KMA and Kenton County member )
Alexander Gavsyuk ’ s family came here from the USSR . He ’ s a born and raised Louisvillian , went from duPont Manual to Boston University , and is a 3rd year student at the UK College of Medicine . He ’ s always dreamed of becoming a doctor and is interested in interventional cardiology . ( KMA and Campbell County member )
During the course of history , mankind assumed certain illnesses were part of the human condition ( early infant mortality , TB , smallpox , wound infection , etc .) but we learned to minimize these mortal dangers . Over the last 100 years , physicians were brought up to accept lung cancer as part of our regular medical lives and to assume it to be an inevitable risk from personal habits plus increasing life expectancy . Often patients were shamed for their individual choices , but rarely so the industry and regulators who facilitated universal access to tobacco and failed to notice or police air quality .
Lung cancer is not a natural part of a normal life , one of good personal health habits , enjoyed within a healthy environment . Non-smoking lung cancers occur - because cancer is beastly - with
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