Over the past five years, the five-year survival rate for lung cancer in the US has increased a significant 22%, according to a new report from the American Lung Association. But the number of people who get tested for lung cancer is still not nearly enough, experts say.
About 26.6% of people who get lung cancer survive at least five years past their initial diagnosis, Tuesday’s report says, up from 21.7% in 2016. The survival rate for people of color has also increased 17% in the past two years, but there are still significant racial disparities in treatment, diagnosis and survival, the report says.
Black and Latino people with lung cancer are less likely than White patients to survive five years after an initial diagnosis. Compared with White patients, Latinos were 30% more likely to not receive any treatment and were 9% less likely to survive, and Black people were 19% less likely to get surgical treatment and 16% less likely to survive.
Asians and Pacific Islanders are 17% less likely to be diagnosed early, but they were 17% more likely to get surgical treatment and 14% more likely to survive five years than White people.
Lung cancer is still the leading cause of cancer death in the United States, according to the US Centers for Disease Control and Prevention, but it doesn’t have to be a death sentence. There have been recent advances in targeted therapy and immunotherapy, and more personalized treatment is becoming available. Experts say there’s also an easy tool that could save many more lives: More people need to get screened.
Screening reduces the lung cancer death rate by up to 20%, the new report says.
As with any cancer, catching lung cancer early can improve the chance of survival. Other research has shown that if it’s diagnosed at an early stage, lung cancer has an almost 60% five-year survival rate that drops to 7% with late detection. Screening saves lives because people with lung cancer often don’t have symptoms until the cancer is so far advanced that there are few options to help them.
Initial lung cancer symptoms may include a persistent cough, shortness of breath, fatigue and a kind of vague chest discomfort. Some people also develop a hoarse voice, cough up blood, lose their taste for food and lose weight unexpectedly.
Only about 4.5% of people who are at high risk of lung cancer get screened for it, the report says. But in some states, the number is much lower. In California, for example, only 0.7% of people at high risk of lung cancer get screened, although this may be an undercount.
“There’s a lot more room for improvement,” said Dr. Panagis Galiatsatos, a volunteer medical spokesperson for the American Lung Association. “We’re hoping with the updated guidelines that more of the population that needs to be screened will be screened.”
The American Cancer Society recently expanded its screening recommendations to say that anyone between the ages of 50 and 80 should get checked for lung cancer if they currently smoke or formerly smoked – no matter how long ago – at a rate of 20 pack-years. A pack-year is defined as smoking an average of a pack of cigarettes per day for one year.
Galiatsatos, who is also director of the Tobacco Treatment Clinic and associate professor of medicine at Johns Hopkins Medicine, said he’s optimistic that screening rates will improve. Unlike with cancers like cervical and prostate, which had decades of data to show the effectiveness of screening, doctors have been encouraging people to get screened for lung cancer only in the past decade or so, he said.
The guidelines around lung cancer also have been confusing, he said. Until the new change, people had to remember how long and how much they smoked in order to get screened for lung cancer. By comparison, doctors will usually encourage a mammogram to screen for breast cancer only if someone is 45 or older. They don’t have to calculate any other factors to qualify for the test.
The new report says that at current rates, lung cancer screening adds 80,000 years of life for people in the US and saves the US economy $40 million. if everyone who was eligible got screened, it would add 500,000 years of life and save the nation $500 million.
Getting screened for lung cancer is relatively straightforward, Galiatsatos said. Unlike a procedure like a colonoscopy that requires an inconvenient and often unpleasant preparation, lung cancer screening involves only a low-dose CT scan.
The best way to prevent cancer is to stop using tobacco, which is to blame for 80% to 90% of lung cancer cases, the report says. Even people who have a long history of smoking can reduce their risk if they become former smokers.
Galiatsatos said doctors also need to make sure high-risk people feel like their doctor’s office will be a safe space to get screened and to get access to smoking cessation programs.
“We haven’t done the best in our ability in promoting what will help them, in a way that doesn’t make them feel stigmatized or judged,” he said. “People with lung cancer oftentimes have been told ‘you did this to yourself,’ and that’s really not fair to them.”
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The second leading cause of lung cancer is exposure to radon, the CDC says, a colorless, odorless radioactive gas that is naturally released from soil, water and rocks. The gas can get in through cracks in a building and build up in the air over time. Over time, these radioactive particles can get trapped in the lungs and cause cancer.
Radon tests are available at many hardware stores. If a test shows a high level, the CDC recommends getting a radon reduction system, but you can also increase air flow in the home by keeping windows open, using fans to circulate the air and sealing cracks in floors and walls.
Exposure to year-round particle pollution can also lead to lung cancer. An earlier report from the American Lung Association found that 120 million people live in a part of the United States with high levels of this dangerous level of pollution. To reduce your exposure, the US Environmental Protection Agency recommends using high-efficiency portable air cleaners and exhaust fans that vent to the outdoors when cooking.