Historical lessons and a bright future in the battle against lung cancer
By Patrick Nana-Sinkam, M.D.
Dr. Nana-Sinkam is a pulmonologist and cancer researcher at VCU Massey Cancer Center and chair of the VCU Health Division of Pulmonary Disease and Critical Care Medicine
Today marks the end of Lung Cancer Awareness Month, and as such it allows us to pause and reflect on the great progress that has been made in the ongoing battle against the disease and the hope that exists for patients. Looking back 100 years, lung cancer was actually considered a rare disease. Some of the earliest descriptions of lung cancer included the following quote from 1912: “There is nearly complete consensus of opinion, and that is that primary neoplasms of the lungs are among the rarest forms of disease.”
It would take us nearly a century, through trial and error, to better recognize the diagnosis, to learn about the links between tobacco use and lung cancer, to recognize that lung cancer may develop in non-smokers and to understand the genetic complexities of lung cancer and the importance of early detection. This knowledge made us realize the true prevalence and significant danger of lung cancer—that it is the leading cause of cancer-related deaths for both men and women—but it has also fueled the rise of patient advocacy, our adoption of the concept that “one size does not fit all” for lung cancer diagnosis and therapy and our continued struggle against tobacco use.
In the last 20 years of lung cancer research, we have witnessed exciting developments that have and will continue to shape how both patients and health care providers view a lung cancer diagnosis. For example, therapies have rapidly evolved from very few options with mixed results to therapies that are tailored to the genetic makeup of each person’s tumor. Termed “personalized medicine” and “precision oncology”, this approach to lung cancer has now become standard for guiding treatment decisions regarding therapy and has led to significant improvements in patient outcomes. While we have yet to develop a targeted therapy for every genetic subtype of lung cancer, the increased number of treatment options is impacting our patients in a manner never before seen. More recently, the emergence of immunotherapy has allowed clinicians to target the naturally occurring “brake” that some lung tumors place on the immune system, thus giving the immune system a boost in fighting the tumor.
Clinicians and scientists alike have also recognized for over 50 years that early detection of lung cancer can impact patient outcomes by offering, in many cases, surgical removal of the tumor. Yet, identifying the truly “at-risk” individual while impacting patient outcomes was challenging for most of the 20th century. Recently, researchers have shown that screening high-risk active or former smokers with low-dose CT scans can lead to early lung cancer detection and decreased mortality. This has revolutionized how we define and screen high-risk individuals and has become the standard of care. Estimates suggest we could save nearly 12,000 lives in the U.S. every year through broad adoption of lung cancer screening.
In our journey to diagnose and treat lung cancer, history has taught us some important lessons, while technology has afforded us the opportunity to study the disease in new and exciting ways. While we remain in the midst of a battle, we are achieving meaningful gains that are making a difference in patients’ lives. We still have a long way to go, and the challenges will continue, but I truly believe that the future appears brighter than ever.