Important Facts About Lung Cancer

Coloured CT scan showing cancer of a lung

ALFRED PASIEKA / SCIENCE PHOTO LIBRARY / Getty Images

Important facts about lung cancer can be both sobering and surprising. Many people are surprised to hear the real story about lung cancer, though the stigma, and lack of the funding due to the stigma, has left lung cancer behind in research until recent years. Let's take a look at some of the statistics, as well as some interesting and uncommon facts you may not know.

Facts About Lung Cancer Incidence

Many people believe that breast cancer is the leading killer in women and prostate cancer in men, but that's not the case.

Lung Cancer Is the Leading Cause of Cancer Deaths in the U.S.

As the leading cause of cancer deaths in both men and women in the United States, lung cancer kills more people each year than breast cancer, prostate cancer, and colon cancer combined. In 2019, it is estimated that 142,670 people will die from lung cancer, roughly half men and half women. At the same time, it's estimated that 41,760 women will die from breast cancer and 31,620 men will die from prostate cancer.

Lung Cancer Occurs in Young Adults

While many people equate lung cancer with older adults, and the average age at diagnosis is 71, lung cancer can and does occur in young adults and even children.

Considering that 13.4% of people with lung cancer are under the age of 50, and multiplying this by the number of deaths, it's estimated that slightly over 21,000 young adults will die from lung cancer in 2019. Using the same calculation with breast cancer, in which 20% of women are under the age of 54, it translates to 8,300 young adults dying from breast cancer. Upon hearing of a young person's cancer death, many people would be surprised to hear that it's almost three times more likely to be from lung cancer statistically.

Lung Cancer Happens in Non-Smokers

Smoking is the leading cause of lung cancer, but at the current time, the majority of people who develop lung cancer do not currently smoke. Overall, more than 50% of lung cancers occur in former smokers and 10% to 20% in never smokers. At least 20% of women who develop the disease have never smoked, and the disease tends to occur at an earlier age in women.

Lung Cancer in Never Smokers is Increasing

The surprising fact here is that lung cancer is both decreasing and increasing. It is decreasing, in general, in men, while leveling off in women. At the same time, however, lung cancer is increasing in young adults, especially young who have never smoked. The reasons for this increase aren't clear at this time, but from tests looking at the mutational signature of the tumors, it's not secondhand smoke nor closet smoking.

There Are Causes Other Than Smoking

It's commonly known that smoking is a leading cause of lung cancer, but it's not the only cause.

Radon Is the Second Leading Cause of Lung Cancer

It is less well-known that exposure to radon in our homes is considered to be the second leading cause of lung cancer and the leading cause in non-smokers.

Radon causes almost eight times as many lung cancers as secondhand smoke, and those who are at the greatest risk are those who spend the most amount of time in the home: women and children.

To make another comparison with breast cancer, it's currently estimated that there are 21,000 to 27,000 radon-induced lung cancer deaths each year in the United States. Comparing this to the slightly over 40,000 breast cancer deaths, this is a very large number of people. Radon is easy to test for (a kit for around $10 can be purchased at most hardware stores) and easily treated (if levels are abnormal, radon mitigation can almost always eliminate the problem for around $800 to $1200. If we had an inexpensive test to find if a breast cancer cause was present in our homes, and if half of breast cancer deaths could be eliminated for roughly 1K, it's likely we would all be very familiar with radon testing.

On-The-Job Exposures are an Important Cause of Lung Cancer

Occupational exposures are also an important cause of lung cancer, accounting for up to 27% of lung cancers in men. Some other lung cancer causes include exposure to secondhand smoke and air pollution.

Symptoms

Common symptoms of lung cancer include a cough that doesn't go away or coughing up blood, but there are many exceptions.

Lung Cancer May Have No Symptoms

Many people with lung cancer have no symptoms, and even when present, the early symptoms of lung cancer are often mistaken for another problem, such as a lung infection, allergies, or muscle pain in the shoulder, back, or chest. Some may even dismiss them as "normal" changes that come with aging or deconditioning.

Lung Cancer Symptoms May Not Be "Typical"

Just as heart disease symptoms differ in men and women, lung cancer symptoms may differ as well. Young adults, women, and never smokers are most likely to develop a type of non-small cell lung cancer called lung adenocarcinoma. These tumors usually grow in the periphery of the lungs (unlike the formerly more common types that tend to grow in the large airways). Instead of coughing, the first symptoms are often mild shortness of breath with activity or extreme fatigue; symptoms easily dismissed as due to something else.

Survival Rates Are Changing

Lung cancer not only has the stigma of being a smoker's disease but of being rapidly fatal.

Stage 4 Lung Cancer Isn't a Death Sentence

While metastatic lung cancer (stage 4) still takes far too many lives, things are starting to change with new treatments such as targeted therapies and immunotherapy drugs. Just a few short years ago, the expected survival for someone diagnosed with stage 4 lung cancer was roughly a year (and still is for some people).

But for people with some mutations (or other genomic alternations) in their tumors, and among people who respond to immunotherapy, that one year mark is getting budged.

As an example, stage 4 non-small cell lung cancer harboring an ALK mutation had the same prognosis as other stage 4 lung cancers until very recently. That said, a 2018 study found that (and this is important) for people treated with the appropriate medications, the median survival was 6.8 years, even if people had brain metastases.

With immunotherapy, some people have achieved long term control of their disease, and we've reached a stage at which oncologists are wondering whether we may be able to, at least for a minority of people, cure stage 4 lung cancer.

These statistics aren't meant to ignore the very real fact that far too many people still follow the old statistics when it comes to stage 4 lung cancer. But it does bring hope that we are heading in the right direction.

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  1. Pacheco JM, Gao D, Smith D, et al. Natural History and Factors Associated with Overall Survival in Stage IV ALK Rearranged Non-Small-Cell Lung CancerJournal of Thoracic Oncology. 2018. 14(4):691-700. doi:10.1016/j.jtho.2018.12.014

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