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14 • BRONX VOICE• August 10 - 16, 2022
Breaking the Lung Cancer stigma
By Neel M. Chudgar, M.D., cancer surgeon at Montefiore Einstein Cancer Center and assistant professor of cardiothoracic & vascular surgery at Albert Einstein College of Medicine World Lung Cancer Day was observed across the world on August 1, and while this cancer claims more lives each year than the combination of breast, colon, and prostate cancer, the screening and overall culture surrounding this disease is treated quite differently. Breast, colon and prostate cancer exams are part of regular primary care screenings. The science is well-established as is the care routine. We’ve come to expect that once we reach an appropriate age, we will hear about screenings like a mammogram or colonoscopy as part of an annual physical exam. Though we all know someone who has been impacted or even died from lung cancer, screening for lung cancer by way of low dose CT scans is less established as a norm within health maintenance. People between the age of 50 and 80, who are either current smokers or who have quit within the past 15 years and have smoked the equivalent of at least one pack per day for 20 years (20 packyears) are eligible for screening. Despite these guidelines, only one out of every 15 eligible people participate in screening.
The relative novelty of screening along with its rigorous inclusion criteria, which requires a history of smoking, likely contributes to some of the difficulties with uptake. Lung cancer remaining stigmatized as a self-inflicted disease of smokers also contributes to the challenge of education and overall awareness of the disease. With large studies now demonstrating the overwhelming survival advantages of lung cancer screening, it’s time to ditch this mentality and focus on saving lives. Recent Advances in Lung Cancer Care As we embrace World Lung Cancer Day, we seek not only to honor people who have succumbed to this disease, but also to recharge our efforts to improve the statistics. Nearly half of the individuals who are diagnosed with
lung cancer have done so at late stages of the disease. In fact, there are less stage I cancers and more advanced (stage IV) cancers in the Bronx compared to most other places in the United States – a clear call for intervention. Screening provides an opportunity to make a significant change and help identify cancers when there is the greatest chance for a cure. This includes surgery to remove cancers, which are often done with small incisions and shorter hospital stays. In addition to surgical therapies, last year has brought other advances to the treatment of lung cancer. Immunotherapy, or treatments that support the body’s own immune system in fighting cancers, has been a hot topic in cancer care. Landmark trials investigating these drugs given either before or after surgery have demonstrated huge improvements in survival. Moving out of the Shadows of the Pandemic The focus of healthcare over the last two years has largely been on the COVID-19 pandemic. As a result, many cancer screenings including lung cancer screening rates have subsequently slumped. Now is the time to renew efforts that push lung cancer screening back into the conversation. One way we are doing this is through a partnership
Neel M. Chudgar, M.D., cancer surgeon at Montefiore Einstein Cancer Center and assistant professor of cardiothoracic & vascular surgery at Albert Einstein College of Medicine
with the LUNGevity Foundation to understand barriers to people accessing care, particularly among Black and Latino members of our community. We’re doing this through tailored educational materials and by deploying peer navigators to help us address challenges with accessing care that may be overlooked in our daily practice. These activities are enabling us to tackle the pervasive anxiety and stigma associated with screening. As a result, we are identifying more cancers at early stages, enabling more chances for diseases to be cured. We’re also adding more software to automatically detect lung nodules (or lesions)
which may appear on scans through our high-risk lung nodule clinic. Our objective is to avoid missed opportunities to find lung cancer so we can decrease risk of advanced disease and death. There is great hope on the horizon for the treatment of lung cancer. As screening rates improve, more people will be eligible for treatments that pose less of an imposition on a person’s daily life. However, we must find the cancers first. To honor this international awareness day, let’s forget about stigma and blame. Cancer is a disease that nobody deserves. As a community, let’s concentrate on support, education and hope – together, we can make a difference.