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Good Questions

Lung Cancer Puzzle

By Gregory Mott
Washington Post Staff Writer
Tuesday, April 12, 2005; Page HE01

Though headlines more frequently focus on cancers of the breast, prostate or colon, last week's announcement that ABC News anchor Peter Jennings has lung cancer is a reminder that this form remains the most deadly of all malignancies.

According to the American Cancer Society (ACS), more than 172,000 Americans will be diagnosed with lung cancer in 2005. About 60 percent of those will be dead within a year of diagnosis; between 70 and 80 percent will be dead within two years. More people die of lung cancer than of colon, breast and prostate cancers combined, according to the ACS.

Most frustrating for cancer experts is that most lung cancer is rooted in a lifestyle choice that people freely make: the decision to smoke.

We spoke late last week with Peter Mazzone, co-director of the lung cancer program at the Cleveland Clinic, about the state of cancer research and treatment.

We often hear that lung cancer is difficult to detect in the early stages. Why is that?

When lung cancer is in its early stages, few patients have symptoms. . . . They're not coughing or having chest pains or shortness of breath. They often don't have any symptoms until the cancer has progressed to a later stage of the disease, so there'd be no reason for them to come to the attention of the medical system. . . .

What are the typical first indicators? There are two quite separate ways that someone might present with lung cancer. One is with symptoms that are pretty nonspecific. . . . Someone could have a cough because they had smoked, or they could have emphysema or they could have a cold that's taken a long time to go away.

The second way is that a lot of people get pictures of their lungs taken -- chest X-rays or CAT scans -- for entirely different reasons, and those scans or pictures might incidentally show an abnormality that later on turns out to have been a lung cancer.

Since nine out of 10 cases occur in smokers, should smokers have this sort of screening for cancer even when there are no symptoms?

There've been many, many studies through the years looking for ways to screen for lung cancer, just like mammography can screen for breast cancer and or a Pap smear can screen for cervical cancer. The methods used have been chest X-rays, examination of the sputum, now more recently CAT scans in people who are at risk for lung cancer -- right age group, having had a significant smoking history. To date there has been no screening test that has been proven to reduce lung-cancer-specific mortality and/or be cost-effective.

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