Ask the Expert: Jennifer Garst, MD, on Lung Cancer

In 2010, lung cancer caused 157,300 deaths in the United States according to estimates from the American Cancer Society. More women will die from lung cancer than from breast and ovarian combined. Research funding, however, is considerably less than funding for other major types of cancer.

Many people think that only smokers get lung cancer, but 10 percent of men and at least 20 percent of women who have lung cancer have never smoked. We spoke with Jennifer Garst, MD, a thoracic oncologist with the Cancer Institute, about the disease.

Besides smoking, how can someone get lung cancer?
Over the last 10 years or so, we have seen a rise in non-smokers who are getting lung cancer. We do not fully understand why, but we do know some of the causes.

Secondhand smoke is the number two cause of lung cancer after smoking. It is not a good idea to be around smokers, whether it is at a bar or in your home.

Radon is the number three cause of lung cancer. Although radon is more prevalent in certain parts of the country, it is probably beneficial for everyone to have their houses tested for radon since it is an odorless gas.

What symptoms are there? Are there tests to determine if someone has lung cancer? What are the treatment options?
The symptoms can be vague: fatigue, cough, and weight loss. It is usually not until someone is coughing up blood that the person will see the doctor. Because of this, 60 percent of patients are diagnosed in the advanced stages of cancer, when there is a very low survival rate.

There are various new treatment options such as a specialized chemotherapy, targeted pills, and the use of genomics to customize treatments for individuals. Research to produce more effective treatments is needed.

Since studies have shown that a yearly chest x-ray does not improve the survival rate for lung cancer, more research needs to be done to develop diagnostic tests.

How are men and women different when it comes to lung cancer?
On average, compared with men, women with lung cancer are diagnosed at an earlier age, have less exposure to tobacco, and live longer once diagnosed. Also, while the rate of lung cancer in men is going down, it has gone up dramatically in women.

More research needs to be done to determine why these differences exist, but researchers hypothesize it may be due to the fact that women’s lungs are smaller, leading to a higher concentration of toxins or that they metabolize these toxins differently. In addition, estrogen and genetics may play a role.

Is there hope for people who have been smoking for years? What’s the best way to quit?
It is never too late to quit. In addition to lowering your risk of getting cancer, those who quit are also able to breathe easier, lower their blood pressure, and respond better to treatments of several types of cancer.

Interestingly, the most successful quitters are those who go “cold turkey.” I usually recommend a combination of nicotine replacement such as the patch, medicine such as Azithromycin, and counseling.

At Duke, we are fortunate to have the Center for Nicotine and Smoking Cessation Research where smokers can get paid to participate in research studies that investigate effective ways to quit.