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HEALTHWISE: Lung cancer can emerge long after quitting smoking

Date Published: 05/31/2020 [Source]

She had called with a cough. Lena, in her 70s, but lean, lively and looking 15 years younger, rarely complained about anything. "I've had a little more sinus drainage than usual and it seems to be giving me a cough. I didn't want to bother you with it, but it seems to just be dragging on."

After a listen to her lungs and an ear, nose, throat exam I treated her and told her to see me back if that wasn't taking care of things. A couple weeks later, Lena was back in the office. There was a little less drainage, but the cough was no better. As I placed the stethoscope on her back and had her take a deep breath, she gave an odd catch as she inhaled, followed by a short wheeze. Just something about it I didn't like. But in the 15 years I'd seen her as a patient, she hadn't been a smoker. I wasn't that suspicious, just wanted to make sure everything looked clear.

"Lena, I think we'll get a chest x-ray and make sure everything looks ok."

It didn't look ok. The radiologist called saying there was a mass in the right lower lobe of the lung. Lena is a very strong woman, and she took the news as in-stride as anyone could, wanting to know what the next step was in combatting this foe. Reviewing her smoking history and confirming that it had been some 25 years since she had quit smoking, I was again surprised that a lung cancer had waited that long to show up. It got me looking back through the data on lung cancer. Each year in the US, over 40,000 women die from breast cancer. But over 60,000 women die from lung cancer each year, and more than 70,000 men. The combined deaths from lung cancer every year in the US (over 130,000) are about two-and-a-half times the second leading cause of cancer death (colon cancer). Although the vast majority of lung cancer deaths are present or past smokers, over 20,000 lung cancer deaths each year are partially or totally attributable to radon exposure, and over 7,000 are due to second-hand smoke. So, lung cancer is the grim king of cancers, just not always getting all the attention of, say, breast cancer.

On a side note, it's probably worth getting your house checked for radon. The testing kits are pretty inexpensive and can tell you whether your house has a high level of this carcinogen. Any house can have this problem so it's a good idea to check yours, and if it turns out your house has a problem, there are some pretty clear steps you can take to reduce the radon levels. Imagine if someone said they could get rid of half of the breast cancer deaths every year; there would be a huge amount of excitement. Well, that's what we would be talking about (in numbers) if we eliminated all of the lung cancer deaths attributable to radon.

Do all you can to avoid this grim king of cancers, or at least try to catch him and kick him out as soon as he shows up.