Lung cancer is one of the most common cancers in America, with over 220,000 new cases each year.
Lung cancer is cancer that usually starts in the lining of the bronchi (the main airways of the lungs), but can also begin in other areas of the lungs, including the bronchioles, or alveoli.
More women die from lung cancer than any other cancer.
Even though smoking is the number one cause of lung cancer in women, a higher percentage of women who develop lung cancer are life-long non-smokers.
Does estrogen play a role in the development and progression of lung cancer?
In general, why do healthy non-smokers get lung cancer?
These questions and more are answered today as Loretta Erhunmwunsee, M.D. discusses lung cancer, how women are at risk, and how a few precautions can help to lower your risk of getting lung cancer.
Selected Podcast
Lung Cancer Trends in Women and Non-Smokers
Featured Speaker:
Board-certified in surgery, Dr. Erhunmwunsee has been the recipient of numerous honors and awards including the World Congress on Lung Cancer Young Investigator’s Award in 2009. She was chosen as an NIH/NMA Academic Career in Medicine Fellow in 2015, and was chosen as a Feagin Leadership Scholar from Duke University in 2014. Dr. Erhunmwunsee is also the recipient of the Peter C. Pairolero Scholarship Award which she received in 2015 from the General Thoracic Surgical Club. She sees patients with lung, esophageal and mediastinal tumors. Her research focuses on eliminating health inequity in thoracic oncology patients.
Learn more about Loretta Erhunmwunsee, M.D.
Loretta Erhunmwunsee, MD
Loretta Erhunmwunsee, M.D. is an assistant professor in the division of thoracic surgery. Dr. Erhunmwunsee graduated Phi Beta Kappa from Emory University in Atlanta, GA, then went on to receive her medical doctorate from Harvard Medical School in Boston, graduating magna cum laude. She continued her post-graduate training at Duke University Medical Center in Durham, NC, completing a general surgery internship, followed by a residency in general surgery, after which she served as chief resident from 2011 – 2012. This was followed by a residency in cardiothoracic surgery, also at Duke.Board-certified in surgery, Dr. Erhunmwunsee has been the recipient of numerous honors and awards including the World Congress on Lung Cancer Young Investigator’s Award in 2009. She was chosen as an NIH/NMA Academic Career in Medicine Fellow in 2015, and was chosen as a Feagin Leadership Scholar from Duke University in 2014. Dr. Erhunmwunsee is also the recipient of the Peter C. Pairolero Scholarship Award which she received in 2015 from the General Thoracic Surgical Club. She sees patients with lung, esophageal and mediastinal tumors. Her research focuses on eliminating health inequity in thoracic oncology patients.
Learn more about Loretta Erhunmwunsee, M.D.
Transcription:
Lung Cancer Trends in Women and Non-Smokers
Melanie Cole (Host): Lung cancer is one of the most common cancers in America with over 220,000 new cases each year. At City of Hope, we treat the whole person, body and soul, and have a compassionate, unmatched reputation for coordinated comprehensive care. The lung cancer team has pioneered state of the art regimens with procedures that eradicate cancer while minimizing side effects with a broad array of lung cancer expertise from multiple disciplines, all under one roof. My guest today is Dr. Loretta Erhunmwunsee. She's an Assistant Professor in the Division of Thoracic Surgery at City of Hope. Welcome to the show, Dr. Erhunmwunsee. Why is lung cancer in women and non-smokers even, on the rise do you think?
Dr. Loretta Erhunmwunsee (Guest): First of all, thank you so much for having me this morning. That's a very excellent question and it's one that there's a lot of studies going into trying to figure this out. I think primarily its multi-factorial. Specifically for women, it's important to note that lung cancer is, in fact, the number one killer of both men and women. Women in particular continue to have other sort of risk factors that might impact their ability to have lung cancer. Unfortunately, smoking continues to be a significant sort of risk factor that women are exposed to, either primarily smoking themselves to second-hand smoke. I think that's one of the reasons why we're seeing lung cancer in women at such high rates. It's important to understand that there aren't necessarily increased deaths from lung cancer in women. The truth is that the number of deaths from lung cancer in women has actually plateaued and it's actually coming down a bit but it's still a significant problem because it is the number one killer of women. So, long cancer continues to be a problem. Then, with non-smokers, we're starting to realize that actually those numbers are rising and we think that might be secondary to increased rates of second-hand smoking and also through genetic mutations that we're starting to see on the rise.
Melanie: So, is there a genetic component to lung cancer, Dr. Erhunmwunsee?
Dr. Erhunmwunsee: Absolutely. There is a genetic component but we think that the genetic aspect of it is typically sporadic, meaning that it's not the same sort of thing when you consider genetic issues that come from parents. Your parents come together and they, hopefully, will give you normal genes. In most lung cancer patients, they have normal genes but because of the carcinogens or a pollutant, those genes may become injured and then lead to the lung cancer. So, there certainly is a genetic component. There have been lots of studies that show that. We have a better understanding of which gene mutations lead to certain cancers and so, we know that with most tumors, there is a genetic mutation that leads to it. We believe that this is typically secondary to smoking.
Melanie: With estrogen being known to grow things, does that play a role in the development progression of lung cancer? Is there any difference that you see in women that are in perimenopause or post-menopause versus pre-menopausal women and estrogen levels?
Dr. Erhunmwunsee: That's a good question. So, there is a connection between estrogen and lung cancer but it's not as clear as to what that connection is. Certainly, we know that women who take estrogen and progestin sort of when they're menopausal have a higher rate of lung cancer. There are studies that have shown that. We also know that women who have lung cancer who continue to estrogen and progestin have a worse survival with lung cancer. So, there have been studies that have shown that, but it's not as clear because we've also had small studies that have not shown that. So, right now, the thought is that there is a role that estrogen plays with lung cancer and many times if a woman who is on estrogen and progestin develops lung cancer, those drugs will be stopped. We can't say for sure what the exact correlation is because we don't have enough data to support that.
Melanie: Is it more difficult to diagnose lung cancer in non-smokers? If someone is getting a lung cancer screening because they've been a 30 pack a year smoker, and there are a non-smoker but they're exhibiting maybe symptoms or coughing or something and they come to see you, is this the first thing you might think about or is a little more difficult to diagnose?
Dr. Erhunmwunsee: I think you're right. It is, in some ways, very much more difficult to diagnose simply because we are trained to hear smoking history and automatically think of cancer or at least try to rule it out. But, honestly with the increase in rate of lung cancer in non-smokers, this is something that we are starting to look into even in non-smokers. So, if a patient presents with a cough or weight loss or certainly if their coughing up blood, they're going to get imaging of their chest and, hopefully, then we will be able to move forward and find the cancer or whatever, element that they have.
Melanie: Tell us about some of the advances in lung cancer treatment, things that can give people hope if they have been diagnosed with this very scary disease.
Dr. Erhunmwunsee: Yes, it's important to understand that there have been some advances and we're very proud of them. There are many clinical trials on the way that are working to determine which sorts of therapies are best suited for a particular genetic mutation in lung cancer. We, especially here, have focused on minimally invasive surgery in an attempt to improve the way we remove lung cancer from patients who have localized disease. We also are doing more and more studies to understand the role of radiation which may be a way to treat people with lung cancer and hope for a cure if they aren't able to undergo surgery. Then, there are other sorts of therapies that are on the horizon for patients with more advanced disease. So, the truth is there are a lot of therapies that have now been proven to be quite effective and that we're studying and hoping will be effective.
Melanie: Please, in the last few minutes, Dr. Erhunmwunsee, give your best advice for possibly preventing lung cancer in women and non-smokers as well. Lifestyle modifications, things they can do that might reduce that risk, and why they should come to City of Hope for their care.
Dr. Erhunmwunsee: Absolutely. Thank you for asking that. So, the number one risk factor for everyone still is exposure to smoke—to cigarette smoke. So, the number one thing that we can do to prevent lung cancer is to stop smoking. So, if a person is smoking, stopping smoking, abstaining from smoking, never smoking, is the number one thing that can be done to decrease your risk. For those who are not smoking, exposure to second-hand smoke still needs to be stopped. So, if you have loved ones and those around you who smoke, keeping your distance, not allow them to smoke in your car, your home, and reducing that exposure is absolutely key. We also would suggest, be very mindful of your body. So, if you are starting to have symptoms of any sort, if there's a cough that is prolonged, certainly if you’re coughing up blood, see your physician. Honestly, especially those who are smoking, we would recommend talking to your physician about lung cancer screening because that won't prevent lung cancer but it certainly will allow for easier and earlier detection. There are other risk factors including air pollutant and radiation, for patients who have had radiation for lymphoma or those sorts of things, maybe for breast cancer, in the past. There's not much you can do after the fact, but, certainly, again, if there are any sort of symptoms, please make sure to see your physician and discuss further care.
Melanie: Thank you so much. It's great information. You're listening to City of Hope Radio. For more information, you can go to CityofHope.org. That’s CityofHope.org. This is Melanie Cole. Thanks so much for listening.
Lung Cancer Trends in Women and Non-Smokers
Melanie Cole (Host): Lung cancer is one of the most common cancers in America with over 220,000 new cases each year. At City of Hope, we treat the whole person, body and soul, and have a compassionate, unmatched reputation for coordinated comprehensive care. The lung cancer team has pioneered state of the art regimens with procedures that eradicate cancer while minimizing side effects with a broad array of lung cancer expertise from multiple disciplines, all under one roof. My guest today is Dr. Loretta Erhunmwunsee. She's an Assistant Professor in the Division of Thoracic Surgery at City of Hope. Welcome to the show, Dr. Erhunmwunsee. Why is lung cancer in women and non-smokers even, on the rise do you think?
Dr. Loretta Erhunmwunsee (Guest): First of all, thank you so much for having me this morning. That's a very excellent question and it's one that there's a lot of studies going into trying to figure this out. I think primarily its multi-factorial. Specifically for women, it's important to note that lung cancer is, in fact, the number one killer of both men and women. Women in particular continue to have other sort of risk factors that might impact their ability to have lung cancer. Unfortunately, smoking continues to be a significant sort of risk factor that women are exposed to, either primarily smoking themselves to second-hand smoke. I think that's one of the reasons why we're seeing lung cancer in women at such high rates. It's important to understand that there aren't necessarily increased deaths from lung cancer in women. The truth is that the number of deaths from lung cancer in women has actually plateaued and it's actually coming down a bit but it's still a significant problem because it is the number one killer of women. So, long cancer continues to be a problem. Then, with non-smokers, we're starting to realize that actually those numbers are rising and we think that might be secondary to increased rates of second-hand smoking and also through genetic mutations that we're starting to see on the rise.
Melanie: So, is there a genetic component to lung cancer, Dr. Erhunmwunsee?
Dr. Erhunmwunsee: Absolutely. There is a genetic component but we think that the genetic aspect of it is typically sporadic, meaning that it's not the same sort of thing when you consider genetic issues that come from parents. Your parents come together and they, hopefully, will give you normal genes. In most lung cancer patients, they have normal genes but because of the carcinogens or a pollutant, those genes may become injured and then lead to the lung cancer. So, there certainly is a genetic component. There have been lots of studies that show that. We have a better understanding of which gene mutations lead to certain cancers and so, we know that with most tumors, there is a genetic mutation that leads to it. We believe that this is typically secondary to smoking.
Melanie: With estrogen being known to grow things, does that play a role in the development progression of lung cancer? Is there any difference that you see in women that are in perimenopause or post-menopause versus pre-menopausal women and estrogen levels?
Dr. Erhunmwunsee: That's a good question. So, there is a connection between estrogen and lung cancer but it's not as clear as to what that connection is. Certainly, we know that women who take estrogen and progestin sort of when they're menopausal have a higher rate of lung cancer. There are studies that have shown that. We also know that women who have lung cancer who continue to estrogen and progestin have a worse survival with lung cancer. So, there have been studies that have shown that, but it's not as clear because we've also had small studies that have not shown that. So, right now, the thought is that there is a role that estrogen plays with lung cancer and many times if a woman who is on estrogen and progestin develops lung cancer, those drugs will be stopped. We can't say for sure what the exact correlation is because we don't have enough data to support that.
Melanie: Is it more difficult to diagnose lung cancer in non-smokers? If someone is getting a lung cancer screening because they've been a 30 pack a year smoker, and there are a non-smoker but they're exhibiting maybe symptoms or coughing or something and they come to see you, is this the first thing you might think about or is a little more difficult to diagnose?
Dr. Erhunmwunsee: I think you're right. It is, in some ways, very much more difficult to diagnose simply because we are trained to hear smoking history and automatically think of cancer or at least try to rule it out. But, honestly with the increase in rate of lung cancer in non-smokers, this is something that we are starting to look into even in non-smokers. So, if a patient presents with a cough or weight loss or certainly if their coughing up blood, they're going to get imaging of their chest and, hopefully, then we will be able to move forward and find the cancer or whatever, element that they have.
Melanie: Tell us about some of the advances in lung cancer treatment, things that can give people hope if they have been diagnosed with this very scary disease.
Dr. Erhunmwunsee: Yes, it's important to understand that there have been some advances and we're very proud of them. There are many clinical trials on the way that are working to determine which sorts of therapies are best suited for a particular genetic mutation in lung cancer. We, especially here, have focused on minimally invasive surgery in an attempt to improve the way we remove lung cancer from patients who have localized disease. We also are doing more and more studies to understand the role of radiation which may be a way to treat people with lung cancer and hope for a cure if they aren't able to undergo surgery. Then, there are other sorts of therapies that are on the horizon for patients with more advanced disease. So, the truth is there are a lot of therapies that have now been proven to be quite effective and that we're studying and hoping will be effective.
Melanie: Please, in the last few minutes, Dr. Erhunmwunsee, give your best advice for possibly preventing lung cancer in women and non-smokers as well. Lifestyle modifications, things they can do that might reduce that risk, and why they should come to City of Hope for their care.
Dr. Erhunmwunsee: Absolutely. Thank you for asking that. So, the number one risk factor for everyone still is exposure to smoke—to cigarette smoke. So, the number one thing that we can do to prevent lung cancer is to stop smoking. So, if a person is smoking, stopping smoking, abstaining from smoking, never smoking, is the number one thing that can be done to decrease your risk. For those who are not smoking, exposure to second-hand smoke still needs to be stopped. So, if you have loved ones and those around you who smoke, keeping your distance, not allow them to smoke in your car, your home, and reducing that exposure is absolutely key. We also would suggest, be very mindful of your body. So, if you are starting to have symptoms of any sort, if there's a cough that is prolonged, certainly if you’re coughing up blood, see your physician. Honestly, especially those who are smoking, we would recommend talking to your physician about lung cancer screening because that won't prevent lung cancer but it certainly will allow for easier and earlier detection. There are other risk factors including air pollutant and radiation, for patients who have had radiation for lymphoma or those sorts of things, maybe for breast cancer, in the past. There's not much you can do after the fact, but, certainly, again, if there are any sort of symptoms, please make sure to see your physician and discuss further care.
Melanie: Thank you so much. It's great information. You're listening to City of Hope Radio. For more information, you can go to CityofHope.org. That’s CityofHope.org. This is Melanie Cole. Thanks so much for listening.