Lung Cancer: Deadly Truths, Reason for Hope

Lung cancer specialist provides answers to key questions

older man smoking

Lung cancer is the No. 1 cause of cancer deaths. Cleveland Clinic lung cancer specialists Nathan Pennell, MD, PHD answers common questions about this deadly disease – and offers reasons to be optimistic.

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When should I be concerned about a lingering cough?

Dr. Pennell: A cough can indicate a variety of benign problems, but anything that’s not going away with conservative treatment should prompt an imaging of the chest. This is especially important if you are diagnosed and treated multiple times with pneumonia that is not improving. Unexplained weight loss also is fairly common for people with advanced cancer, and shortness of breath that isn’t responding to treatment for infection or an inhaler should prompt follow-up care.

How big is my risk for lung cancer?

Dr. Pennell: If you smoke now or have smoked in the past, your risk is significant. It’s no secret that tobacco smoke is the major risk factor for developing lung cancer. Lifelong smokers have about a 15 percent chance of developing lung cancer in their lifetimes, although your risk starts to drop quickly after you quit. So if you have a cough or respiratory problem and have a significant smoking history, even if it’s in the relatively distant past, you should be wary. Make sure your cough resolves and see your physician if it doesn’t.

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What initial diagnostic tests should be performed if I have symptoms?

Dr. Pennell: A chest X-ray is probably the most reasonable step for someone with shortness of breath or cough, because most people are going to have a benign cause for their symptoms. We recommend patients who have an abnormality on their chest X-ray have a relatively rapid follow-up test to make sure that the abnormality goes away. Anything that is not resolving within a relatively short period of time needs a prompt CT scan.

How many cigarettes can I smoke without increasing my risk of developing lung cancer?

Dr. Pennell: The truth? Zero. Any amount of cigarettes you smoke will increase your risk of getting the disease. However, recent research indicates it probably matters how long you smoke more than how much you smoke. If you quit in your 20s and 30s, you still have a higher risk of developing lung cancer than someone who never smoked, but it is perhaps only twice as high as a never-smoker. But if you continue to smoke into your 50s and 60s, your risk is 20 to 30 times greater.

The flip side? It is never too late to quit. Even up to the day you’re diagnosed with lung cancer, statistically speaking, you will live longer if you quit.

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What is my chance of surviving? Should I be optimistic?

Dr. Pennell: Unfortunately, the five-year survival rate for lung cancer today is really not that very different from where it was 20 years ago, with only about 15 percent of patients surviving more than five years from diagnosis. However, unlike any time in history, we now are making tremendous strides in understanding the underlying genetic changes in the different types of lung cancer. So probably now, more than at any other time, people with lung cancer have a very real chance of finding something that will prolong their lives if they’re seen at a center that is running clinical trials for lung cancer.

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