Clearing the Air

Smoking clouds the health of nearly 31 million Americans, the risk of lung cancer increasing with every puff. Thankfully, new advance screening measures are lifting the haze surrounding this deadliest of diseases

WRITTEN BY Robin Howard
PHOTOGRAPHS BY Scott Henderson

Lung cancer is the number-two most diagnosed cancer in both men and women—in frequency, it’s second only to prostate and breast cancer. But the number of Americans expected to lose their lives to lung cancer every year (a toll of 130,180 in 2022) almost equals the number of estimated deaths from breast, colorectal and prostate cancers combined. And the black cloud hovering over this deadliest of cancers is smoking. “Almost every patient I’ve ever had with small cell lung cancer has a tobacco history,” says Roper St. Francis Healthcare affiliated thoracic surgeon Dr. Elizabeth Kline. “In nearly 30 years of practice, the only patient I’ve ever had with small cell lung cancer who didn’t smoke was married to someone who did.”

Smoking cigarettes is responsible for up to 90 percent of lung cancer deaths, according to the Centers for Disease Control (CDC). For those at high risk, a simple chest scan can catch the disease in its first stages and reduce the chance of dying from lung cancer by up to one-fifth. Early detection is critical; that’s why the United States Preventive Services Task Force (USPSTF) changed its lung cancer screening recommendations in 2021 to include tobacco users at a younger age and with a shorter smoking history.

Through the Haze

Thankfully, as fewer and fewer people are lighting up, the gloomy fog of lung cancer is slowly clearing. (Roughly 13 out of every 100 adults smoked in 2020, compared to 21 out of every 100 in 2005, reports the CDC.) Experts attribute much of this decline to an increasing awareness of the carcinogenic effects of tobacco use.

Need a refresher on the damage caused by smoking? “Healthy lungs are pink and spongy, and they expand quickly when you breathe,” says Dr. Kline. “But in people who smoke, the lungs are black, scarred and less spongy. They can’t bring in oxygen and get rid of carbon dioxide like they’re supposed to.” With repeated exposure to the cancer-causing substances in cigarette smoke, the cells lining the lungs become increasingly damaged and abnormal.

The doctor goes on to explain that smoking doesn’t just affect the lungs; all organ systems are damaged by tobacco use, including the heart, eyes, mouth, blood vessels, bones, bladder, digestive system and reproductive organs. Smoking and also vaping can complicate diabetes; cause infertility; increase LDL or “bad” cholesterol; lead to anxiety, irritability and mood swings; and exacerbate menopause symptoms. What’s most concerning, though, is the irreparable harm smoking does to cells, leading to emphysema, chronic bronchitis and, yes, lung cancer.

Breathe Easy

Two types of lung cancer, small cell and non-small cell, account for the majority of diagnoses. Small cell lung cancer, typically the more aggressive of the two, is predominantly caused by smoking or regular exposure to secondhand smoke. Non-small cell lung cancer may also be caused by smoking, as well as exposure to asbestos or certain chemicals. Treatment for lung cancer may involve surgical resection of the diseased lung tissue, radiation or a multilayered approach using surgery, chemotherapy and radiation.

No matter the type, early-stage lung cancer doesn’t typically have any noticeable symptoms. So, Dr. Kline is passionate about getting at-risk people in for early detection screenings. “When you look at the numbers, 80 percent of lung cancers now are found in the early stages,” she says. “Just 20 years ago, that measure was only 30 percent.” Much of the dramatic uptick in early detection can be attributed to the increased use of CT scans for preventive screenings. In fact, since the national inception of preventive lung cancer screenings in 2013, lung cancer deaths have declined by roughly four percent every year.

The USPSTF now recommends that people between the ages of 50 and 80 who have a 20-pack-year history and currently smoke or quit smoking within the last 15 years get an annual CT screening for lung cancer. A person’s nicotine pack-year history is calculated by multiplying the number of packs they smoke per day by the number of years they’ve smoked. (Someone who smokes one pack of cigarettes every day for 20 years has the same 20-pack-year history as someone who smokes two packs a day for 10 years.)

“Getting screened starts with a visit to your doctor for some shared decision-making,” says Dr. Kline. A computed tomography (CT) lung screening uses low-dose X-rays to detect small nodules or cancer. The noninvasive, painless procedure only takes about 20 minutes and is highly effective at finding cancer in its beginning stages. Whenever Dr. Kline encounters a patient worried about radiation from the scan, she tries to put that low risk into perspective. “A low-dose CT scan exposes you to slightly more radiation than an annual mammogram and about the same amount as flying from South Carolina to Los Angeles or just living in Charleston for six months,” she says.

Patients who have developed lung cancer because of smoking often feel embarrassed or guilty, notes Dr. Kline, but she doesn’t want such feelings to deter anyone from getting screened. “This is a judgment-free zone. We recognize that tobacco isn’t the only risk factor for lung cancer. And if you do smoke, we’re going to help you quit or cut back as much as you want.”

“Roper St. Francis performs about 200 scans a month and has found lung cancer in as many as 1 in 58 people being screened,” Dr. Kline says. “Low-dose CT scans are the most meaningful contribution to lung cancer survival in the 21st century. That’s a big deal.”