Lung cancer is the second most common cancer and causes 25% of all cancer deaths. One in 16 people will be diagnosed with lung cancer in their lifetime. It can be a very aggressive disease, so early detection is vital. Early screening can help reduce the risk of death by 20%.

Tracy Ashby, DO, a UF Health Jacksonville physician specializing in pulmonary disease and critical care medicine, offers her expertise on lung cancer and how UF Health Jacksonville can provide treatment and services.

According to Ashby, smokers make up to 80–90% of lung cancer patients. Other risk factors include family history, occupational exposure to certain chemicals and fumes, and previous lung disease.

Vaping has not been around long enough to determine the long-term health effects or to be considered enough of a risk to get an early screening. However, substances in the vape liquid and metals used to heat the devices are known carcinogens.

The UF Health Jacksonville Thoracic Oncology Program, or TOPS, offers lung cancer screenings using safe, low-dose computed tomography, known as a CT scan. It’s a way to detect lung cancer earlier, before symptoms begin to show. Most insurance companies will pay for the screening, but there are also self-pay options available if needed.

Cancer screenings are available to people who are considered high risk. It’s recommended for people between the ages of 50 and 77 who have smoked more than a pack a day for 20 years and have smoked in the past 15 years. The screening takes pictures of the lungs and looks for nodules or masses that would be suspicious for cancer.

At the end of the screening, the patient is given a LungRADS score between 0 and 4. Scores of 0–2 are considered low risk and screenings will be recommended every 12 months. Scores of 3–4 are considered intermediate to high risk. These patients are typically referred to TOPS for further evaluation with a pulmonologist to discuss next steps.

If something suspicious is detected, then a second scan or biopsy is done to look into further treatment options.

An official diagnosis of lung cancer is obtained by one of two types of biopsies: a biopsy that can be performed endoscopically through a bronchoscopy, or through interventional radiology, also known as a CT-guided biopsy. Surgery may also be recommended if the spot isn’t accessible by biopsy.

The biopsy gathers the tissue that will determine the diagnosis and staging of the cancer for the patient. The biopsy sample can be obtained from the primary tumor, lymph nodes or areas where the cancer has spread, and then it’s broken down into stages based on where the cancer cells are identified.

Staging is determined by a combination of the biopsy, PET scan and an MRI of the brain. The patient’s case is then presented at the TOPS multidisciplinary meeting, where treatment is recommended based on the staging and the consensus of the medical team.

If a patient is in the lower stages — 1 or 2 — then surgery is recommended. Stage 3 patients work with a multidisciplinary team for treatment options — usually a combination of chemotherapy plus radiation and, in some cases, surgery.

If surgery is needed, UF Health Jacksonville offers robot-assisted thoracic surgery. This procedure is less invasive compared with other thoracic surgeries, such as a full thoracotomy or coronary artery bypass graft surgery.

An alternative to surgery for patients is radiation therapy. These patients are referred to the Proton Therapy Center for treatment. If a patient is at stage 4 or has metastatic disease, then systemic medications are used to control the cancer, but it’s seldom curable.

To keep your lungs healthy, Ashby recommends:

• Avoiding fumes of heavily polluted air
• Wearing a mask when exposed to strong chemicals at work
• Staying active and having good cardiovascular health
• Quitting smoking to prevent further damage of your lungs and reduce the risk of cancer