Q&A with Dr. Thomas Buchholz of Scripps for Lung Cancer Awareness Month

November is Lung Cancer Awareness month, drawing attention to the cancer that causes the most deaths in the United States. Thomas Buchholz is medical director of Scripps MD Anderson Cancer Center and a Scripps Clinic physician, and lives in Rancho Santa Fe. In a Q&A, he addressed some of the lung cancer risk factors, treatment options and a screening program.

Answers were lightly edited for clarity and conciseness.

Q: What should people know about the lung cancer screening program at Scripps?

Buchholz: We think the screening program is going to save lives. Lung cancer remains the No. 1 cause of cancer-related deaths in the United States. Over 30,000 people, unfortunately, are expected to pass away from lung cancer in 2022. Partly this reflects that historically lung cancer has been diagnosed at a more advanced disease stage. That means by the time the cancer is diagnosed, the cancer is relatively large and often has spread to lymph nodes or other sites in the body, and can be an incurable situation at that point in time. So the key to improving death rates from cancer are twofold: one, preventive services by promoting healthy lifestyles that avoid tobacco, which continues to be the No. 1 carcinogen. And No. 2, early detection. Our lung cancer screening program is really aimed at the early detection component. We know from clinical trials that people who are at higher risk of developing lung cancer because of their advancing age, and because of their previous or ongoing smoking history, can be detected with much earlier stage, curable disease if they undergo routine regular annual screening with a low-dose CT scan of the chest. Unfortunately, the statistics about how commonly the screening is used in the United States is pretty abysmal.

Q: What risks should non-smokers be aware of in terms of their chances of lung cancer?

Buchholz: Lung cancer can develop in nonsmokers. Significant exposure to tobacco through secondhand is clearly one risk factor, but even outside of tobacco-related, there are a small subset of people who could develop lung cancer on the basis of an unusual gene mutation that happens in the lung cells that convert into cancer. By and large though, tobacco-related lung cancer makes up the majority of lung cancers in the United States. But if someone has persistent symptoms of cough or other pulmonary-type of symptoms, I think you have to get checked out by your primary care doctor.

Q: What difference does early detection make?

Buchholz: There have been a lot of advances in treatment of lung cancer. Even people with what we call metastatic disease are living longer. But even though they’ve lived longer, they’re not necessarily being cured but have spread of the disease to other sites of the body. It still remains an incurable situation. The cure rates for early stage lung cancer, or lung cancer that’s detected by screening where it hasn’t metastasized or spread to the other lymph nodes or other sites in the body is actually pretty good. And we think that’s where the advances in other types of treatments may even continue to make the outcomes better. So I would say the cure rates in early stage disease are up to 80% or higher and the cure rates when diseases spread are near 0%.

Q: How big of a challenge is it to get smokers to quit?

Buchholz: I think we’ve made some progress in the United States. I think we’re seeing the overall lung cancer mortality for our nation improve as a direct result of smoking cessation efforts and smoking education efforts. So there have been a number of things in the United States that point to tobacco as less prevalent than it was in the early days. But tobacco, like other addictive substances, is a real challenging thing to quit. Even for highly motivated people, it’s a hard thing to undergo. So I’m empathetic with people who grew up in a period of time when smoking was acceptable, and even cool. Fortunately, I think generationally we’re moving beyond that. We still have some challenges ahead. The new vaping of tobacco products is something we advocate avoiding in our young population.

Q: What treatments are available to people who have been diagnosed with lung cancer?

Buchholz: Treatment options are highly dependent on how extensive the disease is present. Most lung cancers are non-small cell lung cancer, and the other component is called small cell lung cancer. Non-small cell make up over 75% of lung cancers, and the treatment we would hope for early stage disease can either be surgical removal or radiation treatment can be very effective for a disease that is localized. When the disease has spread to lymph nodes, then the combinations of radiation and chemotherapy, and also this new type of treatment called immunotherapy, are making a difference.