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November 19, 2008 > Lung Cancer: Reaching the Younger Generation

Lung Cancer: Reaching the Younger Generation

Lung Specialist Promotes Lung Cancer Awareness for Patients of All Ages

As a critical care and pulmonary medicine specialist and medical director of Pulmonary Rehabilitation and Respiratory Services at Washington Hospital, Dr. Jason Chu sees the entire gamut of pulmonary diseases and conditions from smoking-related emphysema to sleep apnea.

In recognition of Lung Cancer Awareness Month, Dr. Chu discusses lung cancer, which remains the No. 1 cause of cancer death in the United States.

Lung cancer is one of the most frustrating diagnoses Dr. Chu has to make. And despite its relatively low profile in the public eye compared to other diseases, lung cancer kills three times as many men as prostate cancer each year and twice as many women as breast cancer will, he says.

"Among the majority of groups - Caucasian, black, Asian and others - there is no racial preclusion in terms of lung cancer," Dr. Chu notes. "This disease crosses all barriers and accounts for 30 percent of all cancer deaths."

Lung cancer remains difficult to diagnose, treat

Dr. Chu is incredibly knowledgeable about the disease and relates statistics and facts effortlessly, but he freely admits that lung cancer is confounding when it comes to early diagnosis and treatment.

Unlike colon, cervical, breast and other types of cancer, there exists no reliable form of screening for lung cancer.

"In most cases, lung cancer is undetectable by routine chest X-ray in early stages of the disease," Dr. Chu explains. "It spreads quickly and is asymptotic. There isn't a symptom that has a high correlation to the disease - a chronic cough, for instance, could mean bronchitis. Lung cancer really provides no warning signs.

What makes it difficult is that most patients have typical symptoms that mimic
conditions like bronchitis and serve to cloud the physician's diagnostic acumen. Symptoms of lung cancer are subtle and similar."

By the time the cancer is visible by chest X-ray or another imaging modality, it's fairly advanced, Dr. Chu says. While imaging studies are improving, the medical community is not using the technology for detection, but rather for staging to determine if the cancer is operable or not.

It is less common for lung cancer to be diagnosed in early stages - Stage 1 or 2 of the disease - than it in Stage 3 or 4.

"If the cancer is detected earlier in Stage 1 or 2, that's when you can try for a resection," which refers to the partial removal of an organ, such as the lung, Dr. Chu says. "Unfortunately, by the time the cancer reaches Stage 3 or 4, it has spread to lymphatic system or bloodstream. That's the hard part - that the cancer doesn't show up in early stages."

Most of the patients Dr. Chu sees with lung cancer - between 85 percent and 90 percent of them - have a history of smoking. He estimates that current smokers make up between 35 percent and 40 percent of the lung cancer cases he comes across and another 50 percent encompasses past smokers.

A message for the younger generations

In his practice as a specialist, Dr. Chu says a majority of the patients he sees already suffer from some form of lung disease. When discussing lung cancer, he says his message is particularly crucial for the younger population - those that smoke already and those that haven't started.

"I want young people to receive the message that there's a high prevalence of lung cancer if you smoke, and that it's something that can start very early," Dr. Chu says. "The clock is ticking form the get go. You may feel if you're younger that you have time on your side - that if you quit in your 30s 40s or 50s, you'll be able to dodge lung cancer.

"Smoking is detrimental to your health from the first cigarette you smoke to the very last."

Dr. Chu notes that many younger people are taken in by the rumor that if they stop smoking, their lungs will go back to a pre-smoking condition in five years. This is a myth, he says.

Why it's tough to quit

It's a combination of factors that make it difficult to quit smoking, he says.
"The nicotine is a very powerful addictive chemical that gives a sensation of euphoria and wellbeing and is more addictive than cocaine and morphine," he explains. "There's a much greater difficulty quitting smoking than alcohol or other substance abuse problems. It's partly chemical, but also a kind of lifestyle for people that are used to having a cigarette in their hand and having cigarettes as part of their day-to-day routine."

For young people, particularly teenagers, it's even harder to quit simply because they don't feel like they have to worry for decades, Dr. Chu says.

The truth is that quitting smoking - or not starting - is the only surefire way to reduce the chances of developing many respiratory conditions, such as chronic obstructive pulmonary disorder (COPD), smoking-related emphysema and lung cancer. And it is possible to quit.

Dr. Chu recommends that people ask their primary care physician about pharmaceutical aids for quitting. Combined with smoking cessation programs and social support groups, these medications can help those truly determined to quit.

With so many of his patients being decades-long habitual smokers, Dr. Chu wants his message to reach the members of the community he may never meet because they are still able to make choices that will reduce their likelihood of developing lung disease.

For more information about services and programs at Washington Hospital, visit and click on "Services & Programs." To see local health-related programming, tune into InHealth, a Washington Hospital Channel, on Comcast Cable channel 78.

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