Pressing Issue: The High Incidence of Lung Cancer – URMC

Maria Valeria Hernandez Quintana

Maria Valeria Hernandez Quintana grew up in the vibrant city of Buenos Aires, Argentina, and was raised by two loving parents who happened to smoke cigarettes. Her maternal grandfather died of lung cancer.

But the city’s issues with air pollution, the second-hand smoke,   and the family medical history were hardly on her radar until, at age  48, doctors found a fist-sized tumor on her lungs. She has been officially  diagnosed with adenocarcinoma, the most common form associated with lung  cancer, on Jan. 2, 2020, and went through surgery and months of  chemotherapy and radiation.

“The whole experience felt surreal, ” says the particular Victor resident, who has never smoked.

“What kept me sane was a positive attitude, ” she says. “Telling myself: ‘I’m going to get through this. Malignancy is messing with the wrong woman. ’”

The Data Story

In the particular 27-county Rochester region from which Wilmot Cancer Institute draws patients, the lung cancer incidence rate is a startling 70 cases per 100, 000 people. That’s much higher than in all of New York State, in 58 cases, and in the U. S., which is about 53 instances per 100, 000 people.

Although in some areas cigarette smoking seems to be less prevalent these days, data tell a different story. The Rochester region’s smoking rates are higher than state and national averages, plus combined with other risk factors such as heredity, the lung cancer problem is compelling.

“The data have been a wake-up call in order to the University and to all of us within health care, ” says Carolyn Jones, M. D. , who leads Wilmot’s Lung Cancer Service Line and is also chief of Thoracic plus Foregut Surgery at the College of Rochester Medical Center. “If we have these pockets associated with very high occurrence rates of lung malignancy, are we really doing all we can to help those neighborhoods, those zip codes, and to look for solutions? ”

Jones believes the high rates may boil down to three things: “Not quitting, not getting screened, and not getting linked to proper care. ”

Lung cancer is the second most common cancer in the U. S. and the leading cause of cancer deaths in men and women. As inside the case associated with Maria Valeria Hernandez Quintana, 20 percent of lung cancer patients have never smoked cigarettes.

And yet cigarette smoking — or what some call “the disease of tobaccoism” — is still the cause of 80 percent of lung cancer fatalities, according to Patricia Rivera, Meters. D. , Wilmot’s associate director with regard to Diversity Equity and Inclusion, as well as the C. Jane Davis and Chemical. Robert Davis Distinguished Professor of Pulmonary Medicine from URMC.

“For decades, we’ve shamed these types of individuals instead of leading them to treatment and helping these to quit cigarette smoking, ” she says.

Patricia Rivera, M. D.

Racial plus ethnic differences in how health care is accessed and delivered, lack associated with insurance, and lack of education about risks, are likely aspects that play out in this region, as they do across the country. For example , the lung malignancy incidence prices locally are usually even increased among Black people, with 75 situations per one hundred, 000 individuals. Rivera notes that Dark men in the U. S. are on the highest risk for being diagnosed along with lung cancer and dying — even if these people smoke less than white men.

Lack of awareness regarding lung malignancy screening contributes to the issue.

“Everybody knows about breast cancer screening or colon cancer screening, ” Rivera says, “but lung cancer screening is lagging, which prospects to the higher death rates. ”

“It’s a very complex problem, ” she adds. “And that makes it more difficult in order to come upward with the best approaches. ”

Screening

Detecting lung malignancy early, at stage 1, is a key to survival.

Strong Memorial Hospital and affiliates offer low-dose CT scans to screen those that qualify. The particular scan shows detailed images of the lungs and air tubes, plus can pick up small tumors, using less radiation than conventional CT scans but with more specificity than chest x-rays.

Studies show that individuals whose cancers are detected via low-dose CTs are 20% much less likely to die through lung cancer than those who received chest x-rays, Rivera states.

Who qualifies? Individuals 50 to 80 years old, who are usually currently smoking cigarettes or have quit within the last 15 years. Smoking history must include in least one pack associated with cigarettes a day for 20 years, or a halfpack regarding 40 years.

Rivera emphasizes that will shared decision-making between doctor and patient is required; the particular screening can occasionally turn up benign nodules, and if a person seeks screening but is still smoking, that individual must enter the tobacco-cessation program.

Lung malignancy screening is currently underutilized. Nationally, only about 6. 5% of people who are eligible take advantage of this.

The Patient Experience

The days leading up to Hernandez Quintana’s diagnosis are vivid. She is a longtime fall allergy sufferer, and in August of 2019, the usual dry cough started. In November, the girl was still coughing, which usually was unusual. She remembers that it got so intrusive the lady was “begging my allergist to make it stop. ”

“I felt like something was different, ” she says.

She received a chest x-ray, which showed a shadowy lesion on the lung. After a sacrifice associated with fowl. |Leaving the|A|Using} second x-ray, doctors ruled out pneumonia and other illnesses, and then the bronchoscopy revealed the full mass.

“I’m still not thinking it’s cancer, ” the girl recalls. “I’m a runner, I eat healthy, I’ve never smoked in my life. We’re like, what could this be? ”

It was stage 3 lung cancer. The particular next step was to find out in case it was operable — and this will be when the lady caught a lucky break.

“My oncologist, Dr. (Deborah) Mulford , called one of the surgeons, Dr . (Christian) Peyre , and he happened in order to be in his office at that moment, three floors away, plus agreed to see me immediately. He reviewed my films and scans plus says, ‘I can operate. ’ Well, I started crying with joy, and I hugged him plus kissed him! His mother is from Honduras, so he understands our kissing culture — but he says, ‘Don’t kiss me however. Let’s bring your case to the tumor board and get the particular surgery done first. ’“

In January 2020, Peyre removed the upper lobe of her left lung and nine nearby lymph nodes, three of which were malignant.

“It’s the traumatic thing to go through, ” says Hernandez Quintana, who else works as a Spanish interpreter intended for the Victor Central School District. She actually is known as “Val Cleary” to her local friends and family, which usually includes husband Jason Cleary and two sons.

“But everyone had been so amazing at Wilmot, ” she adds. “They treat you like a human. ”

The girl remains within remission. “Every morning, We thank God that I’m here — and I actually move forward. ”

Her advice for others?

“If you feel want something is wrong in your body, push, push, drive. Don’t just think it will go away. ”

Lung Cancer Treatment

Acting quickly in a multidisciplinary fashion and being able to get the best combinations of treatment to get each individual is the particular goal, states Mulford, Mirielle. D., professor of Clinical Medicine plus a Wilmot leader in clinical research. She prizes Hernandez Quintana as a model of self-awareness.

“Her story — a person who keeps trying in order to uncover why they don’t feel well — is what all of us like to see. New therapies, sometimes, may make a difference inside patient’s lives but there are the lot associated with other factors and, obviously, that’s not the end of the story. ”

For all those who are usually diagnosed with certain types of lung cancer or even cannot have their tumor removed, immunotherapy drugs, such as Keytruda plus Optivo, possess completely changed the landscape of lung cancer treatment, Mulford says. When the particular cancer is usually active, the girl explains, it sets up checkpoints that block the body’s healthy immune cells through attacking malignancy.

The newer drugs release the blockade, allowing immune cells to clear out the cancer cells. Immunotherapy can also provide the possibility of a long-lasting response to therapy.

Clinical trials are available that evaluate new ways in order to stimulate the immune system or to use immunotherapies in combination along with chemotherapies from different stages of illness. Many Wilmot patients have got benefitted, Mulford says.

Other innovations furthermore provide exceptional care options:

• Wilmot has the only state-of-the-art Varian Edge Linear Accelerator within upstate New York. This technology is for individuals with non-small-cell, early-stage lung cancer who do not qualify for surgery. The device uses imaging and customized high-energy beams to target the tumor’s shape and deliver radiation therapy as precisely as possible.
• For biopsies, which are critical for an accurate diagnosis, Wilmot has a super-dimensional robotic tool called the Davinci Ion program . It allows physicians to navigate to small tumors located deep in the lung area for streamlined diagnosis plus staging inside difficult cases.
• UR Medicine includes a dedicated lung cancer pathology team that works closely along with Wilmot surgeons, pulmonologists, medical oncologists and radiation oncologists. Led simply by Moises Velez, M. D., the pathologists provide detailed molecular studies of the particular tumor with an eye toward gene mutations, so that patients can receive the most effective plus personalized treatment possible. They also store tissue pertaining to re-evaluation in the future, when new treatments become available.
• Surgical treatment and recovery are often faster and more efficient , because Wilmot cosmetic surgeons are able to make use of minimally invasive robotic systems in about 50% of cases. One new type of technology offers an one -stop shop for eligible individuals: an imaging scan that marks the particular lesion, plus the ability in order to perform a biopsy and remove the growth in a single surgical treatment.

“Long gone are the times of King George VI’s lung malignancy, ” claims Jones. The former Ruler of Great Britain, which was the late Queen Elizabeth’s father, notoriously had his left lung removed in the makeshift operating room in Buckingham Palace, in 1951. He passed away a year later.

Carolyn Jones, Michael. D.

That was seventy years ago. In more recent times, research-based improvements have come fast plus are continuing. “And that is a good thing, ” Jones states.

Lung Cancer Research

Wilmot scientists are usually studying many aspects of lung cancer, including prevention, lung damage at the cellular level, and protecting the lungs from injury during treatment.

The latter is the focus of Brian Marples, Ph. D. , the Doctor Sidney H. and Barbara L. Sobel Professor associated with Radiation Oncology. A renowned radiation biologist, he and his Wilmot team recently received an award from the National Institute of Allergy and Infectious Diseases to investigate how to reduce pulmonary injury in patients undergoing radiation therapy, especially when those patients have recently been infected with a virus in the lungs.

Another top investigator of lung diseases, Irfan Rahman, Ph. D. , has multiple publications in high-impact medical journals on the harms of cigarette smoke and vaping chemicals on lung tissue plus cells deep within the organs. He has shown that vaping associated with wheezing, for example, can be a precursor to emphysema, lung cancer, and other illnesses. With the popularity associated with vaping in recent years among younger people, Rahman is also focused on providing evidence in order to inform the particular U. S. Food and Drug Administration along with other regulators about the adverse effects of vaping products on health. He is a Dean’s Professor associated with Environmental Medicine, and a professor of Public Health Sciences and of Medicine.

Prevention research is furthermore a priority for Wilmot.

“Lung cancer is something that you cannot examine by touch, so you have to rely on symptoms, which unfortunately don’t always happen until tumors are big, ” Jones says. “So, it’s essential that we focus on who’s at risk plus on preventing cancer. ”

Francisco Cartujano, M. D. , operates clinical studies in community-based settings for people underrepresented within health systems. Many of his projects are smoking cessation-related — inside one case evaluating what types of text messages via mobile phones work best to motivate people to quit. This individual works closely with the local and regional Latino and Puerto Rican communities in order to stem their high rates of smoking, and he is a co-leader of Wilmot’s Community Outreach and Engagement Office .

Carlos Santana, a community building in action coordinator for Action for a Better Community in Rochester, will be a success story. A former heavy cigar smoker, he says he challenged Cartujano and actually set out to prove that his quit-smoking program wouldn’t work. But to Santana’s surprise, he was able to quit.

“I quit smoking through the text messaging program plus then with the help of patches, ” Santana says. “The chemical substances in my lungs went from 100% to zero. You can make believers out of those who think quitting is a joke! ”