Pulmonologist Sandra Gilley, MD says that COPD and lung cancer are a very real risk for women. And she wants physicians to be aware of the current screening recommendations.
"More women die of lung cancer than breast cancer," Gilley said. "Lung cancer in women is on the rise. Rates of smoking in women increased in the 1970s due to targeted advertising, and that population has now aged to the point where they are getting diseases like COPD and lung cancer. And lung cancer doesn't respond to treatment as well as breast cancer does."
Current guidelines suggest that patients over the age of 55 with a smoking history of a 30-pack year (a pack a day for 30 years) should be screened annually with a low-dose CT scan. "That should be part of their routine cancer screening, just like a colonoscopy every 10 years or a mammogram every year for patients who fall into that category," Gilley said. "Women are at least equally at risk for lung disease as men. In fact, there is some evidence that estrogen can make women more prone to lung disease in general.
"Sometimes lung disease can present without symptoms. However, coughing up blood, losing weight, fever, and night sweats are all common symptoms of lung disease."
Gilley suggests that physicians screen women for lung disease with greater care. Women should be asked not only if they smoke themselves, but whether their spouse or others who spend significant time with them are heavy smokers now, or were in the past. While there are no specific guidelines for secondhand smoke, it's an important factor. "If they live in a heavy smoke environment, they are at increased risk for lung disease," she said.
In recent years, several diagnostic devices have been developed that improve the odds of finding cancer.
Navigational bronchoscopy is an advanced imaging technique that uses GPS-like technology, enabling pulmonologists to find and biopsy suspicious masses that can't be viewed via traditional bronchoscopy. The patient must first have a high resolution CT scan. "We put those images into a computer program and it figures out which brochial tubes are closest to the nodule," Gilley said. The resulting map enables the physician to biopsy nodules and potentially save the patient surgery if they are not cancerous.
Endobronchial ultrasound-guided biopsies of lymph nodes and lung masses are minimally invasive procedures that provide relatively new diagnostic benefits. "It's a special bronchoscope with an ultrasound probe on the end of it," Gilley said. "We can identify the target lymph node or mass with the ultrasound, and the needle comes out next to it. We can actually see the needle going into the mass we are trying to biopsy. It used to be a blind procedure, and we had to know from the anatomy where to stick the needle, but that can obviously be problematic. Now we can stage the cancer before we send the patient to surgery. It helps us decide more accurately which patients are candidates for surgery and which are not."
But Gilley points out that having these improved procedures are most helpful when patients are identified through screening earlier in the disease process. "The number of women diagnosed with lung cancer is increasing, because they started smoking later than men," she said. "Women who started smoking in the 1960s and 70s are just now getting to the age to develop these diseases."