Although the incidence of lung cancer has decreased significantly in men over the past two decades and has formed a plateau in women, approximately 222,520 cases of new lung cancer will be diagnosed in 2010. Beginning with the federally mandated warning on cigarette packs and restrictions on advertising in the late 1960s, smoking rates among men began to decline. This declining trend in cigarette consumption has resulted in a very significant reduction in the incidence in lung cancer in males from a peak of 102.1/100,000 in 1984 to the current reportable rate of 84.3/100,000. In the last four years, the incidence rate for women has stabilized at approximately 55/100,000. In Dodge County, the incidence falls within the Confidence Interval rate, which indicates that the lung incidence is consistent with the national experience.
Lung Cancer Incidence Rates 2004-2008 (Confidence Interval)
|Nebraska||82.3 (CI 79.5-85.1)||52 (CI 50-54)|
|Dodge County||94.0 (CI 76.2-114.9)||
57.4 (CI 44.9-72.6)
In declining order of frequency, the five most common cancer sites in the U.S. are lung, prostate, breast, colorectal, and bladder, and in Nebraska, the top five sites are prostate, lung, breast, colorectal, and melanoma. At FAMC, lung cancer is consistently the third most common malignancy recorded.
Lung cancer is the leading cause of cancer death of both men and women, with a total of 157,300 expected in 2010. Since 1990, the death rate in men has been declining and the death rate in women has remained stable since 2003. These improving trends correspond to the declining rates of cigarette smoking over the past 40 years in men and for the past two decades in women.
Each year, non-small cell lung cancer has been consistently the third most common malignancy diagnosed and treated through Fremont Area Medical Center, and it continues to be the most common cause of cancer death with an observed five-year survival rate of 6.8%; the national rate is 16.7%.
While lung cancer is also the leading cause of cancer death in the U.S., there are several characteristics of this patient group treated at FAMC that may account for this significant difference on observed overall five-year survival rates.
The treatment patterns for each stage of lung cancer are very similar to the national experience. A large percentage of stage 1 and 2 cases are treated primarily with a surgical procedure, while the more advanced stages are treated with either radiation, chemotherapy, or a combination of these two modalities. The difference in the outcomes is probably due to patient characteristics.
These patients are significantly older with a much higher percentage in the 70-79 age group than nationally. A greater number of them also present more advanced stages of disease. There are also more men than women with this disease.
The dismal results of attempting to treat this disease process, as well as the current understanding of its etiology, emphasize the importance of palliative care and prevention activities for reducing the burden of this disease on our communities.
There are a significant number of patients with stage 3 and 4 lung cancer who are unable to receive the standard treatment protocol of radiation and chemotherapy because they are too ill. For these patients, symptom management through palliative care is very important and will need to become a major effort at this Medical Center in the future. Current clinical evidence indicates that early intervention with palliative care for patients with stages 3 and 4 lung cancer improves the quality of life and has a survival benefit.
While efforts to develop better screening methods and treatment modalities are important, lung cancer is a disease that is largely preventable. In the majority of cases, the etiology of this disease is directly related to tobacco smoking and efforts to reduce cigarette consumption are very important for reducing the incidence of this disease. For this reason, FAMC’s Community Outreach and Public Relations departments promote and conduct a variety of tobacco cessation and prevention activities each year. In 2010, there were seven tobacco cessation classes held. Prevention activities are focused on the youth in the community, and in 2010, FAMC hosted 23 tours for third grade students, during which tobacco presentations were made to 453 participants.
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