Wed10222014

Your Health

Stacking the pack against smoking: ECH study assesses lung-cancer risk

Photo Elliott Burr/Town CrierOutside El Camino Hospital's Mountain View campus, Jennifer Martin takes a break – not a cigarette break – from her duties. A former heavy smoker participating in the hospital's REACT study, Martin will have her lungs CT-scanned, as shown in the image pictured, to detect early stages of lung cancer.

For 33 years, Jennifer Martin smoked a pack of cigarettes each day and didn’t think twice about lighting up the stick that comes in a pack with nasty pictures and a dire warning to smokers of the havoc tobacco can wreak on human health. Working at El Camino Hospital’s nonsmoking campus in Mountain View didn’t make her think twice, either. Until three years ago.

Experiencing a deep heaviness in her chest, Martin suspected she had pneumonia and needed to get to a hospital.

“I wouldn’t even call my brother until I finished that last cigarette,” she recalled.

What Martin suspected was pneumonia turned out far worse – chronic obstructive pulmonary disease (COPD), a progressive disease of the lungs that makes it difficult to breathe. Cigarettes are the leading cause of the illness, which has no cure. It’s important for Martin to avoid air pollution, perfumes and chemical fumes, dust and other smokers.

“Of course, I can’t barbecue anymore,” she said.

But what she could do was quit smoking, an incredibly difficult feat to accomplish cold turkey – many doctors consider nicotine to be just as addictive as heroin or cocaine. Martin’s weeklong stay in the hospital helped her get over the hump of those early withdrawal cravings.

But in April 2010, her father’s death from cancer – lung cancer that metastasized to his brain – triggered the real alarm.

“Everybody on his side of the family has had (various forms of) cancer at one time or another. It’s just crazy,” she said. “I thought, ‘Oh, my gosh. It has to be genetic.’”

 

It’s in the image

Despite her nonsmoker status, Martin worried: Could lung cancer be in her future, too?

So when El Camino Hospital oncologist Dr. Elwyn Cabebe launched REACT – his “homegrown clinical trial” combining genetic testing and low-dose CT lung screenings to identify high-risk lung-cancer patients, and underwritten by the El Camino Hospital Foundation – Martin climbed aboard.

“I think I was the first one to sign up,” Martin said of the study, introduced last November.

Cabebe launched the three-year study following results from the National Lung Screening Test, a National Cancer Institute study initiated in 2002. With lung cancer causing more deaths each year than breast, prostate, colon and pancreatic cancers combined, the screening of 53,000 former and current heavy smokers compared low-dose helical CT scans and regular chest X-rays to determine which detected cancer earlier.

With 20 percent fewer deaths among the trial’s participants, researchers concluded that the CT scan was more effective in finding cancer in its early stages. But the scans also picked up benign nodules, resulting in false positives. And then there are the costs associated with the scans.

Cabebe’s study expands on the institute’s results to identify those at highest risk for lung cancer to receive continued and regular CT-scan monitoring.

So far, approximately 100 current and former 20-pack-year smokers – a pack-year is the average number of cigarette packs smoked per day multiplied by the number of years smoked – have signed on to the study.

“Smoking is not the only factor in getting lung cancer, but it’s a major factor,” Cabebe said.

 

Gene generalities

Participants are initially screened genetically with a family-history questionnaire and a cheek swab, then scanned for future comparisons.

“The CT scans are available anywhere. The genetic test is not,” he said. “It’s a routine set of periodic tests and examinations that you have to follow through.”

Martin’s family history and genetic cheek-swab results didn’t allay her fears.

“Both my parents smoked – I was already predisposed,” she said. “I actually came in on the high end of the scale – high risk. And, unfortunately, they did find two very small nodules.”

Cabebe said that with patients’ permission, test results are forwarded to their primary-care physicians, but he reviews results with participants. Aside from identifying participants’ genetic predisposition to lung cancer, the study has already uncovered potential problems.

“We’re seeing abnormalities on CAT scans that we’re following up on,” he said.

Quitting the stick

And he’s seeing something else.

“There are people who have stopped smoking since enrolling in the program,” he said. “Those who quit reduce their risk for lung cancer.”

But the psychological and physiological addiction to cigarettes makes quitting a difficult task.

“I always feel that cold turkey is the best way to stop smoking,” Cabebe said. “But I can’t say that one strategy works for everyone.”

Martin’s mother still smokes to this day.

“She has Alzheimer’s,” Martin said of her mom. “That is the one thing she doesn’t forget – it’s the first thing she reaches for every morning.”

Martin is scheduled for another CT scan this week in her second follow-up appointment in the study. Her pulmonologist hopes results will reveal that the nodules are a fungus she may have picked up while living in the Midwest.

But she wants her children – ages 18 and 20 – to take notice.

“Yes, they smoke,” she said. “Even with the unknown nodules, they’re still smoking away. I’m still trying to make my kids understand how serious this is, and that they have to stop.”

Martin said she participated in the study in memory of her father, in the hopes that her children will quit and “to help people see that smoking causes cancer, and cancer kills.”

Cabebe is searching for 100 additional participants for his study. He knows cancer kills, but he’s seen patients fight to live.

“I think I can make a big improvement in someone’s life at a time they need it most,” he said. “I want to be part of that process with them.”

For more information on REACT, call 988-7623 or visit www.elcaminohospital.org.

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