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A 40-year-old African American male with a past medical history of hypertension and myocardial infarction and a 15 pack-year tobacco history presents for a routine health management visit. He has two first-degree relatives with non–small cell lung cancer. He is asymptomatic and has quit smoking, but he requests information on any chemopreventive measures he could utilize to avoid the development of lung cancer. What chemoprevention strategies should be offered to this patient?
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Learning Objectives
What are the lifestyle modifications that reduce lung cancer risk?
What are the preventable causes of lung cancer?
What are the historical chemoprevention strategies that have been utilized in thoracic malignancies?
What strategies have improved the prevention of lung cancer?
What are the future standards for chemoprevention in thoracic malignancies?
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Effective cancer prevention strategies are aimed at reducing the incidence and mortality of that cancer. Primary prevention such as smoking cessation and early screening are covered in other chapters, while lifestyle modification is reviewed here, as well as strategies utilized in both the primary and secondary settings to prevent thoracic cancer. Primary prevention involves interventions in genetic, environmental, biologic, and physical factors that cause cancer. Secondary prevention incorporates strategies to detect cancers in asymptomatic carriers so the treatment can be introduced more promptly. Tertiary prevention refers to prevention of cancers in disease survivors, such as tobacco cessation in lung cancer survivors. Chemoprevention is the use of natural or synthetic compounds to prevent carcinogenesis and the development of cancer.
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CLINICAL PEARL
Tobacco smoking is the primary avoidable risk factor for many pulmonary diseases, including lung cancer. Smoking cessation decreases the incidence of lung cancer (primary prevention) and improves overall survival for those diagnosed with lung cancer (tertiary prevention). The prevention of lung cancer is also improved by increasing physical activity and decreasing exposure to radon, nickel, arsenic, chromium, nitrogen mustard, and asbestos, which have also been linked to an increased risk of lung cancer.
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LIFESTYLE MODIFICATION
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The single most important lifestyle modification for the reduction of lung cancer risk is cessation of smoking. Tobacco carcinogenesis and treatment are presented in Chapter 3. All histologic subtypes of lung cancer are caused by cigarette smoking, and cigarettes and tobacco users can benefit at any time by quitting smoking. While lung cancer risk decreases the longer someone is abstinent from smoking, even at greater than 40 years, the risk of former tobacco smokers fails to return to the risk of never-smokers.1,2 In fact, continued smoking to older age is associated with an exponential increase in the risk of lung cancer compared to people who stop prior to 50. The cumulative risk of death from lung cancer in males who smoke to age 75 is 16%, compared to those who stop by age 50 (6%), and it is even lower if smoking stops by age ...