Lung cancer is the deadliest and second most commonly diagnosed cancer in the United States. And many lung tumors start in the most remote parts of the lung, where they don’t cause symptoms until the cancer has spread.
HealthyWomen spoke with Bianka Eperjesiova, MD, director of interventional pulmonology at Corewell Health and former director of interventional pulmonology at the Veterans Health Administration (VHA), about the risks specific to service members and veterans. Eperjesiova wants to inform all veterans that they are at high risk for lung cancer and are entitled to screening measures to detect lung cancer in its treatable early stages.
Why is lung cancer a major problem for service members and veterans?
Many factors play a role in the development of lung cancer. While women are generally less likely to smoke, we know that all military personnel have had significant exposure to dangerous chemicals, putting all veterans at high risk for lung cancer. The PACT Act, passed in 2022, promised to meaningfully address this issue by identifying conditions associated with exposure, improving access to health care, and encouraging veterans to reach out and undergo lung cancer screening.
What is the connection between exposure to airborne hazards, toxic chemicals, and fire hazards and lung cancer?
While military personnel no longer receive cigarettes in their rations – a true story – exposure to other dangerous chemicals is also known to cause lung cancer. All military personnel are exposed to danger, whether from burn pits, orange warfare agents, asbestos, radon or uranium from ammunition. These are just a few examples. It doesn’t matter if you are not genetically predisposed to cancer or don’t smoke: exposure to these chemicals changes our genetics and allows lung cancer to develop. There is no such thing as a low-risk veteran.
How is lung cancer diagnosed?
We recommend that all eligible veterans receive regular CT scan evaluations. If these tests reveal something that concerns us, we offer a biopsy. We can now use a robotic bronchoscopy device called Ion or Monarch, which can help surgeons take samples from the inside of the lungs in a minimally invasive approach. We then examine the lymph nodes, which tell us how advanced the cancer is to determine what treatment we will do.
How is lung cancer treated?
If the cancer is in the early stages and treatable with surgery, we use the daVinci or Mako surgical system, which can help the surgeon cut out part of the lung. If the patient cannot safely undergo surgery, we may offer radiation. If the cancer has spread, we may treat it with chemotherapy or immunotherapy, or a combination of some or all of these treatments. The wonderful thing about VHA is that it is the largest healthcare system in the world and we have access to the latest equipment and clinical trials.
What role do robotic tools such as robotic bronchoscopy and robotic surgery play in lung cancer?
I know it might sound crazy: a robot performing surgery. But the operation is robotic, and we guide the robotic arms. Robotic surgery can go places human surgeons can’t: we’re limited by how far we can bend our wrists, for example. These tools allow us to remove the smallest amount of tissue needed to fight lung cancer.
Are there racial or socioeconomic disparities in diagnosis and treatment?
In the general population, the black population is more likely to have more advanced lung cancer. We see geographic differences in the veteran population. Veterans in rural areas, far from a medical center of excellence, are less likely to receive checkups. Spreading risk awareness is important: it can mean the difference between treating lung cancer in its early stages or being diagnosed at a later stage.
This educational resource was created with support from Intuitive.
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