WRNMMC, Bethesda, MD  –   The John P. Murtha Cancer Center at Walter Reed National Military Medical Center hosted the 2021 Virtual Lung Cancer Summit Nov. 9.
November is Lung Cancer Awareness Month, observed to educate the public about the disease, encourage action to increase research and treatment of lung cancer, and share stories concerning lung cancer survivors and their families.
According to the Centers of Disease Control and Prevention (CDC), lung cancer is the leading cause of cancer deaths among both men and women in the United States. This year, approximately 250,000 people in the United States will be diagnosed with lung cancer, and about 130,000 people will die from the disease, according to retired Army Col. (Dr.) Craig Shriver, director of the Murtha Cancer Center.
In addition, the CDC indicates “different people have different symptoms for lung cancer, and most people with lung cancer don’t have symptoms until the cancer is advanced.” This is why awareness of the disease is vital, and why the Murtha Cancer Center annually hosts its lung cancer summit.
The John P. Murtha Cancer Center is named after the longest-serving member of the U.S. House of Representatives from Pennsylvania who was also the first Vietnam War veteran elected to the House and a champion for veteran causes including health care. Officials dedicated the center at WRNMMC on Dec. 3, 2012, it’s the Department of Defense’s only center of excellence for cancer care, Shriver stated. Its lung cancer summit also began in 2012 with a focus on providing researchers and clinicians an opportunity to find out the latest advances in the treatment of lung cancer, including early detection, advances in surgical techniques, molecular analysis, targeted therapies in development and treatment options including advanced radiation, endobronchial techniques and palliative therapy.
Dr. Robert Browning, a retired Navy captain and medical director for interventional pulmonology (IP) at WRNMMC, discussed IP in lung cancer at this year’s summit. Interventional pulmonology uses endoscopy and other tools to diagnose and treat conditions in the lungs and chest.
Browning explained military medicine has ventured into a number of areas to gain a better understanding of lung cancer, including Detection of Early Lung Cancer Among Military Personnel (DECAMP), Genomics of Early Lung Cancer Among Military Personnel (GELCAMP), and Applied Proteogenomics Organizational Learning and Outcomes (APOLLO). The latter screens patients for genomic abnormalities and proteomic information to match their tumor types to targeted therapies.
“The earlier, the better” applies when it comes to detecting and treating lung cancer, Browning said. He added the future for small and early lung cancers involves precision medicine with such treatments as laser, radiofrequency ablation (RFA), microwave, cryotherapy and high intensity focused ultrasound.
Browning added the new paradigm for IP in lung cancer disease management includes: early palliative care; early recognition and measured treatments (to preserve the central airways and optimize breathing); avoiding high risk palliative procedures by earlier treatments with minimally invasive technologies/techniques; and early diagnosis, staging and treatment. Efforts in lung cancer disease management have also been focused on smoking cessation, lung cancer screening and research in further understanding the disease.
Army Col. (Dr.) Philip Mullenix, of WRNMMC’s Cardiothoracic Surgery, discussed lung cancer surgery at Walter Reed Bethesda. He explained between November 2015 and November 2021, 54 patients underwent lung cancer surgery at WRNMMC. Those patients were primarily in their early 60s, and included nearly an equal number of women (26) and men (28), Mullenix said.
“Only about half of them smoked, and I mean ever smoked,” Mullenix added. “This often surprises some people who don’t do what I do and who don’t work in our [medical] system.”
In addition to smoking, which can cause cancer and block the body from fighting it, other causes of lung cancer are secondhand smoke, which causes the disease in adults who have never smoked. According to the CDC, people exposed to secondhand smoke at home or work increase their risk of getting lung cancer by 20 to 30 percent.
Radon, a gas people cannot smell, taste or see, is thought to be the second-leading cause of lung cancer in the United States, accounting for more than 20,000 lung cancer deaths each year, the CDC states. People are encouraged to have their homes tested for radon, which comes naturally from rocks and soil, and can dissolve in groundwater. “People can be exposed to radon mainly from breathing radon in air that comes through cracks and gaps in the foundation of buildings and homes. One out of 15 homes has a high level of radon,” the CDC indicates.
At WRNMMC, most surgeries for lung cancer patients were lobectomies rather than wedges, the latter which are smaller removals of the lung, Mullenix explained. He said the goal at WRNMMC is to continually “keep trying to improve minimally invasive capabilities, better correlating radiographic findings with final pathology, better understanding the relationship of markers to therapy and outcomes, and more collaboration with interventional teams and everybody else.” This includes “maximizing preoperative diagnosis and staging, looking at intra-tumoral therapy, and finding ways to help patients avoid surgery where it makes sense.”
Matthew Wilkerson, Ph.D., associate professor in the Department of Anatomy, Physiology and Genetics at Uniformed Services University and director of Data Science Core in the Center for Military Precision Health, discussed a study for which he was one of the researchers titled, “Proteogenomics analysis of lung adenocarcinoma Apollo 1.”
Wilkerson explained lung cancer causes approximately 1 million deaths each year worldwide, and it is a heterogeneous disease. He added lung adenocarcinoma – small airways, is one of a number of categories in the World Health Organization’s histological classification for the disease. There are also subtypes of lung adenocarcinoma, he furthered.
The aims of Apollo include identifying the significant DNA/RNA/protein/phosphoprotein alterations, identifying the significant molecular subtypes, and determining which molecular markers or subtypes associate with clinical outcome, Wilkerson added.
In discussing radiation therapy, Navy Cmdr. (Dr.) Aaron Reed, of radiation oncology at WRNMMC, said Walter Reed Bethesda can deliver extreme hypofractionation for metastatic disease in the lung effectively. He explained that using hypofractionation, or hypofractionated radiation therapy, more doses of radiation are delivered per treatment, so patients can complete their course of radiation therapy faster than conventional treatment. “We should be doing this more often, and possibly as a standard for three or fewer metastatic sites, either synchronous or metachronous. Patient selection is key because not everyone is a candidate. It’s going to be on a case-by-case basis.”
Approximately 1,000 U.S. service members are diagnosed with some type of cancer annually, according to Shriver, who added that because of these numbers, DoD has recognized cancer’s impact on readiness. He explained a cancer diagnosis can take the service member out of the fight for months, if not a year or more, for treatment and rehabilitation.
Military Health System (MHS) beneficiaries interested in quitting smoking, tobacco cessation and other health education information can call the WRNMMC Integrative Health and Wellness Services team at 301-295-0105.
For more information about lung cancer, visit the CDC website at https://www.cdc.gov/cancer/dcpc/resources/features/lungcancer/index.htm.