WRNMMC, Bethesda, Md.  –   The Murtha Cancer Center (MCC), the only Department of Defense Cancer Center of Excellence, hosted its 2023 Lung Cancer Summit at Walter Reed on Dec. 12.

The MCC first opened its doors at Walter Reed National Military Medical Center (WRNMMC) in December 2012 as a tri-service center where military beneficiaries can receive exceptional care in all disciplines of cancer treatment. The center resulted from the integration of the Walter Reed Army Medical Center, National Naval Medical Center, Malcolm Grow Medical Clinic, and the U.S. Military Cancer Institute. The MCC includes more than 300 board-certified oncologists and professional clinical and support staff highly specialized in all aspects of cancer care – from first diagnosis, through therapy and follow-up care, to survivorship. The center enhanced its capabilities by teaming with the Uniformed Services University (USU), the National Cancer Institute (NCI), and the Department of Veterans Affairs to provide excellent state-of-the-science cancer care.

The MCC annually hosts its lung cancer summit, which virtually draws experts and others in research, diagnosis, treatment, and survivorship from around the globe to share the latest information concerning the disease and its impact on service members and other Military Health System beneficiaries.

According to the DOD Congressionally Directed Medical Research Programs, “lung cancer is the leading cause of cancer mortality in the United States, accounting for 21 percent of all deaths. This year, an estimated 238,340 U.S. men and women will be diagnosed with lung cancer, and an estimated 127,070 people will die from the disease this year. Lung cancer is generally diagnosed at an advanced, incurable stage because patients often lack signs and symptoms in the early stages of the disease.” The estimated new cases of lung cancer in 2023 follow only breast cancer (female), with an estimated 297,790 new cases, and prostate cancer, with an estimated 288,300 new cases, this year.

Retired Navy Capt. (Dr.) Joel A Nations, a pulmonologist who worked at WRNMMC and is now affiliated with the Washington D.C. Veterans Affairs Medical Center, explained that several factors have been shown to contribute to the development of lung cancer, with smoking and exposure to environmental carcinogens being the most prevalent. However, 10 to 15 percent of lung cancers occur in people who are non-smokers, according to the American Cancer Society.

The DOD Congressionally Directed Medical Research Programs report also states that lung cancer risk for service members is significant, with 24 percent to as high as 38 percent of those in uniform smoking compared to 14 percent of civilians. Deployments also worsen smoking rates, Nations added. “Among military veterans, lung cancer is a leading cause of cancer-related deaths, with about 15 veterans dying of lung cancer each day.” An estimated 900,000 veterans remain at risk for lung cancer because of age, smoking, and other environmental exposures during and after their military service, according to the report.

Army Col. (Dr.) Sally DelVecchio, deputy chief medical officer for the Defense Health Agency (DHA)-National Capital Region (NCR) Network, explained that in 2021, the U.S. Preventive Services Task Force (USPSTF) changed its guidelines for lung cancer screening, calling for a wider range of former smokers, lowering both the age and the number of smokes that qualify individuals to be screened. You should have an annual lung scan if:

• You’re 50 to 80 years of age and a former or current smoker.

• You have a 20-pack-year history (For example, one pack per day for 20 years, two packs per day for 10 years, etc.).

• You’re a current smoker or quit in the past 15 years.

DelVecchio explained that the requirements for a lung cancer screening program include shared decision-making with patients, the ability to do low-dose CT (computed tomography) scans to check for abnormalities in the lungs, patient counseling, and tobacco cessation. She explained that low-dose CT scans have much less radiation associated with them but the specificity to pick up on nodules that might be precancerous and allow care providers to see the changes over time.

Cancer prevention

Carolyn Mesnak, a public health educator in the Internal Medicine Department at Walter Reed, discussed smoking cessation in the NCR. According to Mesnak, most people try to quit smoking a number of times before they succeed. Although quitting is hard, people usually increase their chances of success with help from a smoking cessation program, like the one provided at Walter Reed. The tobacco cessation program at Walter Reed is part of the Internal Medicine Service’s Integrative Health and Wellness and can be reached at 301-295-0105.

Also focusing on prevention, Dr. Philip Castle, director of the Division of Cancer Prevention at the NCI, explained that although there has been a move forward in cancer prevention by encouraging people not to smoke and highlighting the dangers of tobacco use, there is a “prevention paradox -- If we’re successful with prevention, there’s nothing to observe because we’ve avoided a bad outcome – cancer. We tend to notice the events that occur (cancer) rather than the absence of events. That’s a real hurdle, particularly for getting people to recognize the importance of prevention and support for prevention research.”

Castle also discussed precision cancer prevention, described as “not just the what, but the who, how, and where.” He explained precision cancer prevention “is using what we know about a person – their genetics, risk factors, lifestyle – to tailor our prevention strategies.”

He added that there’s also a need to democratize cancer prevention to make proven prevention measures more broadly accessible, particularly for underserved populations.

“Cancer prevention is challenging, but the payoff, healthy people continuing to lead healthy lives, is priceless,” Castle added.

Novel discoveries of lung adenocarcinoma

Matthew Wilkerson, Ph.D., associate professor, Department of Anatomy, Physiology, and Genetics, and Data Science core director at the Center for Military Precision Health at USU, discussed the novel discoveries of lung adenocarcinoma. He explained that the Applied Proteogenomic Organizational Learning and Outcomes (APOLLO) team, which he leads, recently published a proteogenomic profiling study of 87 lung adenocarcinoma (LUAD) tumors. Their findings, including identifying and characterizing three distinct LUAD subtypes, provide a substantial foundation for future research, Wilkerson explained.

Wilkerson added that “the RNA subtypes have changed our fundamental understanding, giving us new tools to fight lung cancer. RNA subtypes are unified markers for etiology, prognosis, and therapy.”

The APOLLO network is a cancer moonshot-inspired initiative between the NCI, DOD, and VA.

Lung cancer, burn pits

Although there has been much discussion regarding the link between military burn pits and cancer, Nations said it’s inconclusive that burn pits causes cancer. “We don’t have any current evidence that burn pits are related to lung cancer, but we now have research projects looking into this, with intense efforts by the VA and DOD.”

Interventional pulmonology

Navy Capt. (Dr.) Sean McKay, an interventional pulmonologist at Walter Reed, discussed interventional pulmonology, which uses non-surgical, minimally invasive procedures for diagnosis and treatment of lung cancer and other respiratory system diseases. McKay, and Navy Capt. (Dr.) Robert Browning, also an interventional pulmonologist at Walter Reed, recently performed the first robotic-assisted bronchoscopy in DHA, pairing the state-of-the-art device with a cone beam CT scan to reach and biopsy a small nodule in the patient’s lung cavity. The procedure detected cancerous cells in the patient, a milestone that could lead to a more aggressive plan of action to halt the spread of cancer.

The minimally invasive biopsies, like the recently performed robotic bronchoscopy by McKay and Browning, may prevent unnecessary lung surgeries, as well as diagnose lung cancer in its earlier stages when its better treatable, according to the physicians.