Existing High-Risk Criteria
Currently, lung cancer screening is recommended (and covered by most insurance plans and Medicare) for a specific high-risk population. Individuals who meet the following criteria are at the highest risk, but there is ongoing research to determine who else may have an elevated risk of developing lung cancer.
- You are between the ages of 55-80
- You have a 30 pack-year smoking history (see graphic, right, to calculate pack-year history)
- You are a current smoker or quit within the past 15 years
*The criteria above is recommended by the United States Preventive Services Task Force (USPSTF). If you do not meet the high risk criteria but are concerned you are at risk for lung cancer, talk with your doctor about whether screening is right for you.
Tobacco Use is the Primary Risk Factor
Smoking causes 80-85% of lung cancer in the U.S. The risk increases with the number of years and packs per day the person smoked. The 2010 Surgeon General’s report How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease states, “There is no risk-free level of tobacco smoke.” Tobacco smoke causes changes in cells that can lead to cancer.
To reduce your risk, don’t start smoking. If you smoke, quit. Quitting smoking improves your life in many ways and we encourage current smokers to find the best way to quit. If you (or a loved one) have been diagnosed with lung cancer and smoke, continuing to smoke can, among other things, interfere with the way treatments work and make side effects worse. Learn more about smoking after a lung cancer diagnosis.
Other Smoking-Related Risks
Pipe smoking is linked to lung cancer but the risk appears to be lower in people who do not also smoke cigarettes. According to the National Cancer Institute, the risk of lung cancer for cigar smokers may be similar to that of cigarette smokers when adjusted for differences in level of inhalation and quantity smoked per day.
Not all studies have found a link between marijuana use and lung cancer however The Association Between Marijuana Smoking and Lung Cancer: A Systemic Review concluded there is a “biological plausibility for the enhanced risk of lung cancer associated with marijuana.”
Some believe e-cigarettes are a healthier alternative and may even help people to stop smoking traditional cigarettes. Here is what we know:
- There is not enough evidence to support that e-cigarettes are an effective smoking cessation tool.
- Over 2000 unregulated companies manufacture e-cigarettes and we don’t know exactly what ingredients they contain and how dangerous they may be.
- Some e-cigarettes use nicotine solutions that are potentially toxic.
- The effect of e-cigarettes on youth smoking is also unknown, one concern is that use may lead to the smoking of traditional cigarettes. We do know that through the use of flavored e-cigarettes and marketing techniques, children and young adults are being targeted by some e-cigarette manufacturers.
- Also unknown is the effect of inhaling vapors, to the user or others around them.
- Finally, there are concerns that e-cigarettes set back smoking cessation efforts because they glamorize and normalize smoking behaviors.
Additional Risk Factors
Radon is an invisible, odorless, tasteless radioactive gas that occurs naturally in soil and rocks. Exposure to radon is the second-leading cause of lung cancer in the United States but the Environmental Protection Agency estimates that radon is the leading cause of lung cancer in never smokers. Find out more at the Environmental Protection Agency’s radon website.
Asbestos is a mineral fiber that has been used in the manufacturing of many products for decades, including insulation and tiles. No safe level of asbestos exposure has been identified. Most exposure is occupational (job-related) and has been heavily concentrated in the mechanical, construction and shipbuilding industries. However, many buildings and schools today still contain products made of asbestos. Asbestos exposure increases the risk of lung cancer and also of developing mesothelioma, a cancer of the lining of organs that can start in the lungs but also the abdomen, heart and chest. Find out more about asbestos and mesothelioma at the Mesothelioma Applied Research Foundation.
Regular exposure to secondhand smoke (passive smoking)
Regular exposure to smoke from other people’s tobacco use can increase lung cancer risk 20-30% compared to those not exposed. Secondhand smoke is estimated to cause over 3000 lung cancer deaths a year. Find out more from the National Cancer Institute’s Secondhand Smoke and Cancer fact sheet.
Smoking rates for those in the military are higher than in the general population, but past and present military service also increases the risk for developing lung cancer. Estimates are that the rate of lung cancer among veterans may be twice that of the general population. Active duty military continue to be exposed to agents that are likely to increase their future risk, as well. Learn more about Department of Defense lung cancer research efforts.
Exposures unique to veterans that increase risk of lung cancer include: defoliants and herbicides containing dioxin such as Agent Orange and others used to defoliate the Demilitarized Zone, as well as asbestos exposure on board ships, in shipyards and in submarines; fuel exhausts, smoke from burning oil wells, kerosene cookers and heaters in enclosed tents and other battlefield emissions. Research continues on those topics, as well as the impact of depleted uranium on lung cancer risk.
Increasing age is a risk factor for many cancers, including lung cancer. The average age in the United States for a lung cancer diagnosis is around 70 years of age. About 10% of lung cancer cases occur in people younger than 50 years old.
Environmental exposure, industrial chemicals
Environmental chemicals including arsenic, beryllium, air pollution from vehicle and diesel exhaust and industrial and residential emissions, as well as those from power plants.
There is evidence that exposure to industrial chemicals in certain occupations or industries increases the risk of lung cancer. These include: aluminum and coke production; hairdresser and barbers; underground hematite mining with radon exposure; iron and steel founding; painters; production of art glass, glass containers and pressed ware; rubber industry. Find out about occupational carcinogens by reading Listing Occupational Carcinogens, published in the November 2004 edition of Environmental Health Perspectives.
A study investigating if the use of beta-carotene supplements would decrease lung cancer risk in those at high risk (current smokers and asbestos-exposed workers) instead found the opposite. The use of beta carotene supplements actually increased the number of lung cancer diagnoses (and death from lung cancer) for those already at high risk for the disease. It is important to note that foods containing beta-carotene are thought to decrease risk for developing lung cancer, as is increasing fruit consumption.
Even among never smokers, emphysema, chronic bronchitis and asthma may increase lung cancer risk by 50-100%. Also, as more people survive cancer, we are learning more about long term effects of radiation treatment to the chest. In breast cancer survivors, lung cancer risk was greater for those who received post-mastectomy radiation, for the lung on the same side as the initial breast cancer. Risk increases with the radiation dose received. There does not appear to be the same risk for newer, post-lumpectomy breast radiation treatment. Smoking seems to increase the radiation-related lung cancer risk. In Hodgkin’s Disease, survivor’s increased risk for lung cancer is significantly linked to the doses of radiation used in treatment. As in breast cancer, risk increases with the radiation dose received.
Studies suggest that adults who have or had a fully related parent or sibling with lung cancer, especially one who was diagnosed before age 50 or who have multiple relatives diagnosed are at increased risk for lung cancer.
Research is underway to understand more about the family link to lung cancer. If you have at least one biologically-related relative diagnosed with lung cancer, please consider joining the University of Cincinnati College of Medicine Family Lung Cancer Study. There is no cost to participate and you do not have to live in the Cincinnati area to join.
If you have been diagnosed with lung cancer or have two or more relatives who have been diagnosed, you may be eligible to participate in the LSU Health Sciences Center – New Orleans School of Medicine’s Lung Cancer Study. There is no cost to participate and you do not have to live in the New Orleans area to join.