Genetics and Lung Disease

Unlike breast cancer, in which the presence of BRCA1 or BRCA2 is a clear predictor of risk for cancer, specific gene mutations increasing the risk for lung cancer have not yet been identified. Ninety percent of lung cancers develop in people who have smoked tobacco.

Research has found significant biologic differences in the tumors of nonsmokers compared to the tumors of smokers. This information may lead to the development of therapies that are targeted to the biologic characteristics in each group. In addition, research by Columbia doctors and colleagues, as well as other laboratories, has shown that molecular information acquired from microarray analysis of lung cancer specimens may predict tumor progression and patient survival.

Genetic causes have been linked to other lung diseases, such as alpha-1 antitrypsin deficiency for chronic obstructive pulmonary disease (COPD). The genetics program at NewYork-Presbyterian/Columbia has extensive experience in identifying individuals at risk for this and for other genetic lung diseases.

Risk Factors for Lung Cancer

The risk factors for lung cancer are both genetic and environmental, based on exposure to toxins and carcinogens. Lung cancer most often strikes people over age 50 who have a history of smoking.

Among healthy former smokers over age 55, screening will detect a nodule in one third of people. When nodules are found, a process follows to distinguish which may be benign and which may be cancerous; only 1.5-2% of nodules are likely to be cancerous.

To determine whether a nodule is benign or cancerous, information about the nodule itself and the patient's health history are both evaluated. Nodule properties such as size, shape, patterns of irregularity, calcification, and changes in size or shape over time are observed. Overall health factors, including general health, exposure to smoke and toxins, family history, and other factors are also considered. Together, these data are processed to determine whether the individual's nodules have a low, intermediate, or high probability of being cancerous. The determination of risk is then used to guide treatment decisions.

Based on research that found CT lung screening to be highly effective in detecting early lung cancers, most insurance carriers now cover CT screening for lung cancer in patients at high risk. Call 212.326.8505 for information or to schedule your CT screening.