From patient to advocate
Late this summer, Ginny Hicks will reach a milestone she had less than a 10% chance of surviving to see — the five-year anniversary of her stage-four lung cancer diagnosis.
To say she’s satisfied with bucking the trend, however, doesn’t capture all her feelings.
“While I’m still here and happy for each day that I get, the statistics aren’t in my favor,” she said.
That’s why Hicks, a former Medford teacher and principal, now spends her time on a new kind of education: informing policymakers and the public on the realities of the cancer that kills more Americans every year than any other.
She’s one of several patients who, along with lung health advocates and local health care providers, are pushing for local smokers and nonsmokers alike to take the steps they can to protect their breathing and health.
“It’s slow,” Hicks said of the progress of that education. “And we need faster progress.”
Jackson County residents’ thoughts often turn to respiratory health with the now-perennial arrival of summer smoke. Data from the American Lung Association makes a compelling case for concern about the impacts of our air quality.
Jackson County doesn’t score well on the organization’s online “State of the Air” monitor, which issues letter grades to states and counties based on their ozone and particle pollution levels. The county has earned a “D” grade for ozone levels and an “F” grade for high-particle pollution days per year, grades that the ALA bases on data from the Environmental Protection Agency from 2000 (ozone data begins in 1996) though 2017.
“There was a time when ozone wasn’t a problem in our area, but with warmer temperatures, we are seeing more and more exposure to ozone,” said Carrie Nyssen, a senior advocacy director with the American Lung Association.
High ozone levels can trigger irritation in the throat and lungs and in extreme exposure, cause scarring in the lungs. Exposure to high concentrations of particulate matter is a risk factor for lung cancer, the World Health Organization has said.
Annual breakdowns of EPA data show which times of year have tended to see the worst air quality in Medford in recent years.
In 2015, 2016 and 2017, the worst of the high-particulate days were concentrated mostly in the summers, when smoke filled the bowl of the Rogue Valley and sent air quality as high as “extremely unhealthy” between August and September of 2017.
The winter months were also higher in particulate matter than spring or fall, the data showed.
“I think the take-home message for people to understand about air pollution is to track it to make sure you know when it’s bad days out there,” Nyssen said. “When you can see the air and you can smell the air, it’s not a good thing.”
Poor air quality is an especially significant contributor to lung cancer and other respiratory conditions in Africa and Southeast Asia, according to the World Health Organization. In the U.S., the vast majority of lung cancer cases are linked to extended periods of frequent cigarette smoking.
Dr. Julian Bell, director of pulmonary and critical care and sleep medicine at Providence Medford Medical Center, said the majority of his work with patients who are considered high-risk involves to try to get them to quit smoking.
“It’s the low-hanging fruit,” he said.
For several years now, Providence’s Southern Oregon facilities have provided access to the low-level CT scan that is the only recommended way to screen for lung cancer.
The criteria for screening, however, are far more stringent than for other screenings, such as a mammogram or a colonoscopy. Those who qualify must be above the age of 55, usually up to age 80, who have smoked at least a pack of cigarettes a day for 30 years. Otherwise, insurance including Medicare won’t cover the cost, and hospitals might not perform the scan.
As with any cancer, screening early and often helps catch malignant tumors before they metastasize.
Locally, access to lung cancer screening is expanding. Asante Rogue Regional Medical Center will debut its own low-level CT scanner to perform lung cancer screenings beginning Aug. 12.
“I’m excited for it,” said Shelley Day, a registered nurse at Asante Physician Partners’ Pulmonary Consultants and Sleep Specialists.
Day said that she’s talked with many longtime smokers or people with extended exposure to secondhand smoke who were interested in being tested, but didn’t meet one or more of the screening criteria.
“It’s hard to tell people, ‘I’m sorry, you don’t qualify,’” she said.
Day often sees cases where the cancer has already spread to other organs and is incurable.
“Assisting in those biopsies, it can be very heartbreaking,” she said.
Hicks was one of those patients. She discovered a lump in the lymph nodes under her left arm, which led to mammograms that turned up negative. After multiple CT scans, PET scans and an MRI of her brain, she received her stage-four diagnosis.
Hicks exercised regularly and never smoked. She, Day and Nyssen hope that with more research, screening will improve to identify a more diverse range of at-risk people, including those who don’t meet the high-risk threshold for screening.
“If you’ve got lungs, you can get lung cancer,” Nyssen said.
After smoking, radon exposure is the second-leading cause of lung cancer.
The colorless, odorless radioactive gas is released from exposed rock and sediment. Exposure to it for a long time in a confined space can be a catalyst for lung cancer.
A variety of short-term, long-term and continuous radon tests and monitors are available online or in stores.
The short supply of research on lung cancer treatment and development also leaves unanswered questions about the risk to another group of people frequently exposed to smoke and debris: wildland firefighters.
An April 2019 study concluded that wildland firefighters’ risk for lung cancer could be increased by between 8% and 43%, depending on how many years they work.
But Kyle Reed, fire prevention specialist with Douglas Forest Protective Association, said it isn’t a major concern among crews he’s worked with throughout his career.
You won’t see breathing masks, part of the standard outfitting for structure firefighters, worn by wildland firefighters. Masks that filter out particulate matter, such as the recommended N-95 mask, hold heat close to the face and can restrict airflow, which could weaken firefighters’ cognitive function.
“For whatever reasons they choose, the majority choose not to (wear masks),” he said.
Another study by the U.S. Joint Fire Science Program examined wildland firefighters’ exposure to carbon monoxide and respirable particulate matter based on their work, duration of exposure and position near the fire.
It concluded that, “the health effects of acute exposures beyond susceptible populations and the effects of chronic exposures experienced by the wildland firefighter are largely unknown.”
“There remains a need for research on acute and longer term effects of wildland fire smoke exposure,” the authors wrote.
To meet that need, Hicks and other advocates with the GO2 Foundation lobby lawmakers to allocate more money towards lung cancer research.
The GO2 Foundation, which is a partnering effort between two major lung cancer advocacy groups, has a goal to boost funding to the Lung Cancer Research Program to $20 million by 2020.
Hicks recently returned from a trip visiting lawmakers in Washington, D.C., to push for that funding. While at the convention, she was awarded the GO2 Foundation’s national Support Group Facilitator Award, for her work to support fellow patients locally and nationwide.
Shortly after Hicks returned, she went in for another chemo treatment.
Hicks said that the lawmakers she spoke with indicated they would support efforts to push more funding to the program, which, after the National Cancer Institute, is the second-biggest lung cancer research program.
Barring any dangerous smoke, she’ll also be at Southern Oregon’s Relay for Life Aug. 24, where Asante will host a table of people at Harry & David Field to focus specifically on lung cancer.
“I’m certainly hoping that the efforts will help myself,” Hicks said, “but if not me, that it’ll help others behind me.”