Dr. Daniel J. Boffa is a professor of thoracic surgery at Yale School of Medicine.

Dr. Daniel J. Boffa

In honor of Lung Cancer Awareness Month, CURE spoke with Dr. Daniel J. Boffa about how the understanding of lung cancer is evolving beyond smoking.

Understanding That Not All Lung Cancer Cases Are Linked to Smoking

In recognition of Lung Cancer Awareness Month, observed each November, CURE spoke with Dr. Daniel J. Boffa, professor and division chief of Thoracic Surgery at Yale School of Medicine in New Haven, Connecticut.

In this conversation, Boffa discussed how public understanding of lung cancer is evolving beyond its long-standing association with smoking. He highlighted other significant risk factors for the disease and emphasized the importance of awareness and timely imaging for individuals who experience persistent respiratory issues, even if they have never smoked.

Many people still associate lung cancer primarily with smoking. How is that perception changing, and what are some of the other risk factors or causes patients should be aware of?

Smoking is still the big story in lung cancer, as about 80 to 85% of patients who develop lung cancer will have smoked at one point in their lives. But one out of seven lung cancers happen in somebody who never smoked.

There's a variety of things that have been associated with cancer in never smokers. One of them is radon, which is an odorless gas that can seep into your home from the ground, so certainly when you're buying a new home, or if it hasn't been done in a while, it's important to test radon levels because there are ways of reducing those levels.

There are other environmental exposures, some that are less clear, but anything that irritates your throat and lungs when you're breathing is probably not a good thing. So, you want to minimize the time that you're working with chemicals in poorly ventilated areas. When there's wildfire smoke that's particularly thick, you could wear a mask or have a filter until the air clears.

The other category of lung cancer in never smokers can relate to genetics. There are some cancers that run-in families, but a lot of cancers that happen in people who never smoked, they are the first family member to have this. So, if you have a family member who never smoked and developed lung cancer, you do have a somewhat increased risk of lung cancer, and that's something to check in with your primary care provider about. There's no screening guidance for that group yet, but there probably will be in the next few years.

At the same time, even if you don't have a family member who developed lung cancer as someone who never smoked, and you’ve never smoked, if you develop a cough that doesn't go away after four weeks, or if you're coughing up blood, check in with your primary care provider, and you might need some imaging of your chest.

Transcript has been edited for clarity and conciseness.

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Dr. Daniel J. Boffa shared how cancer care teams support patients in quitting smoking and how new data may guide improvements in high-smoking U.S. regions.

How Cancer Care Teams Can Help With the Cessation of Smoking

Yale Cancer Center-led research published in 

 found that 47% of patients diagnosed with cancer in were former or current smokers, compared with 12% of the general U.S. population.

Because of the difference between smokers and never-smokers being diagnosed with cancer, there are initiatives aimed at these individuals aiming to drive the cessation of smoking after a cancer diagnosis. For example, there are different types of therapy, medications and support groups for those trying to quit the habit, Dr. Daniel J. Boffa explained in an interview with CURE.

 patients can expect from their cancer care team when trying to quit smoking. He also goes on to share how this new smoking data may guide future improvements in cancer care, specifically in regions of the United States with high rates of active smoking.

Boffa currently serves as a professor of Surgery (Thoracic); division chief of Thoracic Surgery; and clinical director at the Center for Thoracic Cancers, at Yale School of Medicine, Yale Cancer Center, located in New Haven, Connecticut.

The good news is that there is a lot of help available. There are quit lines, and most hospitals have teams prepared to help people quit — their smoking cessation teams. The first step is to have that conversation and then to realize that there are tremendous benefits, even after a cancer diagnosis.

There are different types of therapy, different types of medication, and different levels of support groups that can help people make this change, which, while difficult, offers returns that are as significant and beneficial as some of our most innovative cancer treatments.

I think this illustrates that the cancer landscape in the United States is not uniform, and there are differences in behaviors of people in different parts of the country, as well as differences in cancer prevalence across the country. Active smoking is more common in several regions, such as the South. Resources can be directed to hospitals in these areas to help strengthen their smoking cessation efforts.

Additionally, there are higher rates of active smoking across different cancer types. For instance, lung cancer has one of the higher rates, whereas thyroid cancer would have a significantly lower rate. Therefore, I think that hospitals treating a greater proportion of lung cancer patients would benefit from additional support efforts, while hospitals in different parts of the country, like the South, where active smoking rates are higher, could benefit from additional resources.

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Most patients in accredited hospitals had smoking discussions documented, showing key care opportunities and smoking’s impact on treatment outcomes.

Smoking Data May Guide Improved Lung Cancer Care and Patient Support

A new study investigated how often smoking discussions are documented at cancer–accredited hospitals, where 70% of patients with new cancer diagnoses receive care, according to Dr. Daniel J. Boffa, a professor of thoracic surgery at Yale School of Medicine. The team found that smoking status was recorded in 97% of cases, an encouraging sign of quality communication between patients and providers.

The study also examined new variables of current, former or never smoking status using the National Cancer Database, which revealed that nearly half of patients had a history of tobacco use. In addition, 15% of patients were still smoking at diagnosis, which gives them the opportunity to quit even after diagnosis.

Smoking can affect how cancer behaves and responds to treatment, with smoking-related cancers often showing different genetic patterns than those found in non-smokers, according to Boffa. He also emphasized that patients can expect robust cessation support, including hospital teams, medications and quit lines.

Well, I think the most actionable finding was that about 15% of people were actively smoking at the time of their diagnosis, and that's a real opportunity to make a difference, because quitting at the time of a cancer diagnosis can really help improve outcomes.

There truly is no point in time when quitting smoking is not a benefit to patients. It's hard when you're diagnosed with cancer—it's a very stressful time, and that's when it's even more difficult to quit a behavior you've been doing for a while.

But the payoff is real. Treatments are associated with fewer complications when you quit smoking, and the treatments can work more effectively. The behavior of the cancer itself can actually improve, and there's a lower chance that the cancer will come back. So, there are tremendous benefits to quitting, even if you've already been diagnosed with cancer.

Dr. Daniel J. Boffa

Understanding That Not All Lung Cancer Cases Are Linked to Smoking

How Cancer Care Teams Can Help With the Cessation of Smoking

Smoking Data May Guide Improved Lung Cancer Care and Patient Support

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