November is Lung Cancer Awareness Month.

The month brings a national spotlight to the disease, but a recent Professional Dairy Producers of Wisconsin webinar helped shine a more narrow beam on a population that has its own specific risks: dairy farmers and others in rural communities.

There’s due reason to focus on lung cancer specifically. Lung cancer is the leading cause of cancer deaths, responsible for 25% of them, an amount greater than those caused by colon, breast and lung cancer combined, said Madhuri Rao, assistant professor of surgery, Division of Thoracic and Foregut Surgery, at the University of Minnesota.

In 2020, there are expected to be about 230,000 new cases of lung cancer and over 135,000 deaths attributed to it, Rao said.

Lung cancer can be divided into two major categories: small cell lung cancer and non small cell lung cancer. Responsible for 80% of cases, non small cell lung cancer, which includes the subcategories of adenocarcinoma, squamous cell carcinoma and large cell carcinoma, could be referred to as the “garden variety” of lung cancer, Rao said.

Localized signs and symptoms of lung cancer can include chronic cough, chest pain, trouble breathing, blood in sputum, hoarseness and others.

Just because those symptoms exist does not mean that it’s cancer, Rao emphasized, as there are a number of other respiratory illnesses that could be at fault, but the symptoms are worth bearing in mind.

If the cancer progresses beyond a localized stage, generalized/metastatic symptoms can include bone pain, headache, blurry vision, nausea, weight loss, fluid around lungs and jaundice.

But, Rao said, it’s important to recognize that lung cancer doesn’t necessarily present with anything, especially in the early stages where it’s most treatable. By the time symptoms do appear, things are probably already a little bit advanced, she said.

Prevention is better than having to try to cure lung cancer, Rao said. Quitting and avoiding smoking is a major step toward prevention, but actions including awareness and avoidance of radon and asbestos exposure and keeping a healthy diet can help, too, Rao said.

Other factors to keep in mind when assessing one’s risk for lung cancer include prior chest radiation, chronic obstructive pulmonary disease, inflammatory lung diseases and to an unknown extent, genetics, Rao said.

Smoking remains the No. 1 risk factor, though, and is associated with 90% of lung cancer deaths, Rao said.

Smokers’ risk is 15 to 30 times higher than that of non-smokers. Even smokers who only smoke a “few” cigarettes or just smoke occasionally will see their risk go up, Rao said. Those who quit smoking will decrease their risk over time but will always have a higher risk than a never smoker because of irreversible damage.

A secondary layer of prevention includes lung cancer screening, which aims to get early diagnoses in high risk populations, Rao said. Anyone aged 55 to 80 years old who smoked the equivalent of a pack a day for 30 years and is a current smoker or quit smoking in the past 15 years is eligible for a lung cancer screening, which they can speak to their doctor about.

While the prevention tips apply generally, the rural health care system presents circumstances that can add specific nuances to the likelihood and treatment of lung cancer.

In rural areas in general, the incidence of smoking and lung cancer is higher, Rao said, but survival is not comparatively worse.

Still, rural residents may notice a difference in the type and timeliness of the treatment they are able to receive after diagnosis due to the structure of the rural health care system.

For example, Rao said, the curative option for lung cancer, only if caught at an early stage and the patient is medically fit to receive the treatment, is to surgically remove the portion of the lung in which the cancer is contained. That option provides the lowest chances of the cancer coming back, but in a rural area, a lack of a specialist who could perform that kind of surgery may mean a patient is sent off for another kind of treatment, Rao said.

Other treatments, which include those used for advanced stages or when surgery is medically not an option, include radiation, chemotherapy and immunotherapy.

For dairy farmers, though, there is some good news about their risk for getting lung cancer in the first place.

Some studies have shown that if age and smoking did not factor in, dairy farmers have a decreased incidence of lung cancer, Rao said.

That is probably due to protective effects of endotoxin, which dairy farmers are exposed to and which promotes anti-cancer substances in the body, Rao said. The protective effects have been shown to vary with exposure levels, with increased exposure having increased effect and protective effects waning over time after cessation of exposure to endotoxin.

Other lung health concerns

Lung cancer isn’t the only pulmonary condition that dairy farmers should be aware of.

“Dairy farming and pulmonary health is a big topic in itself,” she said.

Dairy farmers regularly face factors that can increase their risk for deteriorated pulmonary health, Rao said, including exposure to organic dust, noxious gases and bacterial toxins; duration of exposure; a higher average age in the occupation; and a lack of respirator use, among other factors.

Studies and research have shown that dairy farmers do have a higher incidence of obstructive pulmonary disease. That includes things like COPD and asthma, a worse baseline respiratory function compared to the general population and more respiratory symptoms, such as wheezing and coughing.

Modern/larger dairy farms (over 400 cattle) have been shown to have lower rates due to better working conditions, Rao said, but “it’s still a significant health risk.”

Another item related to farmers’ pulmonary health, Rao said, is farmer’s lung, medical term hypersensitivity pneumonitis. The condition itself isn’t restricted to farmers alone, she said, but it refers to an inflammatory response in the lungs to organic or inorganic antigens (proteins) that dairy farmers are exposed to. Some studies have linked a higher incidence of the condition not only to farmers, but their spouses as well.

Changes in farming practices have helped to decrease the incidence of the condition, but it’s still well-known, Rao said. Avoidance of causative factors and other medications can help cure or manage the condition in its early stages, but left unaddressed, it could progress to more severe lung disease.

When it comes to addressing pulmonary issues, doing so early is key.

“If ignored ... some of these things can get to a point where it could be irreversible,” Rao said, “but most times, if it’s picked up in the initial stages, it’s something that can be improved.

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