'Considerable Overlap’ in Appearance of Chest Abnormalities May Delay Lung Cancer Diagnoses

According to the Centers for Disease Control and Prevention, the symptoms of lung cancer can include chest pain, coughing and shortness of breath.

Unfortunately, they can also be symptoms of other conditions such as pneumonia and bronchitis. Not only that, but the latter can also present as cancer on CAT scans and X-rays, thus resulting in delayed diagnoses.

“A provider’s first inclination might be to think of those conditions before thinking of lung cancer,” Dr. Akshu Balwan, assistant professor of pulmonary and critical care at The University of New Mexico School of Medicine in Albuquerque, told CURE®.

Lung cancer is often diagnosed by biopsy, but imaging tests are generally used to determine in which direction to proceed.

“For certain patients, I see the CAT scan, and (I think), this is cancer until proven otherwise,” Balwan explained. “And there are other ones that we see, and (it) looks more like inflammation and pneumonia than a cancer. But there’s considerable overlap in both the conditions and how they look.”

The Domino Effect of Delays

Delays in the diagnosis of lung cancer can affect whether patients see the right specialist and even the treatment they receive.

“Nowadays, most cancer centers have a multidisciplinary team, and ... with diagnosing lung cancer, we try to avoid those delays,” Balwan noted. “Instead of seeing everybody in the pathway, we want to try to get them to the treatment as soon as we can. We discuss and we try to get them to the right physician, whether it’s an oncologist, a surgeon or a radiation oncologist, in the shortest amount of time.”

That’s not to say that health care professionals cannot determine what lung cancer is and isn’t, but their conclusions may depend on the patient’s medical history, including smoking status.

“Most providers should be able to identify the chronicity of symptoms and would think about the diagnosis such as lung cancer in a patient who has smoked or has other risk factors for lung cancer,” Balwan told CURE®. “Sometimes diagnosis can be challenging in patients who develop lung cancer despite being nonsmokers.”

Most physicians are receptive to what patients think, especially if they’re concerned about lung cancer and have the risk factors for it.

But that doesn’t mean patients are immediately biopsied. Doctors tend to start with chest imaging to spare patients from such unnecessary complications as pain, infection and blood clots.

What Patients Should Do

Balwan recommends that patients describe their symptoms in detail and seek care early on instead of waiting to see what happens.

“(It’s important to be) aware of your bodily functions and what is normal or abnormal for you to avoid any delays,” he explained.

Sometimes, he added, symptom duration can help a physician diagnose a patient in a timely manner, especially if that patient received treatment for another condition but saw no improvement.

“If your symptoms persist despite treatment for the diagnosis that you received, and are in line with possible symptoms with lung cancer, you should discuss (it) with your health care provider, especially if you have risk factors for lung cancer and consider chest imaging,” Balwan concluded.

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