FORT LAUDERDALE, Fla. — Sherrie Smyth had a feeling something was wrong. For several months, she suffered shortness of breath.

After her cardiologist found nothing unusual, she tried an allergist. “I was 57, and the allergist told me I had adult-onset asthma,” said Smyth, a Miami mother of a teenager.

Although she accepted an inhaler, she also requested an X-ray of her chest. When the results showed an abnormality in her right lung, the allergist prescribed antibiotics. Still short of breath, she went to a pulmonologist and learned through a CT scan that the abnormality was a large mass. An immediate full-body PET Scan showed she had stage 4, inoperable lung cancer that had spread to her adrenal glands and brain.

“I am a big believer in early screening and advocating for yourself,” Smyth said. “If I had stopped at adult-onset asthma, I would be dead.”

Floridians are at high risk for lung cancer, and many are waiting too long to get screened.

The 2024 American Lung Association’s “State of Lung Cancer” report, released on Nov. 19, reveals that lung cancer is the most lethal cancer in Florida. The more localized state report shows only a quarter of Floridians with lung cancer get diagnosed early, which lowers their five-year survival rate.

“With lung cancer, the symptoms can be masked as a common cold,” said Ashley Lyerly, Senior Advocacy Director at the American Lung Association. “That’s why we need to increase screenings, to find it early.”

Miami oncologist Dr. Estelamari Rodriguez says several factors contribute to Florida’s lung cancer toll: The population is older, the screening rate is low, and people relocate to the state from countries where smoking is prevalent. Florida’s large Hispanic population may be a factor, too.

“Nationally, the lung cancer rates for Hispanics are highest of the ethnic groups,” said Rodriguez, a thoracic medical oncologist at Sylvester Comprehensive Cancer Center in Miami. Hispanics also are less likely to receive treatment. “Maybe it’s insurance problems or stigma, but they are less likely to seek care.”

Getting screened is getting easier

Lung cancer diagnosis usually starts with an imaging test called a low-dose CT scan to look at the lungs. The report shows that only about 15% of at-risk people get screened in Florida. According to the U.S. National Institutes of Health, the five-year survival rate for lung cancer is 64% when the cancer is detected early, but only 9% for late-stage lung cancer. Early treatment often is surgery to remove the cancer in the lung before it spreads.

Smoking is a well-known risk factor for lung cancer. Although adult smoking rates in Florida are 11%, slightly below the national average, youth vaping in Florida has increased over the past few years, according to Tobacco Free Florida.

The U.S. Preventive Services Task Force guidelines recommend annual lung cancer screening for anyone 50 to 80 years old who has a heavy smoking history, currently smokes or has quit within the past 15 years. Other risks are a family history of lung cancer or radon exposure.

Lately, researchers have seen an alarming increase in the number of women ages 55 and younger being diagnosed with lung cancer, and no one yet knows why.

Rodriguez doesn’t understand why more people are willing to do a colonoscopy for colon cancer than a CT scan for lung cancer, which is a much simpler test.

“People are presenting to me with advanced disease,” said Rodriguez at Sylvester Cancer Insitute. “Maybe they don’t recognize the symptoms, which are shortness of breath, back pain, and cough.”

Some Florida hospitals, such as Moffitt Cancer Center in Pasco County, are entering communities with new mobile lung screening units. And UHealth’s Sylvester is allowing anyone at risk to schedule a CT scan without seeing a physician first.

Across the state, a coalition of health organizations is offering eligible primary-care patients the FirstLook Lung blood test to aid in early detection. If the test returns “Elevated,” the individual gets referred for a CT scan.

New treatments for lung cancer

In an advancement, Florida oncologists are using biomarker testing to create a personalized treatment plan with fewer side effects. A new Florida law requires Medicaid and state employee health insurance plans to cover biomarker testing.

Smyth said the specialists at Sylvester Comprehensive Cancer performed biomarker testing and developed her treatment plan of chemotherapy and immunotherapy. The four-drug therapy included medications new to the market.

Smyth will receive the last of her 24 treatments on Dec. 12, 20 months after her first infusion.

“I am a strong individual, and I have maintained a completely normal existence,” Smyth said. “After my last scan, my doctor told me there is no evidence of disease.”

Smyth wants others to get screened and, if necessary, treated for lung cancer. The new Florida research shows the state is above the national average for people diagnosed who don’t get treatment.

“It is no longer a death sentence to be told you have cancer,” she said. “There are so many treatments.”

Florida hospitals are using robots

At Delray Medical Center, after a lung nodule shows up on a CT scan, specialists use a robot to biopsy it, regardless of its size or location within the lobe. Even a nodule the size of a Cheerio can be biopsied. They can also use a specialized scope to learn whether the lung cancer has spread to the lymph nodes.

“With this advanced biopsy procedure, we are able to diagnose patients earlier to get them to treatment faster,” said Dr. Stephen Milan, an advanced bronchoscopist and pulmonologist at Delray Medical Center.

At Baptist Health in Miami-Dade and Palm Beach counties, specialists are using robots and technology in three ways, said Dr. Manmeet Singh Ahluwalia, chief scientific officer and chief of Medical Oncology at Baptist Health South Florida. They are using robots to help remove lung cancer during surgeries. They are using artificial intelligence with x-rays to determine when lung cancer tumors are malignant or benign. And when a CT scan looks suspicious, they use special blood tests to find DNA fragments that indicate if a nodule is cancerous.

“We are using technology in all these ways for better detection and treatment, ” Ahluwalia said.

Aware that screening rates are low, he wants to use these new blood tests to screen those at high risk in South Florida communities in near future.

This 2024 State of Lung Cancer report highlights an area of progress: Nationally, the lung cancer survival rate has improved 26% in the last five years. “It’s an improvement but we still have a long way to go,” said Lyerly of the American Lung Cancer Association. “Now that we have better treatment for advanced disease, we need to detect it earlier.”

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