Who are at high risk of lung cancer? There are many predisposing factors for lung cancer, and the most accepted ones are smoking and secondhand smoke. However, in the last decade or so, a new phenomenon has emerged, that is, our smoking population is decreasing, but our lung cancer incidence rate is increasing, and these new lung cancers have many characteristic manifestations. First, many lung cancer patients are non-smoking women. A recent study in the United States showed that the incidence of lung cancer in Asian American women was 40% higher than in other populations. In other words, in a pollution-free and non-smoking environment in the United States, Asian women still have a higher incidence rate, indicating that it is our genetic background that is susceptible to lung cancer. In a hazy environment, one is more susceptible to the disease. Second, there are also more and more small nodules in the lungs and more lung adenocarcinomas. This is a phenomenon that was not seen before. According to my judgment and speculation, all lung cancers caused by PM2.5 are lung adenocarcinoma, which is related to the damage it does to alveolar cells. Thirdly, genetic background is very important. Why do some people get lung cancer from smoking and others don’t. Why do some people get lung cancer from smoking and others don’t. Why do some people get it and others don’t when they live under the same sky? It has to do with the genetic background of the person. If you have a tumor patient in your immediate family, then you are more susceptible. Further, if you are a lung cancer patient, then you need to pay high attention to this problem. Fourth, there is a synergistic effect of smoking and haze on the damage to human lungs. Smoking produces larger particles that are generally processed by our bronchial tubes at all levels, while PM2.5 are small particles that are processed by the alveoli. This means that people who smoke are being damaged from the bronchi to the alveoli. Fifth, people who inhale toxic and harmful gases such as chemical or industrial dust for a long time. Such as painters, miners, traffic police and other occupations. In a word, most of the triggering factors of lung cancer are related to our inhalation of toxic and harmful gases. Since human lungs have good compensatory ability, we do not have any symptoms and discomfort in the short term, which will not cause us enough attention. In fact, this is the most dangerous, because the changes are happening quietly. In addition, I would also like to say that old TB foci or chronic inflammatory changes can sometimes be cancerous and should not be ignored. What are the early symptoms of lung cancer? There are no symptoms in the early stage of lung cancer because there are no sensory nerves on our lungs. Most of the patients who are detected in the early stage are found by physical examination or other examinations due to coughing and other discomforts. Once the lung tumor invades the pleura, the patient will have the symptoms of chest pain or breathing discomfort, and if it invades the airway, he or she will have the symptoms of coughing. Therefore, if you have symptoms such as cough, chest pain, tightness in breathing, etc., and if you have ever had a lung examination before, it is better to check it out, of course not that you must have lung cancer. Because sometimes this is your body’s signal to pay attention. How to detect lung cancer early? Early detection of lung cancer is very important. Many early lung cancers do not have any symptoms and cannot be seen on chest X-ray, it will only show up on chest CT, collectively called small lung nodules. The size of these nodules ranges from 5 mm to 20 mm. As the disease progresses, many solid components will appear in the GGN, and the more solid components, the more cancerous components are indicated. Chest radiographs give us a limited amount of information. A chest radiograph is only about 60% informative, so chest radiograph is ranked as the least reliable test to detect early stage lung cancer. Many patients with early stage lung cancer have normal chest radiographs. Therefore, in the current environmental situation, it is recommended to perform a chest CT physical examination, and preferably a low-dose chest CT, but this is currently not a routine physical examination in our Wuhan. In many hospitals in Beijing and Shanghai, chest CT has replaced chest X-ray and is included in the mandatory medical checkups for employees. The recommendations are as follows: for people over 40, get a chest CT once a year. If you are a high-risk group for lung cancer, such as smoking, inhaling toxic and harmful gases in occupational exposure, or having lung cancer patients in your relatives, you should strictly implement it. If you are not a high-risk group, it can be relaxed to once every 2 years. Why is early detection of lung cancer so important? Currently, lung cancer is the number one cause of death in China and is known as the king of cancers. We have all experienced or heard of people around us getting lung cancer. Some of them were found very late and did not have the chance to have surgery. Some have surgery, and after surgery, they need radiotherapy, chemotherapy and targeted therapy. The patient is in pain, the family is in pain, and it’s financially painful. Most of the patients who come to the thoracic surgery department for surgery are late in the middle stage. Those who can be operated are considered lucky, while more have no chance to operate once they are found. After so many years of research, the survival rate of lung cancer has not improved significantly. The reason for this is that lung cancer is not easily detected at an early stage. It is usually found late. In the end, it is a question of the viewpoint of medical examination. An ordinary chest X-ray detects a lung cancer, usually around the middle stage, which is treated with chemotherapy after surgery, and the five-year survival rate is not high. This is why lung cancer is the king of cancers. Firstly, it has no symptoms and you can’t detect it. Secondly, our current means of physical examination, chest X-ray, cannot detect early lesions. If we can popularize chest CT examinations, then many people will be detected at an early stage. As the environment we live in is changing, our examination methods should change as well. In terms of treatment effect, early stage lung cancer can be cured after surgical resection. And nowadays, minimally invasive thoracoscopic technology is developing rapidly, and we can complete lobectomy or segmental lung resection by making one to three holes in the chest. Our thoracoscopic technology in China is leading in the international arena. Patients with early stage, through thoracoscopic surgery, have fast recovery, less trauma and good long-term results. No radiotherapy is needed after surgery. The occurrence of tumor is determined by two major factors, the first intrinsic genetic inheritance and the second extrinsic environment. In fact, these two factors are unchangeable and uncontrollable for most of us. In the dark, some people are destined to get the disease. This is also known as predestination. The only factor that we can control is early detection and treatment. We can prevent it and block it by changing our perspective and awareness. This is the only way we can change our destiny. At present, our medical tools for early detection and treatment are without problems and are of international standard. I think doctors detecting and treating lung cancer in early stage is saving lives, and treating middle and late stage can only be considered as curing the disease. Therefore, as a doctor, it is my duty to tell people about the phenomenon I have observed so that more people can be aware of it accordingly. All this is said here to give a warning to everyone, don’t be defeated by predestination while working hard and living in this wonderful time.