Early Screening is Key for Fighting Lung Cancer

Lung cancer is the leading cause of cancer deaths in Hawaii and across the nation. However, the rate of new lung cancer cases among Asian Americans and Pacific Islanders in Hawaii is significantly higher than nationally, according to the American Lung Association.

Dr. Christian Castañeda, a Hawaii Pacific Health Medical Group pulmonologist based at Pali Momi Medical Center, seeks to provide Hawaii residents vital information about the disease.

"Many (people) on neighbor islands and in rural communities may face challenges accessing lung cancer care. These patients are often underserved. Increasing access to care is a primary goal of our pulmonology team at Pali Momi Medical Center and Hawaii Pacific Health," Castañeda says.

Board certified in internal medicine, critical care medicine and pulmonary disease, Castañeda also is an assistant clinical professor for University of Hawaii at Manoa's John A. Burns School of Medicine.

Below, he emphasizes the importance of early screening to prevent lung cancer and state-of-the-art treatment available at Hawaii Pacific Health.

Why is early screening for lung cancer important?

Lung cancer can be treated. Early screening is vitally important as early diagnosis improves survival rates. If lung cancer is detected when it is very small or before it spreads to other areas, thoracic surgeons can remove the tumor, which removes the cancer. Patients with a tumor measuring 1 centimeter in diameter or smaller without any other cancer spread have a five-year survival rate of greater than 90%. Once cancer has spread beyond the lungs, however, those rates drop to approximately 10%.

Who should be screened for lung cancer?

Low-dose computed tomography (LDCT) is an effective way to screen for lung cancer. The exam takes about 15 minutes, and you don't have to fast or take any medications.

The United States Preventive Services Task Force recommends annual screening with LDCT for adults 50 to 80 years old with a history of smoking. This is for people who have smoked at least 20 pack years – calculated by multiplying the number of packs smoked daily by the number of years smoked – and currently smoke or have quit within the past 15 years.

There are other distinct risk factors that disproportionately affect our communities. Many of our patients grew up in rural communities of the Philippines, or islands such as Tonga or Samoa, where factors such as regular use of wood-burning stoves, air pollution and smoke from burning crops can increase their risk of lung cancer. Different countries also have different laws regarding cancer-causing materials, so some are still using items like radon or asbestos.

What sets Pali Momi's lung program apart from others?

We pride ourselves on our multidisciplinary approach, which focuses on conversations with patients about care goals and to ensure they share in the decision-making process. We also believe in thinking critically and selecting appropriate patients for a biopsy.

When we determine procedures are needed, we have cutting-edge technology here at Pali Momi Medical Center, including the Da Vinci robotic surgical system and Ion robotic navigation platform. With Ion, our ability to access nodules in the lung for biopsy is unprecedented.

My partner, Dr. Eric Crawley, and I are focused on comprehensive care at Pali Momi where lung nodules can be evaluated and treated for lung cancer. Additionally, thanks to support from medical center leadership, Pali Momi is developing a dedicated lung cancer procedure suite, which should greatly expand our capacity.

We have the privilege of working with Dr. Ayman Abdul- Ghani, our thoracic surgeon. We also have dedicated pathologists including Hawaii's only thoracic-trained pathologist, Dr. Martin Ishikawa, on-site during biopsies to provide immediate analysis of the tissue.

In addition, our teams collaborate to minimize the number of times our neighbor island patients have to fly to Oahu. They can often have radiology scans, consultations and procedures during the same trip.

How can you prevent lung cancer?

Don't smoke. This includes electronic vaping cartridges and recreational marijuana. Smoke is a carcinogen that can cause inflammation and damage cells, possibly making them malignant.

This article was first featured in the Nov. 26, 2025, issue of MidWeek as a part of the “Dr. in the House” series. See the full publication.

Published on: November 26, 2025