Cycle Away Lung Disease

September 16, 2009
By Dr. Warren Tomamoto

Dr. Warren Tomamoto
Pulmonologist

Interviewed By Melissa Moniz

Where did you receive your schooling and training?

I graduated from Laupahoehoe High School on the Big Island. I received my bachelor of science degree from University of Hawaii and my medical degree from John A. Burns School of Medicine at University of Hawaii in 1977. I did my internal medicine training in El Paso, Texas, followed by specialty training in pulmonary disease and critical care medicine at Walter Reed Army Medical Center in Washington, D.C. I came back to Hawaii and worked for six years at Tripler Medical Center and then joined Kaiser Permanente, where I’ve been for more than 20 years.

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Can you talk about what conditions you treat?

Pulmonary medicine is taking care of patients with a variety of lung diseases. The conditions that we see are conditions like pneumonia, asthma and emphysema. We also see patients who have trouble breathing or have a cough that doesn’t go away. Those are common reasons that patients are referred to us.

Can you talk about lung cancer and its causes?

Lung cancer is another one of the major reasons that patients are referred to us. About 90-95 percent of lung cancer is due to smoking. Some cases of lung cancer are due to genetic factors, and exposure to radiation is another factor that increases the risk of lung cancer.

What are some of the symptoms?

Lung cancer may present with pain - sometimes pain in the chest. Sometimes, cancer presents with pain in other parts of the body because it has already spread outside of the lungs. A persistent cough, coughing up blood or unusual shortness of breath may also be a symptom of lung cancer.

As far as the other lung diseases, which ones are also associated with smoking?

Emphysema or COPD (chronic obstructive pulmonary disease) is caused by cigarette smoking. These patients often present with shortness of breath with exertion. Pneumonia is indirectly related to smoking. If you are a smoker and you get a cold or respiratory viral infection, then you are at increased risk of developing pneumonia because smoking impairs the lung defense mechanisms.

With all the statistics and studies that show the dangers of smoking, why do you think people still smoke?

I’m sure there are many reasons, but I think most people start when they are young. So it’s really the peer group and just trying something different. And then many of them become addicted to it. So after a period of time they want to quit, but they can’t.

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Is it true that lung cancer is the No. 1 cancer killer in Hawaii?

Yes. It’s the No. 1 cancer killer in the U.S. It’s not the most common cancer, but it’s the No. 1 killer. And that’s because it’s typically found very late. Many lung cancers are right within the lung tissue and surrounded by healthy lung tissue. So those areas are not associated with many symptoms and can grow for years before we find them.

So not even an X-ray would pick it up?

A chest X-ray is a common way for us to detect lung cancer, but it’s not a way for us to detect early lung cancer. If we did X-rays on a smoker every three months, could we cure them once we find a lung cancer? The answer is already proven to be no. The cancer that you find is no more curable than if you find them by chance. So, basically, we don’t have a good way to find lung cancer in its early stages. We find them when they are already advanced. So the overall cure rate for lung cancer is about 10-15 percent. That’s what it was when I started practicing and that’s what it still is.

Can you explain the Breathe Ride and your involvement with it?

I was recruited by Anne LaPorte, the event chairwoman, because she found out that I survived the Tinman. It’s a great fundraiser for the American Lung Association of Hawaii. Breathe Ride participants raise money for American Lung Association of Hawaii and have a fun day of safe bicycling. American Lung Association advocates for patients with lung disease and advocates for protecting the air that you and I breathe. And so, I ask that my friends and family please donate in my name to American Lung Association of Hawaii.