Lung cancer is the leading cause of cancer deaths in men and women. If found early, there are more treatment options available. National Cancer Institute research found that CT screening can reduce the number of deaths from lung cancer by 20 percent.
While smoking causes the majority of lung cancers, lung cancer also occurs in people who have never smoked or been exposed to secondhand smoke.
Listen as Dr. Bill Johnson, pulmonologist with Nebraska Pulmonary Specialties, comes on to discuss your risk of developing lung cancer, and the steps you can take for prevention and early detection so that you can see if you or a loved one qualify for this low-dose CT scan screening.
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The Importance of Getting Screened for Lung Cancer
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Learn more about Dr. Bill Johnson
Bill Johnson, MD, Nebraska Pulmonary Specialties
Dr. Bill Johnson is a pulmonologist with Nebraska Pulmonary Specialties.Learn more about Dr. Bill Johnson
Transcription:
The Importance of Getting Screened for Lung Cancer
Melanie Cole (Host): Lung cancer is the leading cause of cancer deaths in men and women. If found early, there are more treatment options available. The National Cancer Institute Research found that CT screening can reduce the number of deaths from lung cancer by up to 20 percent. My guest today is Dr. Bill Johnson. He's a pulmonologist with Nebraska Pulmonary Specialties. Welcome to the show, Dr. Johnson. Why is screening for lung cancer — we're hearing more and more about it in the media — why is it becoming so important?
Dr. Bill Johnson (Guest): Well, as you had mentioned, lung cancer is the leading cause of cancer death in both men and women. In fact, lung cancer will kill more patients than colon cancer, breast cancer and prostate cancer combined. I think if you ask a lot of people if there's ways they could avoid those cancers, they would like to do that. There are many characteristics of lung cancer that make screening something that we would like to pursue. One of the problems is that patients, probably 3/4 of patients who actually present with symptoms of lung cancer have already presented at a stage where they're not curable. Obviously, finding this early is something that is very helpful. If you find lung cancer at an early stage, your chances of living another five years is much greater. So, the benefits of screening are such that preventing it is probably the most effective strategy. So, we're really looking at trying to find it early.
Melanie: So, who should consider getting screened?
Dr. Johnson: Right now, there are a higher number of patients who have developed lung cancer without a history of smoking. However, smoking clearly is the greatest risk factor for lung cancer and it's the one that's the most identifiable. So, what we have found is we feel that cigarette smoke probably accounts for about 85 percent of lung cancers, or that it be primary smoking or secondary, second hand smoke. The patients who we recommend get screening currently, under the current recommendations, are those that have smoked the equivalent of what we call “30-pack years”. What that means, is that if a patient has smoked one pack a day for 30 years, they have a 30-pack year history. If they smoke two packs a day for 15 years, that's also a 30-pack year history. And so, the equivalent of 30-pack years, somebody who smoked within 15 years, and are between the ages of 54 and 78, are the current patients that are targeted for screening.
Melanie: So, when you say the 30-pack years, or 15-pack years, does that . . . Explain that a little bit more in detail, Dr. Johnson, because people ask about that and they're not quite sure what that means?
Dr. Johnson: Sure. So, the total amount of smoking a person has done through their lifetime is something that we quantify because it is an important factor in determining like risk for cancer or COPD or other smoking-related diseases. So, again, if a person has smoked one pack a day for 30 years, we call that a 30-pack year history. If they smoked one pack a day for 50, it's a 50-pack year. If they smoke two packs a day for 20 years, that would be a 40-pack year history. So, we take the number of packs per day, and multiply it by the number of years smoked and that gives you what we call your "pack years". And that's the thing that we're looking at. So, we're looking for people that have the equivalent of 30-pack years.
Melanie: So, if somebody wants to consider getting screened, who do they ask? Do they go right to a pulmonologist? Do they ask their internal medicine physician? Is this something they can ask for at that age or if they've had this pack year history? What do they do next?
Dr. Johnson: Yes, I suggest that patients discuss this with their physician. There are risk factors to getting any medical procedure, including screening for lung cancer. There are things that people need to understand what it means. But, yes, I recommend patients talk to their primary care doctor or if they have a pulmonologist that they already follow with, to talk to them about it, find out if they feel that they are appropriate for lung cancer screening.
Melanie: And, what's it like? What's the lung cancer screening? What does the patient do?
Dr. Johnson: That's a great question. You know, through the years, we've looked for ways to screen for lung cancer and lung cancer is such a challenging disease. It's so important that we find it early. If you find lung cancer early, what we would call Stage I, the person at Stage I has a chance of living—at five years, has a 60 percent chance of surviving. If you find it at Stage IV, where we've found it's already spread or metastasized, you only have a 5 percent chance of living for five years. So, screening is important to find it early and we've had to look for ways to do that. Chest X-rays have not been found to be helpful in finding it early, and so what has been found to be useful is what's called a “low-dose CT scan”. And essentially, this is a CT scan, or a CAT scan, computed tomography scan, where you lay on a bed, and you go through a little circle — it's not an MRI, so it's open, people really don't have trouble with the claustrophobia that you get with an MRI. It's a low-dose CT scan and what that means is that the dose of radiation given to you is much less than a traditional CT scan. It's less than a third of the amount, but it gives a very good picture of the lungs. It's very quick. It doesn't take very long. Probably the check-in time takes longer than the scan itself, and it's done without any IV contrast, or anything like that. So, it's a very simple test and certainly easier than a lot of the other screening modalities we have for other cancers.
Melanie: Does insurance recognize this screening, Dr. Johnson?
Dr. Johnson: Yes. This has been recommended by the United States Task Force for Preventative Health Care and part of our new healthcare laws that have been in place have required, in a lot of ways, for insurance companies to pay for preventative health care and lung cancer falls into that. It did take Medicare a little while to catch up with some of that, but the private care, almost all of the primary insurance companies and Medicare, do cover this, and they should.
Melanie: Then, what happens if something is found on the screening exam? What would happen next?
Dr. Johnson: Well, what we're looking for, obviously, are any signs that something could be a cancer, and there are times where the consequences of health care technology are that you find things that you aren't really looking for, too. So, there are risk factors that other things are found. There's a risk that we find something that would be benign and what that means that there's a fairly large percentage of individuals that may have a small nodule that's actually not a cancer but rather is a scar from a prior infection. Typically what happens is that we would continue to watch those smaller masses or nodules and make sure that they don't grow or change over time with follow-up CT scans. If a person has a spot that's concerning, then we would go down the usual directed path of making a diagnosis of lung cancer, if that's what's actually found, and then we would obviously want to pursue the right form of therapy for that person.
Melanie: So, wrap it up for us, Dr. Johnson, with your best advice for people listening about getting that low-dose CT scan screening for lung cancer, how often they should do it, and what you really want them to know about preventing lung cancer in the first place.
Dr. Johnson: I think that for those people out there who have been smokers in the past, remember that your risk factors for lung cancer don't go away just because you've stopped smoking. I do think that stopping smoking is far and away the most important thing in preventing lung cancer. Not smoking at all, obviously, is what we would hope for, but we all know that's a challenging process and it's a very challenging habit for people. If you fall into that group where you have the equivalent of a 30-pack year history of smoking and you're between the ages of 54 and 78, I would certainly recommend that you talk to your doctor about the possibility of getting lung cancer screening. It's a simple and easy thing to do and it could, at some point, save your life.
Melanie: Thank you so much for being with us today. If you want to find out if you're at risk for developing lung cancer, you can take our free, quick, and confidential lung screening at bryanhealth.org/onlinescreenings. That's bryanhealth.org/onlinescreenings. You're listening to Bryan Health Radio. This is Melanie Cole. Thanks so much for listening.
The Importance of Getting Screened for Lung Cancer
Melanie Cole (Host): Lung cancer is the leading cause of cancer deaths in men and women. If found early, there are more treatment options available. The National Cancer Institute Research found that CT screening can reduce the number of deaths from lung cancer by up to 20 percent. My guest today is Dr. Bill Johnson. He's a pulmonologist with Nebraska Pulmonary Specialties. Welcome to the show, Dr. Johnson. Why is screening for lung cancer — we're hearing more and more about it in the media — why is it becoming so important?
Dr. Bill Johnson (Guest): Well, as you had mentioned, lung cancer is the leading cause of cancer death in both men and women. In fact, lung cancer will kill more patients than colon cancer, breast cancer and prostate cancer combined. I think if you ask a lot of people if there's ways they could avoid those cancers, they would like to do that. There are many characteristics of lung cancer that make screening something that we would like to pursue. One of the problems is that patients, probably 3/4 of patients who actually present with symptoms of lung cancer have already presented at a stage where they're not curable. Obviously, finding this early is something that is very helpful. If you find lung cancer at an early stage, your chances of living another five years is much greater. So, the benefits of screening are such that preventing it is probably the most effective strategy. So, we're really looking at trying to find it early.
Melanie: So, who should consider getting screened?
Dr. Johnson: Right now, there are a higher number of patients who have developed lung cancer without a history of smoking. However, smoking clearly is the greatest risk factor for lung cancer and it's the one that's the most identifiable. So, what we have found is we feel that cigarette smoke probably accounts for about 85 percent of lung cancers, or that it be primary smoking or secondary, second hand smoke. The patients who we recommend get screening currently, under the current recommendations, are those that have smoked the equivalent of what we call “30-pack years”. What that means, is that if a patient has smoked one pack a day for 30 years, they have a 30-pack year history. If they smoke two packs a day for 15 years, that's also a 30-pack year history. And so, the equivalent of 30-pack years, somebody who smoked within 15 years, and are between the ages of 54 and 78, are the current patients that are targeted for screening.
Melanie: So, when you say the 30-pack years, or 15-pack years, does that . . . Explain that a little bit more in detail, Dr. Johnson, because people ask about that and they're not quite sure what that means?
Dr. Johnson: Sure. So, the total amount of smoking a person has done through their lifetime is something that we quantify because it is an important factor in determining like risk for cancer or COPD or other smoking-related diseases. So, again, if a person has smoked one pack a day for 30 years, we call that a 30-pack year history. If they smoked one pack a day for 50, it's a 50-pack year. If they smoke two packs a day for 20 years, that would be a 40-pack year history. So, we take the number of packs per day, and multiply it by the number of years smoked and that gives you what we call your "pack years". And that's the thing that we're looking at. So, we're looking for people that have the equivalent of 30-pack years.
Melanie: So, if somebody wants to consider getting screened, who do they ask? Do they go right to a pulmonologist? Do they ask their internal medicine physician? Is this something they can ask for at that age or if they've had this pack year history? What do they do next?
Dr. Johnson: Yes, I suggest that patients discuss this with their physician. There are risk factors to getting any medical procedure, including screening for lung cancer. There are things that people need to understand what it means. But, yes, I recommend patients talk to their primary care doctor or if they have a pulmonologist that they already follow with, to talk to them about it, find out if they feel that they are appropriate for lung cancer screening.
Melanie: And, what's it like? What's the lung cancer screening? What does the patient do?
Dr. Johnson: That's a great question. You know, through the years, we've looked for ways to screen for lung cancer and lung cancer is such a challenging disease. It's so important that we find it early. If you find lung cancer early, what we would call Stage I, the person at Stage I has a chance of living—at five years, has a 60 percent chance of surviving. If you find it at Stage IV, where we've found it's already spread or metastasized, you only have a 5 percent chance of living for five years. So, screening is important to find it early and we've had to look for ways to do that. Chest X-rays have not been found to be helpful in finding it early, and so what has been found to be useful is what's called a “low-dose CT scan”. And essentially, this is a CT scan, or a CAT scan, computed tomography scan, where you lay on a bed, and you go through a little circle — it's not an MRI, so it's open, people really don't have trouble with the claustrophobia that you get with an MRI. It's a low-dose CT scan and what that means is that the dose of radiation given to you is much less than a traditional CT scan. It's less than a third of the amount, but it gives a very good picture of the lungs. It's very quick. It doesn't take very long. Probably the check-in time takes longer than the scan itself, and it's done without any IV contrast, or anything like that. So, it's a very simple test and certainly easier than a lot of the other screening modalities we have for other cancers.
Melanie: Does insurance recognize this screening, Dr. Johnson?
Dr. Johnson: Yes. This has been recommended by the United States Task Force for Preventative Health Care and part of our new healthcare laws that have been in place have required, in a lot of ways, for insurance companies to pay for preventative health care and lung cancer falls into that. It did take Medicare a little while to catch up with some of that, but the private care, almost all of the primary insurance companies and Medicare, do cover this, and they should.
Melanie: Then, what happens if something is found on the screening exam? What would happen next?
Dr. Johnson: Well, what we're looking for, obviously, are any signs that something could be a cancer, and there are times where the consequences of health care technology are that you find things that you aren't really looking for, too. So, there are risk factors that other things are found. There's a risk that we find something that would be benign and what that means that there's a fairly large percentage of individuals that may have a small nodule that's actually not a cancer but rather is a scar from a prior infection. Typically what happens is that we would continue to watch those smaller masses or nodules and make sure that they don't grow or change over time with follow-up CT scans. If a person has a spot that's concerning, then we would go down the usual directed path of making a diagnosis of lung cancer, if that's what's actually found, and then we would obviously want to pursue the right form of therapy for that person.
Melanie: So, wrap it up for us, Dr. Johnson, with your best advice for people listening about getting that low-dose CT scan screening for lung cancer, how often they should do it, and what you really want them to know about preventing lung cancer in the first place.
Dr. Johnson: I think that for those people out there who have been smokers in the past, remember that your risk factors for lung cancer don't go away just because you've stopped smoking. I do think that stopping smoking is far and away the most important thing in preventing lung cancer. Not smoking at all, obviously, is what we would hope for, but we all know that's a challenging process and it's a very challenging habit for people. If you fall into that group where you have the equivalent of a 30-pack year history of smoking and you're between the ages of 54 and 78, I would certainly recommend that you talk to your doctor about the possibility of getting lung cancer screening. It's a simple and easy thing to do and it could, at some point, save your life.
Melanie: Thank you so much for being with us today. If you want to find out if you're at risk for developing lung cancer, you can take our free, quick, and confidential lung screening at bryanhealth.org/onlinescreenings. That's bryanhealth.org/onlinescreenings. You're listening to Bryan Health Radio. This is Melanie Cole. Thanks so much for listening.