Amanda Wilde (Host): Ahead, we're discussing a vital topic, lung cancer, and the lung cancer screening program at Dignity Health. Join us as we dive into the significance and intricacies of early detection and the resources available on California Central Coast with Alexis Paulson, nurse practitioner and lung screening program coordinator at Dignity Health.

 This is Hello Healthy, a Dignity Health podcast. I'm Amanda Wilde. And Alexis, thank you so much for being here.

Alexis Paulson: Thank you so much for having me.

Host: So first of all, lung cancer screening has evolved a bit, I think, over the years. Why do we screen for lung cancer? What's the benefit there?

Alexis Paulson: So, lung cancer is our number one cancer killer in the United States and in the world, and that's largely because we catch it too late to treat effectively, because the signs of lung cancer are often not visible or noticeable until the disease is more advanced. So, the goal of screening is to catch lung cancers at the earliest, most treatable stage before you would feel any symptoms.

Host: And who is at risk for lung cancer?

Alexis Paulson: So, anyone with lungs is actually at risk for lung cancer. It's not just a disease of tobacco exposure. But we know that people who smoke or have smoked in the past are at much higher risk for developing lung cancer. And also, people with occupational exposures, exposures to radon, strong family history and genetic components can also be attributed to a higher risk of lung cancer.

Host: So since everyone is potentially at risk, who is eligible for lung cancer screening?

Alexis Paulson: Currently, screening is targeted mostly at the people who are at highest risk. And the way we calculate risk currently for this test in particular is just based on age and smoking history. So, it's really just recommended at this point for people who are 50 to 80 years old and who have smoked tobacco in the past 15 years and who smoked on average a pack a day for 20 years, or the equivalent. So, half a pack a day for 40 years, or two packs a day for 10 years also gets you to that tobacco exposure criteria.

Host: And then, if you are eligible for screening, what should you expect? How is the screening performed?

Alexis Paulson: Part of the screening process is a shared decision-making consultation with your medical provider, where they would go over, your criteria, make sure you qualify and all the risks and benefits of the test. And if you agree and want to proceed, then the test itself is extremely simple. It's just a ten-second CT scan where you lie on your back In a donut-shaped machine, you hold your breath for about 10 seconds, and that's it. There's no fasting, no IV or contrast exposure. So, it's really quick and easy.

Host: Are there risks to this test?

Alexis Paulson: So, the biggest risk of this test is the risk of us seeing something abnormal on the scan that we then have to put you through more testing on, that eventually ends up not being a cancer. So, we call those false positives. Usually, people who have a finding on their scan end up just needing additional imaging. Sometimes though they need a tissue biopsy or even more. Unusually, they would need a surgery to prove that a cancer wasn't actually there. So, just all the time, stress and potential complications with any of those procedures are considered a risk of the initial screening.

Host: And how effective or successful have you seen this kind of screening be for early detection?

Alexis Paulson: So in the research, we see that people at higher risk for lung cancer are screened with CT scan every year. There's a 20% reduction in deaths from lung cancer. And that was based on a very large clinical trial that was done and published in 2011 in the New England Journal of Medicine where lung cancer screening CT scan was compared to chest x-ray, and they actually had to end the trial early because the results were so impressive in the CT arm of the study that it didn't feel right to continue screening people with x-ray. So, we were just seeing such a greater impact on early detection and treatment of early lung cancers. And we save many more lives if we're screening with CT scan.

We also have seen in other trials, especially a trial in Europe that showed that the benefit may be even greater for people at high risk, especially for women, because women are more likely to have adenocarcinomas, which are the slow-growing cancers that lung cancer screening is really great at catching and helping us treat early.

Host: So, screening is significant, particularly for those slow-growing cancers that we can get early and they don't get to advance. If you feel you meet the criteria, how does a patient request a lung cancer screening?

Alexis Paulson: So, the best place to start is usually with your primary care provider, either at your annual visit or send them a message and say, "Hey, I heard about lung cancer screening. Am I a good candidate?" And your primary care provider will probably ask you some of the screening questions that we talked about, mostly to do with your smoking history. And if you are a good candidate, then they would either refer you for a CT scan or to a lung screening program like ours on the central coast where we would help navigate you through that process.

Host: It's really great to know there is a dedicated program for this, and that you will guide us along in that process. What does it cost to do a lung cancer screening?

Alexis Paulson: So if you meet the criteria, this screening is covered in full by Medicare, and almost all private insurers as part of the Affordable Care Acts' commitment to preventative screenings. So if you get a mammogram every year or an annual physical and that's covered in full, lung cancer screening should be covered in full for you as well.

Host: And Alexis, is there anything you want to add that we should know about the lung cancer screening program at Dignity Health?

Alexis Paulson: I would say that Dignity Health is putting a lot of effort into increasing screening rates in California. And we have historically across the United States not done the best job of targeting people and making sure that people are aware of the importance of lung cancer screening and getting them screened. And so, we are redoubling our efforts to make sure that people know about the screening and that we are offering them this very important life-saving service.

Host: Well, Alexis, thank you so much for this information and spreading the word and the work you do to save lives.

Alexis Paulson: Absolutely. Thanks for the opportunity.

Host: That was nurse practitioner Alexis Paulson, Lung Screening Program Coordinator at Dignity Health. For information on lung cancer screening, visit dignityhealth.org/lung screen. If you found this podcast helpful, please share it on your social networks and explore our entire library for more health topics of interest. This is Hello Healthy, a Dignity Health podcast.