Amanda Wilde (Host): Welcome to Living Well with Eisenhower Health. Healthcare as it should be. On this episode, we'll discuss lung cancer screening, exploring its importance, and who can benefit most. I'm Amanda Wilde, and my guests, are Interventional Pulmonologist, Dr. Justin Thomas and Tiffany Haas, Nurse Practitioner who manages the Eisenhower lung cancer screening program.

Welcome to you both. Thank you for being here and sharing your expertise.

Tiffany Haas, NP: Thank you.

Host: So Tiffany, as the manager of the screening program, what is lung cancer screening? What's involved?

Tiffany Haas, NP: Lung cancer screening is a preventative test used to detect lung cancer. It usually includes a process that begins with determining the patient's risk factors for developing lung cancer and a provider ordering a low dose CT scan to detect the possible lung cancer.

Host: So CT low dose scan is the modality that you use. And is it usually smokers or former smokers who end up with lung cancer Dr. Thomas?

Justin Thomas, MD: Yeah, the majority of lung cancer is in patients who previously smoked. So 80 to 90% of lung cancer is caused by smoking. But there is that 10 to 20%, where patients get lung cancer and have never smoked.

Host: How prevalent is lung cancer? What are the symptoms?

Justin Thomas, MD: Lung cancer is actually the most common cause of cancer death in the country. So it's, in both sexes actually. It causes about two and a half million, or at least two and a half million new cases are diagnosed in the world, on an annual basis. And this year alone, about two hundred and thirty, 234,000 people are expected to be diagnosed with lung cancer.

So it is quite common. It is, again, more common in patients who have been smokers. But there are other risk factors including genetic factors, which we're still trying to discover, but also even potentially pollution, you know, and PM10 is a, a significant contributor as well.

Host: And what are the symptoms of lung cancer doctor?

Justin Thomas, MD: The interesting thing is that lung cancer typically does not cause symptoms, and that's why lung cancer screening is so important. Unfortunately, lung cancer is caught in the late stages most of the time, so about 75 to 80% of the time, lung cancer is caught in late stages. So in essentially a non-curable stage. So it's important to do screening for patients who are high risk, and Tiffany can certainly discuss who those high risk patients are. But because lung cancer is caught so much in the late stage; catching it early can help from a standpoint of cure. And cure often can be accomplished through surgery, or even potentially radiation therapy in patients who are high risk for surgery.

Host: So early detection is key. And it sounds like the reason lung cancer is the leading cause of cancer death is that it's often detected too late, as you just mentioned. So Tiffany, who should get screened?

Tiffany Haas, NP: People who should get screened are adults ages 50 to 80 years of age, and who have a 20 pack year or more history, which means smoking one pack a day for 20 years also who are currently smoking or quit in the past 15 years.

Host: And what are the benefits of the lung cancer screening?

Tiffany Haas, NP: First benefit is early detection because of our CT scanning capabilities and the early detection with treatment can save lives.

Host: Tiffany, does this test also show things like lung nodules?

Tiffany Haas, NP: Yes.

Host: I mean, that's one that could be cancer or not, doctor.

Justin Thomas, MD: That's right. Yeah. Lung cancer typically starts out as a small nodule, which essentially is like a spot on the lung. Now those can be seen on chest x-ray, but CT scans are much more sensitive in picking that up. And, they actually have looked at this in a very large trial called the National Lung Screening Trial for NLST back in the early two thousands.

And they compared chest x-ray with CT scan and they found that CT scan, over and above, diagnosed lung cancer much earlier than having a routine chest x-ray. It caused the state shift, meaning it allowed people to be saved by this screening test and catch it earlier.

Host: Dr. Thomas on the other side of that is low dose CT screening dangerous in any way or has any side effects?

Justin Thomas, MD: So low dose CT is not a dangerous per se in and of itself. The amount of radiation that you get from a low dose CT scan is quite negligible and equivalent to about like 10 chest x-rays or so, or flying on a plane for a couple hours, the amount of cosmic radiation you would get from that.

So the scan itself is not dangerous. You know, one of the things that we do have discussions with patients on is, is that the scans can sometimes pick something up that, we may have to act on. And, perhaps that's something that was discovered, may not have impacted that person's life in the first place.

And so we do have those discussions with a patient. It's what we call a shared decision making process. And it's actually required by center for Medicaid Services and Medicare services, that we have that discussion and that we document that discussion before ordering a CAT scan.

Host: Doctor, if someone is screened and they find a nodule, what happens next?

Justin Thomas, MD: The first is kind of risk assessment. So, when we find a nodule, let's say just incidentally, which happens quite frequently and actually more frequently than lung cancer screening, let's say a patient comes into the ER and they're having chest pain and they're found to have a incidental pulmonary nodule.

The risk of that nodule being cancer has to do with the size of the nodule. What the nodule looks like, where it's located in the lung, upper lobe location is often associated with higher risk. And what that patient's history of smoking and other risk factors are. Do they have a family member who's got a history of lung cancer and what's the age of the patient?

So all these things go into account and there's actually calculators out there to kind of help assess the risk of a lung cancer, in a particular nodule or a particular person. So, once we've assessed that risk, then it helps us determine what the next step would be, which would either be, you know, maybe just a follow up scan, if that risk is low, or if it's an intermediate or higher risk that may lead to a biopsy or even surgery, perhaps to cut the nodule out.

So, it really depends on patient's risk, what the nodule looks like. And it also depends whether it's incidental versus whether it's picked up on lung cancer screening. And there's different algorithms that we use, and pathways that we go down, depending on how that nodule was discovered.

Host: Tiffany managing the screening program, how do you assure patients have a smooth process if follow up is needed?

Tiffany Haas, NP: If follow-up was needed, we oftentimes order a CT scan. We can also order a PET scan depending on the size of the nodule. We also utilize biomarker testing. Sometimes we will refer to Dr. Thomas, our pulmonary specialist, who will perform a biopsy.

Host: So a basic question here, Tiffany. Is the screening covered by insurance and is physician referral required?

Tiffany Haas, NP: Generally screening is covered by insurance. Insurance will cover individuals as long as they meet Medicare guidelines and the United States Preventative Task Force guidelines. Some individuals may have unusual situations where they must pay their deductible or pay out of pocket. So oftentimes lung cancer screening, and low dose CT scans are covered by insurance at no cost to the patient.

Host: How do people get in to see you? Physician referral?

Tiffany Haas, NP: Physician referral or self-referral.

Host: Okay. Great news, for people who are at risk. Thank you so much, Dr. Thomas and Tiffany Haas. Thank you for the information and the insights you've shared today.

Justin Thomas, MD: Absolutey. Thank you for having us. I will also mention, as part of the Tiffany downplays this, but she plays a huge role here that you know, part of the, the situation is of course the smoking. And Tiffany is trained in smoking cessation counseling and helps patients quit smoking.

And we've had a, actually, she's had a very excellent success rate to help patients quit smoking. So that is part of the package when patients get referred to her.

Host: And that's the way to bring down the lung cancer rate. Great work.

Tiffany Haas, NP: Absolutely.

Host: For more information, visit eisenhowerhealth.org/lung. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for additional topics of interest.

This is Living Well with Eisenhower Health. Thanks for listening.