Scott Webb (Host): Pink and Pearl is a women's breast cancer and lung cancer awareness initiative at Franciscan Health. And board-certified medical oncologist and hematologist practicing at Franciscan Health, Dr. Meghana Raghavendra, is here to tell us more.

This is the Franciscan Health Doc Pod. I'm Scott Webb. Doctor, it's nice to have you here today. We're going to talk women's breast cancer, lung cancer awareness. And it just sounds like an interesting concept. So, maybe you can share with the audience, you know, what Pink and Pearl is and why Franciscan is sharing this awareness campaign.

Dr. Meghana Raghavendra: Absolutely. Happy to. I think, Scott, when we think of October, we, I think, very easily resonate with the color pink, and that's a very powerful symbol, as we all know, for breast cancer awareness.

As October sort of transitions into November, I think another color that emerges, maybe not as loudly, is the color pearl. And that is the color that represents lung cancer awareness. And I think together these two colors form our Pink and Pearl campaign.

This is an initiative that brings breast and lung cancer awareness together with one mission. I think the mission is to say let's encourage early detection and save lives in patients with both breast cancer as well as lung cancer.

Host: Right. Yeah. Like I said, pink and pearl just makes so much sense to me and glad to have you sort of explain that to us. Give us a sense, Doctor, like how common is it for women to get diagnosed with breast cancer or lung cancer?

Dr. Meghana Raghavendra: From a breast cancer perspective, nearly one in eight women will get diagnosed with breast cancer during their lifetime, right? It's not an uncommon situation that you know someone or somebody in your life has been touched by cancer of the breast itself.

Comparatively, it's one in 17 women that will get diagnosed with lung cancer. So less common. However, two important things to note with that is more women make up the diagnosis of new lung cancer diagnosis than men do. And more patients will actually unfortunately pass away from their lung cancer than women with breast cancer will. So even though breast cancer is a more common diagnosis, more patients with lung cancer are actually not going to survive their cancer diagnosis.

Host: Right. And that you said earlier about early diagnosis and how important that is for the sort of pearl part of this. But what are some of the risk factors for each of these cancers?

Dr. Meghana Raghavendra: Absolutely. So from a breast cancer perspective, I think being a woman increases the risk of developing breast cancer, so more women than men will develop breast cancer. Having a family history is very important. So, there are certain mutations that are present in family members that might increase the risk of breast cancer, such as BRCA or BRCA mutations. Increasing age is a risk factor as well. So women, typically around the age of 55 is the average age of breast cancer development. In women who have dense breasts on mammogram, there's an increased risk. And because the dense breasts make it a little harder for the mammograms to pick up any subtle abnormalities.

And in patients who have previously had breast cancer diagnosis or pre-cancerous changes within the breast, that's a risk factor as well. Any prior history of radiation exposure, what I mean by that is for somebody who has been treated for a certain other cancer like Hodgkin lymphoma in their childhood, and they received radiation treatment to their chest, those patients can be at increased risk of developing breast cancer down the road.

And reproductive history, so women who have had early menarche, those who have had late menopause, those who have never been pregnant, you have had uninterrupted estrogen exposure, those can be increased risk factor for breast cancer development as well.

Now, pivoting over to lung cancer. Of course, the most commonly associated risk factor is smoking, and that remains the leading risk factor, and the risk increases with cumulative exposure. So, the longer you smoke for, the higher the risk of cancer development.

Previous smoking. So even in patients who've quit smoking, previous smoking history can still pertain, risk factors as we go on forward. Second-hand smoke exposure, occupational exposure such as to asbestos, diesel exhaust, silica, they can be increasing the risk as well. And previous chest radiation, like we talked about in patients with breast cancer, previous chest radiation can also increase the risk of lung cancer.

One important thing to remember is while smoking is the most common reason for patients to develop lung cancer, nearly 20% of lung cancers that develop actually develop in non-smokers. So, not smoking, while it decreases the risk, does not eliminate the risk of cancer formation in the lungs. So, pay attention to your symptoms when they develop.

Host: Yeah. And you mentioned mammograms there, and I wanted to talk about that. We'll talk about the screenings for both types of cancer. We'll start with breast cancer. At what age should a woman start getting the yearly mammogram, and how long, you know, do those have to continue?

Dr. Meghana Raghavendra: The USPSTF, which is the US Preventive Service Task Force, recommend that we get screening mammograms starting at the age of 40 if you are a standard risk woman. What I mean by that is if you don't have a family history, you do not have a history of a known mutation that increases your risk of breast cancer, then you start at the age of 40.

And we recommend annual mammograms in standard risk women, and we continue until the age of 74 or until the age where we feel like a woman is very independently functional and we can continue to recommend treatment options. But the current recommendation is at least through the age of 74 in women.

In patients who have higher risk, such as those with family history or those with genetic mutations, in addition to the screening mammograms, we would recommend additional testing or earlier age of screening depending on the mutation that is present. And these additional testing usually would include an MRI of the breast, which we alternate with the mammogram. So, it is not instead of, but it is in addition to a screening mammogram, and sometimes we use an ultrasound depending on the clinical situation as well for screening.

Host: Okay. Yeah. And we often hear, Doctor, that self-exams for breast cancer are important. But why is screening mammogram also so important? And maybe just talk about some of the other screenings. I know you mentioned there, but let's just go over those again.

Dr. Meghana Raghavendra: Self-exams are very important. I think it's very, very important for a woman to get familiar with what her normal breast tissue looks like, so then you're more aware of when there is a change within the breast that you can then bring to the attention of your primary care physician.

Having said that, for an exam to detect an abnormality within the breast, it has to be a certain size, and typically that size is about 8 to 10 millimeters or so before it becomes easily felt on an exam. And the mammograms actually are much more sensitive. And a lot of times mammograms will pick up very, very subtle abnormalities or subtle changes within the breast tissue, and it can give us a lead-in period of up to two years.

What I mean by that is a mammogram can become abnormal and lead to detection of cancers even up to two years prior to what a physical exam would feel that exact tumor. So, it is essentially shifting the diagnosis to an earlier stage. And what we know is the earlier the stage of diagnosis, the higher the chance of cure. So, that's the importance of doing screening studies, right? To kind of catch the cancer early so we can cure more patients.

Host: Yeah. Screening, diagnosis, earlier the better, of course. So, let's move on to the pearl component, if you will, lung cancer. We often hear about lung screening to check for cancer. But at what age, again, do we begin? And what are the, let's say, qualifications to get a lung scan?

Dr. Meghana Raghavendra: So, for our patients who are interested in lung cancer screening, we screen with a test called a low-dose CT or LDCT. And usually, the recommended age to begin the screening is age 50 through the age of 80, and we recommend doing this annually. And the requirements or the eligibility is somebody who's a smoker, who smoked for at what we call a 20-pack-year smoking history.

What that means is if you've smoked one pack per day, and you've smoked for 20 years, if you're a two pack per day smoker, if you smoked for 10 years, then those are the patients who would qualify for the screening. And currently, patients who are smoking or who have quit in the last 15 years would qualify.

Having said that, the screening for lung cancer that we offer at Franciscan does not have a time cap on it. Meaning even if you quit more than 15 years ago, but you have the other risk factors, we truly would encourage you to have that screening scan done anyway. And that is a national movement right now to try to lift that cap as well.

Host: Right. Yeah, you mentioned smoking there. So, be it a current smoker or someone who has a smoking history, I think, Doctor, one of the things that might sort of scare people away from doing lung scans is they just don't want to know, right? Like, they know they need to know, but they don't want to know. So, what would you tell them, you know, really to, encourage them to get that yearly lung scan?

Dr. Meghana Raghavendra: Absolutely. So, I kind of break it down. I'll tell you what are the typical concerns that I hear. I think the first one is, you know, "I feel fine. Why do I need to do a scan if I feel fine?" And the message I usually like to tell is, you know, screening is truly designed for people without symptoms, right? We want to find the cancer before the cancer's grown enough to cause symptoms, right? So, that's why you need to have a scan.

And for patients who have quit smoking many years ago, again, we ask, you know, "I've quit smoking a long time ago. Why do I have to get the scan anyway?" Yes, your risk of cancer drops significantly after you quit smoking. However, when you have had a prior history of smoking, there is still an increased risk of lung cancer development. So, we really want to continue to include those individuals in screening. And the big one is, you know, "I'm scared, and I don't really want to know if they find something abnormal on a scan."

And, again, what I emphasize is, you know, screening gives us information, and it helps us diagnose a cancer if it is present at a much earlier stage. So while it is scary, we have such incredible options for treatment that might portend a great prognosis and maybe potentially increase the rate of cure that we do want to try get these screenings done early.

And the other thing, the big thing, I think is, as opposed to breast cancer or any other cancer screening that we do, lung cancer is significantly associated with smoking. And, a lot of patients feel stigma or the fear of being judged or being ashamed of the cancer diagnosis. And I want to encourage my patients that this is about healthcare.This is not about placing blame. This is about ensuring that everyone deserves compassionate care. We truly are here to help our patients live longer. And a low-dose CT is truly painless. It takes only a few minutes. And it should be a very easy screening that we should include in our daily discussion with our patients. And hopefully, this can help mitigate the stigma as well

Host: Right. Yeah, it's a no judging zone, and it's been great to talk to you today about this Pink and Pearl sort of initiative and increasing awareness of breast and lung cancer and screening and diagnosis and all these important things. Doctor, if you could leave every woman with three examples of things that she could do, you know, let's say starting today, right, to prevent breast and/or lung cancer, catch it earlier, what would they be?

Dr. Meghana Raghavendra: Absolutely. I think the most important thing we can do for both cancers, I'd say, is, you know, maintaining a healthy weight, particularly after menopause in relation to breast cancer. But exercising regularly is very, very important. Alcohol, definitely limit alcohol. There are multiple studies now which have indicated there's no safe limit of alcohol. But if you do consume it, definitely try limit it to a minimal amount.

In women with a history of smoking, I would encourage you to avoid smoking. Quit if you're currently smoking. There are multiple tools that are available that your primary care physician would be able to discuss with you to provide you tools to help quit smoking.

Test homes for radon. I think this is pretty routine, but definitely make sure you are testing your home for radon. And review your smoking history. Know your family history. These are so important, especially for breast cancer patients. Definitely gather your family history.

And more importantly, be an advocate. If you feel something is abnormal, please discuss that with your physician. So, we can address that appropriately and get you screening.

Host: Yeah, you mentioned radon there. It's just something most of us don't think about anymore. It seems like something from the '70s, but folks may still have that in their homes, so testing their homes. Just great advice from an expert today. Appreciate it so much. Thank you.

Dr. Meghana Raghavendra: Happy to do it. Thank you so much for having me.

Host: And to learn more, visit franciscanhealth.org/pinkandpearl. And if you found this podcast helpful, please share it on your social channels. And be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.