Amanda Wilde (Host): Meet thoracic surgical oncologist, Dr. Riny Karras. She'll share her insights into this special field of medicine as we discuss how she provides care to patients who are dealing with lung cancer.

This is Your Best Life Podcast from Holy Cross Health. I'm Amanda Wilde. Dr. Karras, welcome. It's great to have you here.

Dr. Riny Karras: Thank you. Thank you for having me.

Host: I'm curious what led you to pursue a career in Medicine, but specifically in a field with relatively few women surgeons, Thoracic Surgery. Can you share a bit about your journey?

Dr. Riny Karras: So actually, it's very interesting. My journey actually started off as an Anesthesiology resident. So, I started off as an anesthesia resident and was very, very interested in the cardiopulmonary system. So after a year of anesthesia, I switched to surgery, and completed my General Surgery residency, and then went on to my fellowship in Cardiothoracic Surgery.

Host: So once you discovered this field, it sounds like you did not look back.

Dr. Riny Karras: I really didn't. I mean, especially since the training is around eight years, there's only movement forward at that point. Once through CT fellowship or Cardiothoracic Surgery fellowship, I fractioned off into Thoracic Surgery as we do. Usually, we choose one or the other. And at the time that I was going through fellowship, of course, there are more women in Thoracic Surgery now, but at that time, all of the women in Thoracic Surgery, you could fit into probably a small townhouse. All the women in North America in thoracic surgery, you could probably fit into a small area. Now, it's certainly more than that.

Host: I think I read a statistic that said 3-4% of thoracic surgeons were women.

Dr. Riny Karras: Yes. At that time, it was less than 1%, but that's absolutely correct.

Host: So, what ignited your passions within this thoracic surgical discipline?

Dr. Riny Karras: Well, I think just looking at the progress that has been made, but still needs to be made in thoracic surgery is very intriguing. It's almost as if you're getting into a field where you can make a difference from the ground up. So, the mortality for lung cancer in the '70s was quite high and that's all-comers, early stage and late stage. And then, when you look at the mortality around year 2000, it hadn't changed at all, which is very odd because you saw such great advancements in breast cancer and colorectal cancer with bringing on mammography and colonoscopy as screening. So, this field was older, but still in its infancy and that was something that was very intriguing.

Host: So, there was no early detection system, because that's what happened in those fields to bring the cancer or at least the death rate from cancer down and the cure rate up.

Dr. Riny Karras: So initially, there was a National Lung Screening Trial, which basically had to end early, only because it wasn't ethically sound to continue, and they used CT scan as a mode of screening. So, that trial brought upon the CT scan era, which was we're going to use CT scans the same way we screen for mammography, the same way we screen for colorectal cancer with colonoscopy. And it brought upon such a change in early stage detection. And they had started to-- they meaning multiple meetings and societies-- initiated a pivot point where if you were over the age of 55 with a past smoking history, et cetera, et cetera, you would get these yearly low-dose CT scans that could make a huge impact in detection.

Host: And so, nowadays are there various types of screenings available for lung cancer?

Dr. Riny Karras: Yes. But the mainstay is actually the low-dose CT scan, which has been in effect for now over 15 years. The change or the pivot point is those patients that get early screening are over the age of 55 and smoking is something that is a pretense. Okay, well we can do early screening because you're a previous smoker, you're over the age of 55, you fall into this category. But now, we're seeing 20-30% of lung cancers occur in non-smokers and in a younger patient population. So, there's this era for a pivot point. And everyone is working to see what our next steps are.

Host: So, there's really been a change in your patient base. What is it that brings a patient to find their way to a thoracic surgeon?

Dr. Riny Karras: At this point, usually, it is a patient that has a previous history like we discussed. Other times, it's just a simple "I'm going in because I've had this cough" or "My asthma has gotten out of hand," or "I can't shake the flu." And we see a CT scan being done by a primary care physician or the emergency department or another subspecialist, and all of a sudden you've noticed something on the CT scan, and that brings the patient to us. We can get patient referrals by self-referral. A lot of patients will call the office and say, "I fall into this age category, and I have a previous smoking history," or "I have had a lot of secondhand smoke exposure," or "I have been exposed to environmental hazards or issues, and I'd really like a screening." So, we get all walks, all-comers.

Host: You mentioned earlier that you were attracted to this field because it allowed you to make a difference from the ground up. Can you talk a little more about once someone has been screened and gone through the process of being diagnosed? How do you provide care to your patients who are dealing with lung cancer?

Dr. Riny Karras: Also, there's a lot of layers to that onion. When we have a patient that gets diagnosed or we see something specific on CT scan, so ultimately first step diagnosis, second step treatment. So if let's say a nodule is seen on CT scan and we're not sure what it is, we have multiple non-invasive treatment modalities, right? And in a way to biopsy the nodule that we see, whether it is navigational bronchoscopy, whether it is CT-guided biopsy, all of these are essentially non-invasive techniques. Once a diagnosis has been made of a lung cancer, we're able to then move to the next step, which is it all comes down to many doctors lending their opinion, a multidisciplinary approach. So, we have oncologists that can get on board at that point. Now, we have a diagnosis. We have radiation oncologists that can get on board. And then, the discussion becomes a larger discussion. How would this patient ultimately benefit from their treatment? Is it a combination of radiation therapy, chemotherapy, immunotherapy, and surgery? Is it one of these and not the others? So on and so forth. So, everything is tailored specific to each individual patient and each individual diagnosis.

Host: And have you seen higher success rates because of that?

Dr. Riny Karras: Well, vigilance itself brings a higher success rate. So for example, if we don't have a diagnosis based on a nodule and we decide to continue to screen and continue to watch via serial imaging, if there is a change in that nodule or a change in the screening, we're able to act quickly and appropriately as opposed to a passive approach where we will encounter a patient that has not undergone screening but fits the criteria.

Host: A proactive approach is especially comforting, I think, for people dealing with this illness. Dr. Karras, thank you so much for your insights and for tuning us into lung cancer screening and treatment.

Dr. Riny Karras: Thank you.

Host: For more information, please visit holycrosshealth.org. If you found this podcast helpful, please share it on your social channels and check out the entire podcast library for topics of interest to you. This is Your Best Life Podcast presented by Holy Cross Health.