Cigarette smoking is the number one risk factor for lung cancer. In fact, cigarette smoke causes 80-90% of all lung cancer deaths in the United States. If you are a smoker it’s incredibly important for you to know the risk factors for lung cancer as well as the importance of regular screenings.
However, only 16 percent of lung cancers are caught at an early stage. Early detection of lung cancer provides patients with more treatment options and a greater chance of survival. Dr. Adrian DiVittorio, pulmonologist with Diagnostic & Medical Clinic, joins us to talk about risk factors, screening methods and how Infirmary Health is investing in the latest technology to detect lung cancer as early as possible.
Selected Podcast
I’m a Smoker. Am I at Risk for Lung Cancer?
Featuring:
Adrian DiVittorio, MD
Adrian DiVittorio, M.D., is a board-certified and fellowship trained pulmonologist and critical care physician with Diagnostic & Medical Clinic. Dr. DiVittorio has clinical interests in sleep medicine, interventional pulmonology, pulmonary hypertension and critical care medicine. He is certified in the use of the Ion Endoluminal System. This advanced technology aids physicians in early detection of lung cancer. Transcription:
Deborah Howell (Host): Well, we've all heard that smoking can cause lung cancer, but just how great of a risk factor is it? I'm Deborah Howell. And to learn more about smoking and the risk of lung cancer, we'll talk to Dr. Adrian DiVittorio, a board certified and fellowship trained pulmonologist and critical care physician with Diagnostic and Medical Clinic. Dr. DiVittorio, welcome to you.
Dr Adrian DiVittrio: Well, thank you very much for having me.
Deborah Howell (Host): Our pleasure. Now, let's dive right into it. Just what is lung cancer and who is at risk for this disease?
Dr Adrian DiVittrio: So lung cancer is unfortunately one of the most common and sometimes under-recognized cancer that develops in the lung. And cancer is basically a cell that has lost the ability. To appropriately die, all of our cells grow and die repeatedly throughout our life cycle. However, any kind of cancer, particular lung cancer means a cell has lost that ability to stop. So it continues to grow and grow and grow until it can cause harm, damage, and ultimately death. And the main people that are at risk are smokers.
Deborah Howell (Host): And I would assume people who are exposed to smoke?
Dr Adrian DiVittrio: Exactly. So whether it's firsthand smoke or secondhand smoke, the risks exist. Obviously if you're a firsthand smoker, we're gonna see a greater incidence of anywhere 10 to 30 fold more than a non-smoker in the development of cancer. Secondhand smoke also increases that risk factor for cancer, but also an occasional cigarette. So you are either a smoker or you're not a smoker. Now whether you're a one to two pack a day kind of person, or what I hear very often a social smoker, smoking is smoking, and just by the ingestion of all those carcinogens, poisons, and toxins, you will increase your risk of lung cancer as well as other head and neck cancers associated with.
Deborah Howell (Host): What are the current screening guidelines?
Dr Adrian DiVittrio: With respect to lung cancer, it's been compared to other cancers such as breasts and colon cancer who have had well established screening guidelines. Lung cancer took a little bit longer to figure out. Who and when to appropriately start screening so that we weren't unnecessarily doing x-rays or CAT scans. So to answer your question, what we have found out over the last couple years, the recommendations are that anybody past the age of about 50 to 55 that has a quote, significant smoking history, anywhere from half to one pack per day, times a couple years needs to get what's called a low dose CAT scan or simply put a CAT scan, CT scan of the lungs.
That is the best way to see a very early lung cancer, which starts off as a lung nodule, a little spot in the lungs, and these aren't readily visible on a chest x-ray. So unfortunately a simple chest x-ray will not suffice unless it is too far gone usually.
Deborah Howell (Host): And, what is a pack year?
Dr Adrian DiVittrio: A pack year is when we add how many packs per day you've been smoking for what particular duration. So we will categorize somebody as a 20 pack year history of smoking. So if they started smoking when they were 14, they stopped at 30, then they're resumed at 40. We try to do our best to ascertain how much they were smoking in that time. Add up the years and come up with Pac years, history of smoking, which will help us one, have an increased, heightened, surveillance for lung cancer, but also other lung associated diseases such as COPD, emphysema, bronchitis.
Deborah Howell (Host): Okay. And let's get into it. How is someone screened for lung cancer?
Dr Adrian DiVittrio: In order to get screened for lung cancer. Again, once past the age of 50, your physician has to simply order a low-dose CAT scan. There is no IV material given for it, so there's no risks of allergic reactions. A low-dose CAT scan has very low-dose radiation exposure. It is covered by insurance, and a CAT scan even for our most claustrophobic patients is a big, big open tube that. Sometimes under three minutes to get done. It's a very, very quick scan.
Deborah Howell (Host): Yeah, I just had one. It was absolutely pain free and so easy, in and out. Now if something is detected on a low dose CT, what are the next steps?
Dr Adrian DiVittrio: So once we detect a lung nodule, on a CAT scan, that's when the patient needs to see a pulmonologist, a lung doctor, and in particular a lung doctor who is experienced with the management and follow up of a lung nodule. An early diagnosis, meaning the sooner we get a piece of tissue, as soon as we get a biopsy, the earlier the better. So one, ascertain whether this is a cancer or not, so that we're not unnecessarily repeating CAT scans every six months, just quote watching it, which is one of the most, common adopted methods of following pulmonary nodules.
However, over the last couple years, there's been great advances in our ability to diagnose very early small lung, no. Through a scope procedure where you're asleep, there's no cutting, there's no recovery, and we're able to go after nodules, even as small as four to five millimeters, which is less than half an inch.
Deborah Howell (Host): Wow. And is that called an endoscopy?
Dr Adrian DiVittrio: So that's called a robotic bronchoscopy. And there's a particular technology called the ion endoluminal robotic bronch. , which I'm thankful we have here at Mobile Infirmary. And it is just completely revolutionized, our ability to go after these early lung nodules rather than saying, Hey, you've got a little spot. We think it's cancer, but it's so small. All we can do is watch it grow. Let's get another CAT scan in six months. And if it's grown uh, oh, we better try to think how we can cut this out.
With the realization that lung surgery is a major production, they cut you open between the ribs and, there's a good recovery time pain involved. And we certainly don't want to be removing people's lungs or lung parts until we have an appropriate diagnosis if something is cancerous or benign. And so that's where this ion and Luminal robotic system allows us to be at the top of technology, state-of-the-art and diagnosing these.
Deborah Howell (Host): And how is it helping pave the way for early lung cancer detection?
Dr Adrian DiVittrio: So in my years of practice, there's been a dramatic, change in what we're doing. Meaning whenever we stage a lung cancer, if it's very early, we call it a stage one. If it's very advanced, we call it a stage four. Over the last couple of years of me doing robotic and what are called navigational broncho, I've been able to diagnose more and more people as a stage one cancer, which means it's surgically curable rather than diagnosing somebody very late stage where we can't cure them, we can treat them with chemotherapy and or radiation, but we know that the chance of a cure is very, very small because you're more advanced or beyond a stage one or stage two lung cancer.
Deborah Howell (Host): I just wanted to go back a little bit to the ion endoluminal system. Does it actually go in there and zap these little nodules or, extract them? How does it work?
Dr Adrian DiVittrio: So right now the ion endoluminal is a diagnostic tool, meaning it allows us to get. Lesions and spots that we could have never even gotten to. But to elude to your question, there is a lot of research and development as to how we can also use this tool to basically zap a little nodule. And there are some trials going on at certain major academic centers, and there are some devices that we have used in the past to zap other lesions that we're looking at incorporating at some point in time. Hopefully near future to be able to provide both diagnosis and cure if we're catching something very early on, at a small stage.
Deborah Howell (Host): Boy, I'm gonna cross my fingers. What a great technology that would be. How does Infirmary Health support patients with lung cancer from diagnosis to recovery?
Dr Adrian DiVittrio: So we're very lucky and thankful and privileged here at the infirmary to have a multi-specialty team of physicians, surgeons, and what are called lung nodule and or lung cancer navigators, meaning it's a collection of nurses, nurse practitioners, other staff members, not just the physicians. That are in the process of saying, hey, we see there's a CAT scan. This person has a lung nodule, Dr. DiVittorio, you need to see this patient. Absolutely, I'll see them right away and the minute I get a diagnosis, I'm calling my colleague, the lung surgeon, going, Hey, I just did a lung biopsy.
My pathology doctor gave me the result the same day, which we get same day results with this system. You need to cut this particular section of lung out, so there is no passing go here, go there, go there, go there. It is all under one center. We all share the same information, the same computer system, and a lot of us involved in what's called the thoracic lung cancer program here at our hospital, we're in constant communication. So it's very easy to expedite the diagnosis and potential cure of a patient.
Deborah Howell (Host): Because the patient is already overwhelmed with hearing. And then having to go to three different places for three different, you know, it just gets so complicated for the patient.
Dr Adrian DiVittrio: Exactly. And then the more variability or different appointments that a patient gets, the greater chance of introducing either error or a difference of opinion. Oh, I think you should go there. I think you should go there. And before you know it, this has been delayed six weeks, whereas it could have been a three day process had you just gone here, get this done, and then have this final result.
Deborah Howell (Host): Yeah. And then all on one bill, you know, so you're not dealing with three different systems. Yeah. it's a wonderful, wonderful thing. Is there anything else you'd like to add to our conversation today?
Dr Adrian DiVittrio: You know what I will add is that I've seen that over the last one to three years, there's been. tremendous advancement in our ability to diagnose early lung cancers. I would venture to say that if you still talk to most pulmonologists and most radiology doctors that routinely read CAT scans, the recommendation on any CAT scan that shows a small lung nodule, I guarantee you, nine out of 10 radiology reports will say consider repeating a CAT scan in six months to ensure that this lung spot, that this lung nodule is not growing.
However, with the advancement of technology that we have, there needs to be a shift in that thought process where the radiology doctors will say there's a lung spot. Go get a biopsy with this highly advanced system. So the watch and wait is coming to a finale with respect to a lot of lung nodules because of our ability to get in there so early at these small, tiny nodules that are otherwise undiagnosed any other way. So that's a very positive, favorable thing in the fight against lung cancer. Obviously the ultimate cure would be the avoidance of lung cancer producing agents, cigarette smoke being at the top of the list.
Deborah Howell (Host): Absolutely. Well, thank you so much Dr. DiVittorio, for this valuable information for being with us today. I learned a lot, and I know our audience did as well.
Dr Adrian DiVittrio: Absolutely. My pleasure.
Deborah Howell (Host): Dr. Adrian DiVittorio is a board certified and fellowship trained pulmonologist and critical care physician with Diagnostic and Medical Clinic. I'm Deborah Howell as the first choice for healthcare for the Gulf Coast region. Infirmary Health is here for you here for life. Visit us at infirmaryhealth.org to learn more about our comprehensive lung health services or to find a physician near you. Thank you for joining us today for this broadcast from Infirmary Health. Be well.
Deborah Howell (Host): Well, we've all heard that smoking can cause lung cancer, but just how great of a risk factor is it? I'm Deborah Howell. And to learn more about smoking and the risk of lung cancer, we'll talk to Dr. Adrian DiVittorio, a board certified and fellowship trained pulmonologist and critical care physician with Diagnostic and Medical Clinic. Dr. DiVittorio, welcome to you.
Dr Adrian DiVittrio: Well, thank you very much for having me.
Deborah Howell (Host): Our pleasure. Now, let's dive right into it. Just what is lung cancer and who is at risk for this disease?
Dr Adrian DiVittrio: So lung cancer is unfortunately one of the most common and sometimes under-recognized cancer that develops in the lung. And cancer is basically a cell that has lost the ability. To appropriately die, all of our cells grow and die repeatedly throughout our life cycle. However, any kind of cancer, particular lung cancer means a cell has lost that ability to stop. So it continues to grow and grow and grow until it can cause harm, damage, and ultimately death. And the main people that are at risk are smokers.
Deborah Howell (Host): And I would assume people who are exposed to smoke?
Dr Adrian DiVittrio: Exactly. So whether it's firsthand smoke or secondhand smoke, the risks exist. Obviously if you're a firsthand smoker, we're gonna see a greater incidence of anywhere 10 to 30 fold more than a non-smoker in the development of cancer. Secondhand smoke also increases that risk factor for cancer, but also an occasional cigarette. So you are either a smoker or you're not a smoker. Now whether you're a one to two pack a day kind of person, or what I hear very often a social smoker, smoking is smoking, and just by the ingestion of all those carcinogens, poisons, and toxins, you will increase your risk of lung cancer as well as other head and neck cancers associated with.
Deborah Howell (Host): What are the current screening guidelines?
Dr Adrian DiVittrio: With respect to lung cancer, it's been compared to other cancers such as breasts and colon cancer who have had well established screening guidelines. Lung cancer took a little bit longer to figure out. Who and when to appropriately start screening so that we weren't unnecessarily doing x-rays or CAT scans. So to answer your question, what we have found out over the last couple years, the recommendations are that anybody past the age of about 50 to 55 that has a quote, significant smoking history, anywhere from half to one pack per day, times a couple years needs to get what's called a low dose CAT scan or simply put a CAT scan, CT scan of the lungs.
That is the best way to see a very early lung cancer, which starts off as a lung nodule, a little spot in the lungs, and these aren't readily visible on a chest x-ray. So unfortunately a simple chest x-ray will not suffice unless it is too far gone usually.
Deborah Howell (Host): And, what is a pack year?
Dr Adrian DiVittrio: A pack year is when we add how many packs per day you've been smoking for what particular duration. So we will categorize somebody as a 20 pack year history of smoking. So if they started smoking when they were 14, they stopped at 30, then they're resumed at 40. We try to do our best to ascertain how much they were smoking in that time. Add up the years and come up with Pac years, history of smoking, which will help us one, have an increased, heightened, surveillance for lung cancer, but also other lung associated diseases such as COPD, emphysema, bronchitis.
Deborah Howell (Host): Okay. And let's get into it. How is someone screened for lung cancer?
Dr Adrian DiVittrio: In order to get screened for lung cancer. Again, once past the age of 50, your physician has to simply order a low-dose CAT scan. There is no IV material given for it, so there's no risks of allergic reactions. A low-dose CAT scan has very low-dose radiation exposure. It is covered by insurance, and a CAT scan even for our most claustrophobic patients is a big, big open tube that. Sometimes under three minutes to get done. It's a very, very quick scan.
Deborah Howell (Host): Yeah, I just had one. It was absolutely pain free and so easy, in and out. Now if something is detected on a low dose CT, what are the next steps?
Dr Adrian DiVittrio: So once we detect a lung nodule, on a CAT scan, that's when the patient needs to see a pulmonologist, a lung doctor, and in particular a lung doctor who is experienced with the management and follow up of a lung nodule. An early diagnosis, meaning the sooner we get a piece of tissue, as soon as we get a biopsy, the earlier the better. So one, ascertain whether this is a cancer or not, so that we're not unnecessarily repeating CAT scans every six months, just quote watching it, which is one of the most, common adopted methods of following pulmonary nodules.
However, over the last couple years, there's been great advances in our ability to diagnose very early small lung, no. Through a scope procedure where you're asleep, there's no cutting, there's no recovery, and we're able to go after nodules, even as small as four to five millimeters, which is less than half an inch.
Deborah Howell (Host): Wow. And is that called an endoscopy?
Dr Adrian DiVittrio: So that's called a robotic bronchoscopy. And there's a particular technology called the ion endoluminal robotic bronch. , which I'm thankful we have here at Mobile Infirmary. And it is just completely revolutionized, our ability to go after these early lung nodules rather than saying, Hey, you've got a little spot. We think it's cancer, but it's so small. All we can do is watch it grow. Let's get another CAT scan in six months. And if it's grown uh, oh, we better try to think how we can cut this out.
With the realization that lung surgery is a major production, they cut you open between the ribs and, there's a good recovery time pain involved. And we certainly don't want to be removing people's lungs or lung parts until we have an appropriate diagnosis if something is cancerous or benign. And so that's where this ion and Luminal robotic system allows us to be at the top of technology, state-of-the-art and diagnosing these.
Deborah Howell (Host): And how is it helping pave the way for early lung cancer detection?
Dr Adrian DiVittrio: So in my years of practice, there's been a dramatic, change in what we're doing. Meaning whenever we stage a lung cancer, if it's very early, we call it a stage one. If it's very advanced, we call it a stage four. Over the last couple of years of me doing robotic and what are called navigational broncho, I've been able to diagnose more and more people as a stage one cancer, which means it's surgically curable rather than diagnosing somebody very late stage where we can't cure them, we can treat them with chemotherapy and or radiation, but we know that the chance of a cure is very, very small because you're more advanced or beyond a stage one or stage two lung cancer.
Deborah Howell (Host): I just wanted to go back a little bit to the ion endoluminal system. Does it actually go in there and zap these little nodules or, extract them? How does it work?
Dr Adrian DiVittrio: So right now the ion endoluminal is a diagnostic tool, meaning it allows us to get. Lesions and spots that we could have never even gotten to. But to elude to your question, there is a lot of research and development as to how we can also use this tool to basically zap a little nodule. And there are some trials going on at certain major academic centers, and there are some devices that we have used in the past to zap other lesions that we're looking at incorporating at some point in time. Hopefully near future to be able to provide both diagnosis and cure if we're catching something very early on, at a small stage.
Deborah Howell (Host): Boy, I'm gonna cross my fingers. What a great technology that would be. How does Infirmary Health support patients with lung cancer from diagnosis to recovery?
Dr Adrian DiVittrio: So we're very lucky and thankful and privileged here at the infirmary to have a multi-specialty team of physicians, surgeons, and what are called lung nodule and or lung cancer navigators, meaning it's a collection of nurses, nurse practitioners, other staff members, not just the physicians. That are in the process of saying, hey, we see there's a CAT scan. This person has a lung nodule, Dr. DiVittorio, you need to see this patient. Absolutely, I'll see them right away and the minute I get a diagnosis, I'm calling my colleague, the lung surgeon, going, Hey, I just did a lung biopsy.
My pathology doctor gave me the result the same day, which we get same day results with this system. You need to cut this particular section of lung out, so there is no passing go here, go there, go there, go there. It is all under one center. We all share the same information, the same computer system, and a lot of us involved in what's called the thoracic lung cancer program here at our hospital, we're in constant communication. So it's very easy to expedite the diagnosis and potential cure of a patient.
Deborah Howell (Host): Because the patient is already overwhelmed with hearing. And then having to go to three different places for three different, you know, it just gets so complicated for the patient.
Dr Adrian DiVittrio: Exactly. And then the more variability or different appointments that a patient gets, the greater chance of introducing either error or a difference of opinion. Oh, I think you should go there. I think you should go there. And before you know it, this has been delayed six weeks, whereas it could have been a three day process had you just gone here, get this done, and then have this final result.
Deborah Howell (Host): Yeah. And then all on one bill, you know, so you're not dealing with three different systems. Yeah. it's a wonderful, wonderful thing. Is there anything else you'd like to add to our conversation today?
Dr Adrian DiVittrio: You know what I will add is that I've seen that over the last one to three years, there's been. tremendous advancement in our ability to diagnose early lung cancers. I would venture to say that if you still talk to most pulmonologists and most radiology doctors that routinely read CAT scans, the recommendation on any CAT scan that shows a small lung nodule, I guarantee you, nine out of 10 radiology reports will say consider repeating a CAT scan in six months to ensure that this lung spot, that this lung nodule is not growing.
However, with the advancement of technology that we have, there needs to be a shift in that thought process where the radiology doctors will say there's a lung spot. Go get a biopsy with this highly advanced system. So the watch and wait is coming to a finale with respect to a lot of lung nodules because of our ability to get in there so early at these small, tiny nodules that are otherwise undiagnosed any other way. So that's a very positive, favorable thing in the fight against lung cancer. Obviously the ultimate cure would be the avoidance of lung cancer producing agents, cigarette smoke being at the top of the list.
Deborah Howell (Host): Absolutely. Well, thank you so much Dr. DiVittorio, for this valuable information for being with us today. I learned a lot, and I know our audience did as well.
Dr Adrian DiVittrio: Absolutely. My pleasure.
Deborah Howell (Host): Dr. Adrian DiVittorio is a board certified and fellowship trained pulmonologist and critical care physician with Diagnostic and Medical Clinic. I'm Deborah Howell as the first choice for healthcare for the Gulf Coast region. Infirmary Health is here for you here for life. Visit us at infirmaryhealth.org to learn more about our comprehensive lung health services or to find a physician near you. Thank you for joining us today for this broadcast from Infirmary Health. Be well.