Heather Lee (Host): Hi there, everyone. Thanks so much for joining us for this latest episode of Medically Speaking. I'm your host, Heather Lee. And joining me today is Josh Mancini, who is the lung cancer screening coordinator for Kaleida Health and relatively new to the team. Welcome aboard.

Joshua Mancini: Thank you.

Host: So, tell me a little bit about your background. What brought you on this path when it comes to lung cancer and lung cancer screening? It wasn't always your focus, right?

Joshua Mancini: Right. I have a background in primary care. So as anyone knows, if you have a physical, you have to go through certain amount of things, right? There's all these checklists, medications. So, I noticed that there was a need for a greater time and expansion into smoking cessation, low-dose CT scans. So, that's screening for lung cancer.

Host: Yeah, I noticed—yeah, when you go in, I just had my, you know, primary care appointment, just the annual checkup, and they go down the list, right? What's your smoking history? You know, drug use or, you know, drinking history, mental health, that sort of thing. But I feel like it's just like a touch point. It's very, very quick. Talk about some of the patients that you worked with in the past where you realized, "You know what, they need a little bit more help" or "We do need to dig a little deeper on this."

Joshua Mancini: Right. So, you know, like you said, you ask them, you know, are they currently smoking? Did they smoke in the past? Any family history of smoking? So when somebody tells me in primary care if they were smoking, "Okay, what did you try? How recently did you try? Do you have any plans to quit?" So, that does take time and it takes a lot of, I think, specialized training hopefully to get you to that point where you can quit. It's not an easy thing to do. Yeah. And a lot of people struggle with it, so that's kind of what we're filling that void with.

Host: Yeah. I feel like, you know, I've heard of people that quit cold turkey. And then, I've known people personally that have tried over and over, and some were successful and some were not. But again, you're trying in your new role to be that conduit of smoker or former smoker to definitely done, you know, definitely quitting and on the path to better health.

Joshua Mancini: Right. And that availability, right? I can give them a call, I can followup with them. So, that's a huge part of this program.

Host: How excited are you to be in this new role? Because it seems like it scratched that itch that you saw the need for it. And now, here you are helping us at Kaleida get folks on the path to being much healthier.

Joshua Mancini: Yeah, I'm very excited. There's a huge opportunity for people that are smokers or have quit recently that, you know, can be screened for lung cancer. It's a need. It's a need in this community, that's for sure.

Host: Yeah, definitely. I know that we do have relatively high rates of lung cancer in the western New York community. Let's rewind a little bit and get back to the bare basics. What is lung cancer? What are the types of lung cancer? Because there are two different kinds, right?

Joshua Mancini: Correct. Lung cancer is just basically the abnormal growth of cells, uncontrollable cells in the lungs. So, that can happen in the lung tissue or the airways. Ninety percent of lung cancers are caused by smoking. There's two types of lung cancer. There's non-small cell lung cancer, and then there's small cell lung cancer. And basically, non-small cell lung cancer is the most common type. And both are caused by smoking.

Host: Okay. You detect it earlier, I mean, we always talk about early detection is key with all types of cancer. But when you're talking about lung cancer, how much of a difference can that make catching things very, very early on?

Joshua Mancini: It's huge. Early detection in stage I type lung cancers, right? There's a 60-90% survivability rate if we catch it that early. Stage IV, so that's when it spreads to the lymph nodes, it can be like less than 10% after five years of survivability.

Host: !Wow.

Joshua Mancini: Yeah.

Host: A lot of times people might wait too long to get screened, or perhaps never get screened at all, so they don't even know that this is growing inside of their body. I guess who qualifies? On whose radar should this be the screening?

Joshua Mancini: Yeah. So, anyone ages 50 to 80 who have significant smoking history, so that's heavy smoking, so that's an average of a pack per day for, like, 20 years.

Host: Oh, wow. Okay.

Joshua Mancini: Okay. And then, they either have to be currently smoking or have quit within the last 15 years. If they have quit longer than 15 years, usually their risk of smoking or lung cancer developing it is cut by half.

Host: Wow. So, the second you quit could make that much of a difference in your outcome.

Joshua Mancini: It's huge. You'll feel better. You can taste food better. You start breathing a little bit better. These are all things that, you know, you'll notice pretty early on.

Host: Yeah. So, early detection is key. If somebody is eligible, they fall within that criteria, that 50 to 80 you said, and either are still smoking or recently quit. And they say, "Okay, I want to get screened." What does the screening entail? And how do they go about contacting our team to make sure that they can be a part of this?

Joshua Mancini: Yeah. So, first step is they can talk to their primary care, but I'm here now, so 716-254-LUNG. They can call and set up an appointment with me. I'll go through discussing what the low-dose CT is. And if they qualify for that, most insurances cover that. Medicare also covers that screening if you do argue within that eligibility requirements.

Basically a low-dose CT, if anyone that hasn't done a CT, it's you go in the donut, right? And it's very quick. I think it's a couple minutes. They ask you to hold your breath. And basically what it does is it takes a very detailed image of your lungs, and it's very low radiation. So, it's like one 10th of a normal CT scan.

Host: Okay. So if folks are concerned about having that, it's the risk versus the reward and it sounds like it's a very low risk to potentially finding something in Its very early stages.

Joshua Mancini: Right.

Host: If somebody is diagnosed with lung cancer at any stage, how do you then work with the team at Kaleida to make sure that they get on the path to the correct care?

Joshua Mancini: Yeah. So, we have a great team at Kaleida. We have great oncology team. We have a great interventional pulmonologist. We have a great thoracic surgeon. So yeah, if you come to me or you are somebody that was diagnosed with lung cancer recently, we can get you to the right care team.

Host: Yeah. And I think one of the nice things we talk about it a lot at here at Kaleida is sort of that continuum of care. You know, we have the infusion centers at Buff General, we have it at Spindrift, we have the emergent care. It's sort of the whole package if a person is diagnosed. They have lots of options of who they can see and meeting all of their needs, whatever they might be throughout their cancer journey, right?

Joshua Mancini: Right.

Host: Let's talk about smoking cessation—that is, you know, a passion for you and something that's really important. You mentioned some training that you know you're going through to better help you help patients.

Joshua Mancini: Right. So yeah, I'm going to be starting the Mayo Clinic Tobacco Treatment Specialist Program, and what it will do is kind of guide me to help people quit smoking. So, that's motivational interviewing, that's, you know, learning the ins and outs of how nicotine affects the brain and a little bit of tricks of the trade, right? So just to help, there's like combination therapy, right? That's using the patches as well as gum. Behavioral counseling, that's another big part of this too, right? So, there's multifactorial that can help you quit.

Host: With your knowledge and your experience, both, you know, in your previous role and now here with Kaleida, what can you say to somebody who is trying and maybe not having that success or who thinks, you know, "I'll try to quit later." And they keep, you know, kicking the can down the road. What is your best advice to them and sort of those words of support that I think a lot of folks could use.

Joshua Mancini: Yeah, don't give up. You can reach out to me. There's a ton of resources out there. New York State has their own website that you can reach out to. I think most of the nicotine replacement therapies are free to patients. But yeah, it's going to take multiple times for you to actually be successful in quitting, and a lot of times people will relapse. And that's normal. That's a part of life. So, we're there for support. You can contact me and I'll follow up with you and we can call every once in a while or something like that just to stay in touch.

Host: Yeah. It's not easy, but it's worth it.

Joshua Mancini: Absolutely.

Host: All right. Give us that phone number again. If folks want more information, how can they contact you and your team?

Joshua Mancini: 716-254-LUNG, I think it's 5864.

Host: So, L-U-N-G.

Joshua Mancini: Correct.

Host: Lots of resources here at Kaleida Health for folks who, you know, want to get on that path to better health. And it starts with stopping smoking and it also starts with taking your health into your own hands. So even if you quit, you know, being proactive. Because, again, it can make such a difference if you catch it early, right?

Joshua Mancini: Absolutely. And the biggest thing is, you know, lung cancer in its early stages is silent, but treatable. And I want to get that across that you might not be feeling bad, you might not have a persistent cough, you're not coughing up blood, chest pains, stuff like that, right? So, that's early signs of lung cancer. Earlier than that, you could feel fine, but there could be lung cancer there. So, that's why it's so important to get in, to get screened, that we can catch it before you start feeling these things.

Host: Yeah. Any other signs and symptoms? You mentioned some of the big ones, but things that people should be looking out for, if they, you know, are or were a heavy smoker, what are the sort of the warning signs?

Joshua Mancini: Yeah. Just to retouch on that again, so it's shortness of breath, right? If you, you know, maybe you have a little bit of shortness of breath with exertion or you're like, "I just went up the stairs and I feel a little bit more tired than I used to." Obviously, coughing up blood is never a good thing. I would always go to get checked out for that.

Host: Sure.

Joshua Mancini: You know, chest pain, it doesn't necessarily have to be cardiac-related, right? So, that's something that could be a sign of lung cancer.

Host: But it sounds like if you have any of these symptoms that are, you know, out of the ordinary for you, and then again, you know that you have that history, so talking to your primary care physician, but getting in touch with your team as well.

Joshua Mancini: Right. So yeah, if you have any of those signs of symptoms that needs to be discussed with your primary care, that's something that you shouldn't wait. So, the big thing for us is we're trying to catch the lung cancer before you get to that point, because that's when it's the most treatable.

Host: Yeah. And I know that I've, you know, interviewed folks in the past and have done stories with them that were diagnosed with lung cancer that didn't have a history of smoking. There's other risk factors, right? I know it doesn't pertain to this particular screening. Because again, there are very specific guidelines, the ages and whether or not you used tobacco. But just for general knowledge, what are some of those other risk factors that folks should know about?

Joshua Mancini: Sure. In Western New York, we have exposure to radon. That's in a lot of basements.

Host: I have the radon fan in my basement.

Joshua Mancini: Yeah. So, that's something that can cause lung cancer. It's a known cause. There's also asbestos. I've met people in the past that had break dust exposure that could be due to the asbestos. So yeah, environmental secondhand exposure, occupational, things like that.

Host: Yeah. So regardless of whether or not you qualify for this particular screening, again, with the age and tobacco use, if you notice any of those symptoms, if you have any of that contact or history, whether it's work or environment, definitely reach out to your primary care physician, and then we can take it from there. But your team is always willing to help folks.

Joshua Mancini: Absolutely.

Host: We are so glad to have you on board. Thank you so much.

Joshua Mancini: Thank you.

Host: Again, Josh Mancini, who is the lung cancer screening coordinator here at Kaleida Health, a new addition to our team. And again, we're thrilled to have you and you are going to do so much to help a lot of people and save a lot of lives.

Joshua Mancini: Hopefully. Thank you.

Host: Yeah. All right. Thank you. And thank you for listening to this latest episode of Medically Speaking. We'll see you next time.