Evo Terra (Host): The key to keeping lung cancer at bay is early detection. But what if you don't have any symptoms? Hmm. Let's find out with Dr. Luigi Tullo, Vice Chair of the Department of Ambulatory Care and Medical Director in the Division of Population Health at Jamaica Hospital Medical Center. This is Jamaica Hospital MedTalk from Jamaica Hospital Medical Center. I'm Evo Terra. Thanks for joining me today, Dr. Tullo. Can you start by giving us an overview of what we call lung cancer? What is it?

Luigi Tullo, MD, FAAFP: So lung cancer is a type of cancer that starts as a growth of cells in the lungs, which are two organs in your chest that control your breathing. It is the second most common cancer behind breast cancer and the leading cause of cancer death in the United States. It also makes no differentiation between men and women because it is the leading cancer death for both men and women.

Host: Hmm. And the cause, I mean, I think I know the cause. I've seen enough commercials and cigarette advertisements or packages to know the cause, but there's more to it than that. I'll let you explain.

Luigi Tullo, MD, FAAFP: Yes, of course, everyone knows that the leading cause of lung cancer is smoking, but there are other causes of this because there are people who get lung cancer and have never smoked in their lives. One of them is secondhand smoke. The other one is exposure to cancer causing chemicals such as radon and asbestos.

Also, people who have pre existing lung conditions like pulmonary fibrosis are at much higher risk of getting this. Plus, also, you have to take into consideration family history, personal history, any person who may have had radiation for other issues to the chest, can also be causes for cancer.

Host: I wanna ask a question that's pollution and, air pollution. I lived in Southeast Asia for a number of years in Bangkok, and the pollution there is terrible. I've lived in Los Angeles and big cities. Is that a factor in lung cancer?

Luigi Tullo, MD, FAAFP: Absolutely. Air pollution can be a cause, especially in areas that have very high smog levels, and a lot of trucks, especially back in the old days when they used to have leaded gas, and in other countries, there is leaded gas. These are all causes because any type of smoke, not only the one you get from a cigarette, definitely in large doses can be causes of lung cancer.

So trying to stay in a nice environment where there's not a lot of pollution would be the best thing, but sometimes not that easy to avoid.

Host: Yeah, definitely. Well, let's talk about the signs and symptoms of lung cancer and what of which of those should lead someone to actually maybe see a doctor?

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Luigi Tullo, MD, FAAFP: Well, again, a lot of the symptoms that I will talk about that can be signs, warning signs for cancer can also be just other issues. So it's really important that if you do see these, you really should not get worried, but contact your provider and get an appointment right away with your physician.

And some of these symptoms are a cough that does not go away, a new cough that comes on and you just can't shake it. Coughing up blood or a rust, reddish color sputum or phlegm or spit. Chest pain that often is worse when you take a deep breath, if you cough, or when you're laughing. Voice change, hoarseness in your voice can cause this. A lack of appetite or unexpected weight loss, shortness of breath. A sense of feeling tired and weak frequently, and any type of lung infections that don't go away with the normal treatment or keep coming back.

These are all signs that should really prompt you to contact your provider as soon as possible and get in and be seen.

Host: Right. Right. And so if we go to the doctor, what is our doctor going to do for us? How will the, how will this diagnosis of cancer or non-cancer uh, be done?

Luigi Tullo, MD, FAAFP: Well, the most important part is a good history and physical. The doctor is going to ask you about your smoking history or any other type of issues. They're going to do a physical exam, listen to your heart and your lungs, and then they most likely will order some imaging, either a chest x-ray, a CAT scan, or a MRI or magnetic resonance imaging.

Again, there are further tests that could be done. There are things called bronchoscopy, which is where we take a scope, the doctor will put it down your throat, go into your lungs. And usually what they try to do is identify the area where they saw the mass on the imaging and take a biopsy, a piece of that mass. So that we can look at it under a microscope and understand if this is cancer or not. So those are pretty much the major ways that we make our diagnosis.

Host: Great. And once a diagnosis has been made, if it's the bad news, obviously we need to do something about lung cancer. I know there are lots of types of cancers, but in general, how do we treat lung cancer?

Luigi Tullo, MD, FAAFP: Well, it always depends on what stage we're in of the cancer and we'll talk about that little later on in the lung cancer, but the four major ways of treating it is surgery, where we remove the cancer, radiation, where we radiate the area with a special emitter that allows us to kill the cancer cells that we may not see visually, but we'll be able, will be there. Then there's chemotherapy. Everyone knows about these are medications that get injected into your blood system to kill the cancer. And most recently we've been using a thing called immunotherapy, where we have antibodies that attack the cancer, and this can work in certain cases.

Host: Excellent. This seems like an obvious question, but you said that lung cancer is the second most common and the one that kills both men and women more than anything else. Can it be prevented? Can I be guaranteed to not get lung cancer before I die of something else, I guess?

Luigi Tullo, MD, FAAFP: Well, in medicine, we can never guarantee that it's not going to happen, but there are definitely things that every person can do to improve their risks of not getting cancer. And the first one is if you don't smoke. Keep on not smoking. If you do smoke, you want to try to quit as soon as possible.

Avoid secondhand smoke. So keep your cars and your home as smoke free as possible. Avoid and limit contact with chemicals in your work, in your home place, like asbestos and radon. Eating healthy, fruits, vegetables, having a healthy diet is extremely important and exercise regularly. These are all things that will benefit your health and will hopefully help you avoid getting lung cancer.

Host: Always good things to try. Let's go back to the lung cancer screening topic. Why should we do that? Even if we're not having symptoms, I guess is my first question, should we do lung cancer screening as a part of life, and what are the advantages of having it done?

Luigi Tullo, MD, FAAFP: So what lung cancer is really is an imaging with what we call a low dose CT scan. So we decrease the amount of radiation that you're going to get. And the objective really is to identify nodules or masses in your lung as early as possible because what we know is that the earlier we catch cancer, the more effective our treatments are.

So it's extremely important. Many people say, well, I don't need one because I'm not having symptoms, but unfortunately signs and symptoms of lung cancer usually mean that you're in a later stage of the cancer, which becomes much more difficult to treat. So it's really important. And what we have learned also is in a recent study, it's shown that lung cancer screening programs have reduced the lung cancer mortality rate by 20 percent. So, again, getting this can really, not only decrease mortality, but also can increase the probability of you, staying alive on, for longer periods of time than catching it later when the patient's already symptomatic?

Host: Right, right. So, who is eligible to get this? If I'm not a smoker, but if I am exposed to secondhand smoke, or just a regular person, who eligible to get this lung cancer screening?

Luigi Tullo, MD, FAAFP: Well, as of right now the people that are eligible for lung cancer screening are people between the age of 50 and 80 years of age, who have smoked at least what we call a 20 pack year smoking history, which is a pack year would be the number of packs you smoke a day, times the number of years you smoked.

For example, if you smoked two packs a day for 20 years, two times 20 is 40 pack years. So anyone with 20 pack years or more, and the final one is people who are either current smokers or have quit within the last 15 years.

Host: Excellent. And we should, any of those people, we should definitely be seeing our doctors and saying, Hey, let's get the lung cancer screening done. Wonderful. So, well, actually let's stay with that for just a second. What should I do? Let's say that I am at high risk for lung cancer and I'm interested in screening. Ask my doctor, I suppose is the easy answer, but is there more to it than that?

Luigi Tullo, MD, FAAFP: Obviously, the first thing is speak to your doctor. That's the most important thing. But unfortunately, we know that a lot of people really don't have a doctor. They don't know where to go. So if you don't have a primary care physician, you can definitely reach out to Jamaica Hospital at our Jamaica Lung Cancer Screening Program.

The number is 718-206-5603, or you can send an email to the LungCancerScreening at jhmc.org. And again, that way there we can contact you, we can get you in. If you don't have a primary care doctor; we can definitely set you up with a primary care doctor if you don't have one.

Testing, this lung cancer screening is covered by the majority of health insurances. So it's, something that we know really helps and can both help our patients and hopefully avoid, having them go through chemotherapy and other things and catching it as soon as possible.

Host: That's wonderful. Is there anything else you want to add before we go, Dr. Tullo?

Luigi Tullo, MD, FAAFP: The only thing I tell people all the time is, we've finally gotten to the point where we can really make an impact on this disease and people have to understand that, you know, it's maybe a little scary saying, I don't know if I want to do a CAT scan cause I don't want to know, again, we can really make an impact in people's lives and it's not something that we should avoid doing.

You really should think about if you're a high risk person, get to see your physician and get into a lung cancer screening program. We will, we'll be following you on a regular basis with these CT scans so that we make sure we catch anything like very, very early. And it's worked similarly with breast cancer. So it's something that we have experience with and it's really important in people's lives. So hopefully this will make an impact on people reaching out and getting themselves tested.

Host: Well, I hope so too. Dr. Tullo, thank you very much for all the information today.

Luigi Tullo, MD, FAAFP: No problem. Thank you.

Host: And once again, that was Dr. Luigi Tullo, Vice Chair of the Department of Ambulatory Care and Medical Director in the Division of Population Health at Jamaica Hospital Medical Center. To find out more about the Lung Cancer Screening Program at Jamaica Hospital Medical Center, please call 718-206-5603. For more information about the services Jamaica Hospital offers, visit our website at jamaicahospital.org.

All content of this podcast is intended for general information purposes only, and is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. Please consult a medical professional before adopting any of the suggestions discussed on this podcast.

If you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. I'm Evo Terra, and this has been Jamaica Hospital Med Talk from Jamaica Hospital Medical Center. Thanks for listening.