Joey Wahler (Host): It's an advanced form of cancer screening. So, we're discussing low-dose CT lung scans. Our guest is Dr. Kris McDonough. He's a pulmonologist. This is Silver Cross Hospital's iMatter Health Podcast, where medical experts bring you the latest information on health topics that matter most to you and your family. Thanks so much for joining us. I'm Joey Wahler. Hi there, Doctor. Welcome.

Kris McDonough, MD: Thank you so much for having me, Joey. I really appreciate your time.

Host: Absolutely. Same here. And so first, in a nutshell, what exactly is a low-dose CT lung scan? And of course, how does it differ from a regular chest X-ray, let's say?

Kris McDonough, MD: And that really encompasses both of the things about this. So, one is a low-dose CAT scan is much different than a chest X-ray in the sense that it gives us a three-dimensional picture of the chest so that we can see all throughout the lungs, and not just the edges of the lungs, which might be more available on a chest X-ray.

The low dose portion is also really crucial. Everybody knows that when you get an X-ray, there's some radiation involved, and a low-dose CAT scan is a much safer option that provides radiation that is less than a fifth of what it would be with a normal CT.

Host: And when you mentioned 3D, 3D and just a lot better, more detailed, more elaborate imaging has become a big part of the healthcare world in all circles these days, right? The pictures are just so much better than they used to be even not that much further back than right now, yes?

Kris McDonough, MD: Yeah, there's no doubt about it. I mean, even if you look back to where I was at the beginning part of my career when we had CAT scans, but we had to print them up in these little tiny pictures and look at them up on a light board and examine them with a magnifying glass. And now, we can put them on a computer and render them in different planes, in different ways so that we can see things and really scroll up and down through the chest or through any part of the body. It's been fantastic.

The advent of new technology that allows us to do this with even lower radiation exposure has really been an important aspect in helping protect our patients, but also be able to supply really excellent images, both of the lung and other parts of the body.

Host: And when you mention their lower radiation exposure, how important is that to people? Very, right?

Kris McDonough, MD: I think so. I think we know that an exposure to any one X-ray or any one CT scan is probably not that big of a deal over the course of a lifetime. But that said, many of us will end up getting not just one CAT scan or two CAT scans, but we may be getting, you know, any number, dozens of them over the course of our lives. And so, that adds up. The accumulation of radiation can add up over time. And certainly, we can minimize each individual dose, and we're doing the right thing for our patients.

Host: Absolutely. So, who should consider getting this low-dose screening? For instance, are there risk factors that make someone a particularly good candidate?

Kris McDonough, MD: Yeah, there sure are. So, here's what we know about lung cancer. We know that those individuals who have been ever smokers are at increased risk of lung cancer compared to an average population. And we describe an ever smoker as somebody who has smoked more than 100 cigarettes over the course of their lives.

That said, and it makes intuitive sense that people who've been smoking for longer, heavier smokers and older smokers are going to be at increased risk compared to somebody who, say, you know, smoked a pack of cigarettes a day fo their 21st and 22nd year, right?

And so, we then look at that group and we say, "Okay, who are our biggest risk patients?" And our biggest risk patients are people who are between the ages of 50 and 80 and who are currently still smoking or who have been cigarette smokers in the past 15 years. And that's the way we will pick out a group of people who really we should looking at very closely. And this can be, you know, sort of part of the meat and potatoes of their routine healthcare.

Host: Gotcha. So, why is early detection of lung cancer so important, and how can finding cancer early affect treatment options and outcomes? How much of a difference does it make?

Kris McDonough, MD: That's another great question, Joey, because it makes a huge difference. You know, historically, we have done a very bad job at catching lung cancer early. And that is spelled out when you look at the numbers. You know, across the country and indeed across the world lung cancer is only about the third most common cancer in both men and women. So in women, breast cancer and colon cancer are more common. In men, prostate cancer and colon cancer are more common. But lung cancer is their number three for both. And yet, even though it occupies that third spot, it is the leading cause of cancer death in this country. And so, it is a fatal disease. About half of people who are diagnosed with lung cancer historically will die from that disease. And that's a bad number. That's a scary number. And a lot of that is attributable to the fact that we've always caught it late. We've caught lung cancer after it has spread, right?

So, I use a lot of my own personal stories in talking to my patients. And so, several of my relatives have been diagnosed with lung cancer. And so, my grandfather, for instance, woke up one day and couldn't move his right hand, thought he was having a stroke and, in fact, he had a tumor that had spread to his brain from his lung. And that is a really common story, you know, historically.

If, though, we catch people early we can treat them early, survival is really excellent. So if we catch people, for instance, who have the earliest stage lung cancer, stage IA cancer, those people who are treated effectively have a 93% five-year survival. So, more than nine out of ten of them are still alive and cancer-free five years later. And that's a big disparity. That's a huge difference between, you know, what has historically been the case and what we are finding now. And so, screening people allows us to capture those people much earlier in the course of their disease so that we can provide aggressive and excellent therapy to them and keep them alive so that they're there and, you know, going out and seeing their grandkids play softball or making it out on the next cruise or reading the next great book or, you know, like you watching the Knicks win an NBA title.

Host: Yes. Yes. Yes. That was a special moment. That's a whole other podcast though, Doc.

Kris McDonough, MD: I'm sure it is. I'm sure it is.

Host: We'll talk about that another time, because I'll be talking about it for a heck of a long time from now, that I can tell you. But anyway, you're focused, of course, on patients naturally in Will County. So how prevalent is lung cancer close to home from your experience?

Kris McDonough, MD: It's a big deal. It's a big part of my practice. Obviously, as an interventional pulmonologist, a lot of what I do is the evaluation and management of lung nodules. And many of those turn out to be cancers, and then helping people navigate through that process.

We are diagnosing, you know, somewhere around 200 to 250 cases of lung cancer annually at Silver Cross Hospital. And so, that's a pretty frequent thing that we are seeing and navigating people through that. We probably should be catching more though. You know, what we know is that in our geographic area, there are probably about 10,000 people, who should be getting annual lung cancer screening studies.

And really, we're pretty close to national average, where only about one out of every seven people who should be getting a screening study are getting them. And so, there are probably cancers out there that we're not finding that we're going to catch too late. And so if we can find those early, that would be great.

Host: Absolutely. Now, you touched on it earlier. I want to go back to it in a little more depth here. Many people, of course, as you well know, hear the word radiation, and they get a little bit nervous, maybe even quite nervous. So, how much radiation is involved in layman's terms, and is the scan considered safe? I mean, I'm sure it's safe, but how safe is it?

Kris McDonough, MD: Sure. You know, I'm a nerdy guy. I spent all my life taking biology and chemistry and physics classes. And so, I'll try not to get too wonkish about this. But here in the Midwest, we see a fair amount of radiation from the ground. Radon in the limestone here is another source of that. And that amounts to somewhere between eight and twelve of what we call a millisievert of radiation every year.

There are certainly people who get more than that. So, a guy like me who's standing in front of a real-time X-ray machine all the time will catch more of that. Interestingly enough, pilots are the ones who probably get the most radiation because they fly up in the sky where they get less protection from the atmosphere.

Host: If a scan finds a spot or a nodule on the lung, it doesn't automatically mean cancer necessarily, right?

Kris McDonough, MD: That's 100% correct. So, what we know is that in our at-risk patients, remember that group of people who are 50 to 80, who are current cigarette smokers, who have been cigarette smokers, if we do scans on them, we often find abnormalities and irregularities. It's a pretty common thing. In fact, that probably happens in about one out of every four people who gets a lung cancer screening. We're going to find something that's abnormal in there. Only about 4% of those are actually lung cancers, though.

Host: And, Doc, if something negative is found on a scan, whatever it may be, how often should someone then follow up for another?

Kris McDonough, MD: It really gets to the heart of two different things. When we see one of these lung cancer screening studies, if they are normal or if there's a finding that is more than likely to be benign, then that person will just continue to get annual screenings until such time as they age out.

So if you are all of a sudden 81, or if you are more than 15 years removed from your last cigarette, then you won't need additional scans, so just every year. If, on the other hand, there's an abnormality, the abnormality is going to be reviewed by a team of folks. In fact, we meet every Tuesday. There's a bunch of nerdy docs like me. There's a radiologist, a thoracic surgeon, a couple of other pulmonologists, some oncologists who all meet and review these cases, and we'll make individual recommendations based on those findings. That may mean that we need to refer you for a biopsy. It may mean that you need a repeat CAT scan again in three months just to assess for any type of interval change. But altogether, you'll have a group of people who are taking care of you and helping you through that process.

Host: How about the biggest misconception or fear that you hear from patients concerning lung cancer overall?

Kris McDonough, MD: I think there are several of them, and one of them is exactly what we talked about at the beginning, which is that lung cancer is necessarily a death sentence. And that's definitely not the case. Like I said, if we catch you early, your chances of living an awful long time cancer-free are fantastic. And so, that's a really big part of it, and it's probably the biggest message that I want to stress.

The second one is a lot of people have the misconception that if we end up looking after a cancer and we do a biopsy, for instance, or you get a surgery to remove a cancer, that somehow that procedure in and of itself will cause the cancer to spread elsewhere in the body. And indeed, that is also not the case. There are a couple of weird tumors in the body that can do that, but lung cancers are not one of them. And so, the process through this, if you are in the unlucky few to actually have a lung cancer, it's very safe. And we're going to do our very best to take good care of you.

Host: And in summary here, Doc, what would you say to someone joining us right now who qualifies for lung cancer screening but is putting it off for whatever reason, procrastinator?

Kris McDonough, MD: Yeah, I know all about that too from my own academic career. So, absolutely this is something that's easy to do. It's painless. It takes just a few minutes. Get your CAT scan. You don't need an IV to do it. All you need to do is talk to your care provider, get an order, show up, and get it taken care of, and it may save your life.

Host: Literally indeed. Well, folks, we trust you are now more familiar with low-dose CT lung scans. Doctor, always a pleasure, always great fun as well to chat with you. Thanks so much again.

Kris McDonough, MD: Thank you so much for your time, Joey. I appreciate you.

Host: Absolutely. Same here. And for more information, please visit silvercross.org. If you found this podcast helpful, please do share it on your social media. I'm Joey Wahler. And thanks so much again for being part of Silver Cross Hospital's iMatter Health podcast.