Scott Webb (Host):  Lung cancer is the leading cause of death from cancer in the United States and more than 80% of people develop it from smoking. We’re talking today with Dr. Kostas Arnaoutakis about what you should know about your risk and when to see a doctor. He’s a Hematologist and Oncologist at UAMS. This is Health Talk, the podcast from the University of Arkansas for Medical Sciences. I’m Scott Webb. So, doctor, thanks so much for joining me today. we know that lung cancer is the leading cause of death from cancer in the United States. And more than 80% of the people develop it from smoking. When we talk about the average person, what’s the average person’s risk for lung cancer?

Konstantinos Arnaoutakis, MD (Guest):  The risk of lung cancer increases with smoking and there are a lot of other risk factors that we know but smoking and tobacco use is the number one cause of lung cancer.

Host:  Why do you think people continue to smoke and what can we do to help them?

Dr. Arnaoutakis:  Oh that’s a great question. Well smoking is a form of addiction and one of the problems that we face in our clinic is that people are stigmatized for that and they don’t get the help, the right help that they need. There’s a lot of advertisements that promoted as you know smoking in the past and that was kind of the cultural norm in many ways. So, these kinds of things are difficult to get rid of. And a good number of adult people in the United States smoke. It’s about 15 to 16% of adults in the United States that still smoke.

Host:  I didn’t realize it was that high and when we talk about ways to quit smoking, what are some of the suggestions that you have?

Dr. Arnaoutakis:  There are many available resources to quit smoking nowadays. I think the first step is to talk to your healthcare provider and especially if you think that they are kind of familiar with the modern approaches of smoking cessation; I think it’s very important to give it a try. There are many things that people can do. The most important thing is to be part of a team that is specialized and experienced with smoking cessation. A lot of people sometimes try to quit smoking by themselves and that’s something that can happen and there are many stories of people who quit smoking by themselves, but the chances are that they can quit better and they have a less risk of relapse if they do that in the proper way. And that is usually a lot of times the combination of pharmacotherapy such as nicotine replacement therapy, along with behavioral therapy. There are many interesting things that people who are specialized in smoking cessation that can do with motivational interviewing and other techniques because the important thing is not only to quit smoking but to remain tobacco free for the rest of your life.

Host:  Yeah, I think that’s the real trick, right, for a lot of people is a lot of people can quit initially but it’s remaining as you say, tobacco free. And Doctor, what are your thoughts about Chantix and other nicotine replacements like E-cigarettes?

Dr. Arnaoutakis:  I think Chantix is one of the ways to start the journey to quit smoking. This is part of our guidelines as the first line pharmacotherapy along with sometimes nicotine replacement therapy which usually it’s suggested to be in a combined way with nicotine replacement therapies such as the nicotine patch along with a short acting nicotine replacement therapy like a gum, something like that. E-cigarettes is a very hot topic, and a lot of people talk about it and a lot of people are studying that. There’s a lot of emerging data about electronic cigarettes. But still the guidelines do not support the use of electronic cigarettes as a way to quit smoking despite the kind of the anecdotal and limited evidence that we have right now. So, from my side, electronic cigarettes is not highly recommended at this point, but the combination of pharmacotherapy and behavioral therapy is still emphasized the importance of having – be connected in the right team which continues to help you in that journey of quitting smoking.

Host:  Let’s go back now and talk about lung cancer specifically and let’s talk about screening and who should be screened?

Dr. Arnaoutakis:  People who are high risk to develop lung cancer should be screened and there’s some specific criteria for electing who needs to be screened. So, there are different guidelines right now. Most of them require patients to be between the age of 55 to 77 or 74 depending on the guidelines and having at least a 30 pack year smoking history which is essentially something that we calculate multiplying the number of packs times the duration of smoking. So, if someone for example who smokes one pack a day on average for 30 years has a 30 pack year smoking history. Someone who smokes two packs for 15 years has the same 30 pack year smoking history. There are some other guidelines that require patients to be above the age of 50, have at least 20 pack year smoking history and at least another risk factor because there are other risk factors outside of the smoke or the tobacco that we have recognized.

So, generally speaking, patients who have a high risk to develop lung cancer based on those criteria they definitely need to talk to their healthcare provider and make sure that they can get a lung cancer screening test which is usually something that we call a low dose CT which is essentially a CAT scan without contrast that can be done very quickly, literally within a minute and that can show if there is a nodule, a mass or something else that needs further workup.

Host:  Are there any risks related to the screening itself?

Dr. Arnaoutakis:  Yeah, that’s a good question. So, there – I would say three potential risks. One is that the scans nowadays are very sensitive so they can always pick up something that is not cancer that sometimes needs to be worked up. Sometimes it may require biopsy. And so, then you have the risk of a biopsy that it’s performed in something that is found to be benign. And that is why it is also important to have this type of workup and screening in places where they’re experienced with lung cancer screening. So, it’s not just the scan itself but it’s also the multidisciplinary approach of working up something that you recognize to be suspicious. For example, in our group, we have a radiologist who has special interest in lung cancer screening, interventional pulmonologist and pulmonologist who can identify if something needs to be worked up further. And surgeons and medical oncologists and a group in general who can determine if someone needs a biopsy or not and if they don’t, what type of work up they will need down the road because something that is very small and it’s not let’s say suspicious may still need to be worked up just in case it’s proved to be lung cancer down the road.

Host:  And though it does seem like the benefits outweigh the risks as you say, there are some possible risks that people need to factor in that the team needs to think about.

Dr. Arnaoutakis:  Right and of course another thing is, and we don’t know yet in the long run the role of radiation that patients get from many scans down the road that there’s always a risk. And of course the financial toxicity in some ways because they can add to the healthcare costs in some ways however, many studies have shown that actually lung cancer screening is cost effective if you take into account the fact that many patients who if they don’t have screening they may diagnose with lung cancer that requires treatment that the treatment itself can also be expensive. So, the cost effectiveness of lung cancer screening is probably recognized lately as being cost effective and I think that’s something to take that into account as well.

Host:  Yeah, definitely. And I want to throw you a little bit of a curve ball here and just ask you and see if you know, what thoughts you have on this or what the data supports. When we talk about COVID-19, are smokers at any higher risk for contracting COVID-19 or if they do, are they any higher risk for having a more severe case of COVID-19?

Dr. Arnaoutakis:  Well I’m not a COVID expert by no means but the smokers are recognized as a risk group for developing COVID infection and if they do, they have a more severe case of COVID than someone who is a never smoker or a nonsmoker. And that’s kind of recognized from the data that we know at least, the recent data that we know.

Host:  You know Doctor, it’s so great having you on today and a lot of great information. As we get close to wrapping up here, is there anything else a person can do to lower their risk for lung cancer besides the obvious, besides just don’t smoke or quit smoking. What else can people do to lower their risk?

Dr. Arnaoutakis:  The risk factors are tobacco, but there are other risk factors for lung cancer. For example, radon is the second most common cause of lung cancer. We know that it’s not about the active tobacco use only but it’s also the secondhand smoking. So, it’s important not to smoke but it’s also important to be surrounded by people who don’t smoke and to encourage policies that allow smoke free environments and there are still some environments where people still smoke in places where they can – because secondhand smoking is also important as active smoking is. So, I think that those things are important.

Host:  So, anything else as we wrap up here today, anything else you want to tell people?

Dr. Arnaoutakis:  The goal is preventing and identifying cancer in the early stage. If you develop lung cancer, still there is a plethora of new novel treatments that we have right now. One of them for example is something called immunotherapy. So, there’s a lot of progress and success over the last ten years in the treatment of lung cancer as well. But obviously, the most important thing is to prevent and to identify early on. Many patients with lung cancer oftentimes are diagnosed in an advanced setting stage 4 or stage 3 when things are a little more difficult than for example if you detect something at the stage 1 which is usually the case with lung cancer screening. In many states lung cancer screening has been embraced but there are still many other states and places where lung cancer screening for a variety of reasons has not been fully embraced.

Host:  Yeah, it’s a bit of a head scratcher but good to know that it is available for people who live in the area of UAMS and as you say, prevention, screening, that’s the best way to go. Obviously, don’t smoke, quit smoking, all good stuff. Great information today Doctor. Thank you so much for being on and you stay well.

Dr. Arnaoutakis:  Thank you so much. Thank you.

Host:  That’s Hematologist and Oncologist Dr. Kostas Arnaoutakis. For more information, visit www.uamshealth.com. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for additional topics of interest. This is UAMS Health Talk, the podcast from the University of Arkansas for Medical Sciences. I’m Scott Webb. Stay well.