Caitlin Whyte (Host): For smokers, lung cancer screening is a critical tool, even if you're an ex-smoker. So to tell us more about who should get screened and when, is Dr. Lloyd Del Mundo, a Pulmonologist at Valley Health System.

 This is Health Talk with the Valley Health System presented by the Valley Health System.

I'm Caitlin White. Well, Doctor, thank you so much for joining us today for this discussion. To start us off, can you tell us who is a good candidate to get a lung cancer screening?

Lloyd Del Mundo, DO, FACOI: The United States Preventive Task Force just changed the guidelines a couple years ago. It used to be 55 to 80 years old. Now they've changed it to 50 to 80 years old and you have to have smoked for at least 20 pack years and haven't quit within the last 15 years. So if you quit more than 15 years ago, you don't qualify. And then the other question I get all the time are, what are pack years? So pack years are basically, if you smoke one pack per day for a year, that's a pack year. It's not like you smoke one pack a year. It's a pack is a one day for every year.

So if you smoke half a pack a day for 10 years, you smoke five pack years. So the guidelines is 50 to 80, smoking for 20 pack years, you are either a current smoker or have quit within the past 15 years.

Host: Gotcha. Well, what about people who have never smoked in their lifetime? Should they be concerned about getting screened or just worrying about lung cancer in general?

Lloyd Del Mundo, DO, FACOI: Yeah, I think so. I mean, I think that's one of the flaws of the guidelines to be honest. It's the fact that people that do not smoke don't qualify for lung cancer screening. Granted, most of the people that have lung cancer do smoke, but that leaves 20 percent of people, depending on where you look whether you're looking at the CDC or another resource, they say 10 to 20 people that do not smoke do develop lung cancer. But you know, most of the time it is ideal to get screening if you qualify, but there's no rules for people that don't smoke, which in my own opinion is kind of the flaw because, you know, when you do breast cancer and prostate cancer, colon cancer, those are just ages.

So, it doesn't matter if you have, if you have history, you actually get screened sooner, but when it comes to lung cancer, it's only for people who smoke, the guidelines say.

Host: So on that note, are there any symptoms that people can look out for when it comes to lung cancer, then?

Lloyd Del Mundo, DO, FACOI: Yeah, that's a good question too. So I'll be honest with you, most of the time the answer is going to be no. Most people don't come in with symptoms of lung cancer. Actually only about a quarter of people have shortness of breath or some type of chest pain. Most people that have lung cancer, they come in with a normal cough.

So a lot of these people, you got to think to have, you know, COPD from smoking and things like that. So they attribute their cough to their underlying lung condition already. So most people, they don't, they don't have symptoms. I would, I would argue that by the time you have symptoms, or if you're like, say, coughing up blood, cause a lot of people ask you that all the time too, or you're coughing up blood, you may have lung cancer; it's probably pretty far gone by the time you have it by then. So most of the time I will say that most patients do not, but if you have, you know, new shortness of breath or you can't walk as far as you used to, or the, the shortness of breath is different from what you are used to, it's not your regular cough, then those can sometimes present as signs and symptoms.

Host: Gotcha. Okay, so we go and we book the screening. We're in this class of people who should get screened. What exactly happens during a lung cancer screening, then?

Lloyd Del Mundo, DO, FACOI: Lung cancer screening is basically just a CT scan. The most difficult part actually is getting it approved by your insurance, which seems kind of counterintuitive, but it is. I've had a lot of doctors come ask me how we get these people screened, even though they actively smoke. So just as a heads up to, you know, other the other physicians who are listening also, you have to write that they're smokers or they have a history of smoking and you have to include the number of pack years that they've smoked to get them qualified.

Once it gets approved by the insurance, you get the referral sent to whatever radiology place that you get your imaging done at. You go over there and it takes like 5 seconds to do the actual scan, really like 5 minutes. But they put you in the CT scan machine. It's a low dose CT, meaning you get about 10 times less the radiation than you would a normal CT scan.

And then that's all it is. The radiologist reads it, or we read it, and you get the report. And that's how the CT scan goes. You can qualify every year. So, people that qualify for screening get yearly CT scans. It's not just a one time thing.

Host: That's a good point. Thank you for clarifying that. I'd now like to focus on Nevada specifically. What trends are we seeing in the state in terms of lung cancer diagnosis?

Lloyd Del Mundo, DO, FACOI: Yeah, so Nevada, my friend, is not very good when it comes to screening for lung cancer. I've been really big on this lung cancer for about the last five, six years now. When we started this and started talking about the screening, we were number 49 out of 51.

Then we became 50 out of 51 in the country. Worst state actually is, California, in screening. But for us, we're 50 out of 51 as of two years ago. I do have a little bit of good news. We did move up to 47. So now we're number 47 out of 51 in the game. It's progress, you know. It's from an F minus to an F now.

So we screened about 1.4 percent of the people that qualify for screening. That's an amazing number. 1.4 percent only gets screened. In the country, it's only 4.5%. So it's not like the whole country is doing any better, but we're just not, we're at the very bottom of the tier when it comes to screening.

Host: Hmm. Well, let's focus on some positives as we wrap up here. What innovations have we seen that help with this early detection and diagnosis?

Lloyd Del Mundo, DO, FACOI: Well, as of right now, there's new modalities to do diagnosis for the lung cancer, which I think are extremely game changing. The technology we had before was very inaccurate and, you know, it didn't even give us, like, the procedure of it a lot of confidence. Most of the time now, people will get sent to radiology for a biopsy.

Basically what that means is they get the CT scan, they will put a needle through your chest and get a sample of what they see as a nodule or what may be a tumor. What we can do now actually is we go from inside out. So meaning you actually go, we go into the lung and we poke into the nodule that way.

And the technology is completely unreal. We can go as far as the lung can go and we can get nodules from sub centimeter to beyond. So normally when you go get a biopsy, they won't do it if it's less than a centimeter. But I myself and a couple of my partners have gotten lesions that are about five millimeters big to be positive.

And when you get the smaller lesion, if it's positive for cancer, I mean, most of these people will survive the cancer. You know, you can get that taken out. And you don't have to go through chemo and radiation half the time if you can get it at stage one. So I think the biggest part of that is that the technology nowadays, what we use is called the Ion Robot, by Intuitive. They are all over the country. It allows you to diagnose earlier. It's a lot less complications, so when you do it from CT guide, which still yields very well and there's still a role, don't get me wrong. But, the complication rate there is much higher. This one, the complication rate is much lower.

And the other advantage that it has is that we can do something called staging. So, when you have cancer, people always want to know, am I stage 1, stage 2, stage 3, or stage 4? What we can do is stage the chest, and if we get like a lymph node or something in the chest other than the target nodule that we're supposed to get, and we find that something else is positive, that can change the stage, and that ultimately also changes your treatment.

So you can do all of that at one time. Before it used to be two separate procedures, can now be just one procedure. And now, we're also getting at things much smaller, which, the goal of what we do now is not only to diagnose earlier, but it's also to stage shift.

Meaning, most of the people that get diagnosed with lung cancer, 54 percent actually, have stage 3 and above, which is inoperable, the survival rate is very low. But if we can get you to stage one, depending the type of cancer you have, you have a 92 percent chance of living after five years and just ultimately beat the cancer. So, I think the technology now is much, much better.

Host: That is wonderful to hear. So last question here, Doctor. How can someone find out more or go about actually making that appointment with Valley Health System?

Lloyd Del Mundo, DO, FACOI: Over at Valley, we have the referrals. If you go onto the Valley Hospital or one of the UHS hospital's websites, there's a link where you can find a physician. There's multiple pulmonologists on there that are all very good as well. So you can always directly call us. You can look us up on lvlungs.com, or like I said, you can hit up the UHS or the Valley Health System website. There's links to find a physician and you can go and find one, make an appointment or just contact your primary doctor and say, Hey, I think I qualify for a lung cancer screening. And then you can refer to us or they can do it and we can get it for you.

Host: Well, some wonderful information here. Doctor, thank you so much for joining us and for all the work that you do. You can find more about lung screening online at valleyhealthsystemlv.com and thank you for listening. If you found this podcast to be helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. I'm Caitlyn White. And this has been Health Talk with the Valley Health System, presented by the

Caitlin Whyte (Host): Valley Health System.

Host: Physicians are independent practitioners who are not employees or agents of the

Caitlin Whyte (Host): valley Health System.

Host: The system shall not be liable for actions or treatments provided by physicians.