Carl Maronich (Host): Welcome to the Live Greater podcast series, information for a healthier you from the University of Maryland Medical System. I'm Carl Moronich and joining me today is Dr. Peter Olivieri, a Board Certified Pulmonary and Critical Care physician at the University of Maryland, Baltimore Washington Medical Center.

Doctor welcome to the podcast.

Peter Olivieri III, MD: Good morning. Thanks for having me.

Host: Today we're going to be talking about the importance of early lung cancer screening. So Doctor, let's get right into it. And let me ask, why is early diagnosis so critical when it comes to lung cancer?

Peter Olivieri III, MD: Well simply put, early diagnosis saves lives. Early stage lung cancer is small. It has not yet spread to the lymph nodes or other parts of the body, and it presents us with an opportunity to cure the disease if we can diagnose it early.

Host: You know, when people talk about lung cancer, they often think of it as a smoker's disease. What are the other risks? And who else is at risk?

Peter Olivieri III, MD: Yeah, you're absolutely right. So certainly in the United States, smoking remains the number one risk factor for lung cancer. Lung cancer accounts for about 80 to 85% of cases in the United States. However, that leaves 15 to 20% of patients in the US that have lung cancer that have never smoked. So clearly there are other factors at play.

Some of these include secondhand smoking, certainly an important one. There are also other occupational exposures such as patients that have been exposed to asbestos and even radon in our homes. There's actually a growing body of evidence that suggests that even air pollution and air quality can play a role in lung cancer development and certainly having a family history.

So having a first degree relative, that would be parents, siblings, and children with lung cancer, does increase the chance that someone could also develop lung cancer. So there seems to be a genetic component as well.

Host: So if someone has been a smoker, certainly they don't want to just say, oh, I've been smoking so it's too late for me to do. Stopping smoking certainly helps the circumstance.

Peter Olivieri III, MD: Absolutely. Yeah, and it's never too late.

Host: Great advice there. Certainly, for a lot of health reasons, smoking should be avoided. Let's talk a little bit about low dose CT scan and how that affects early diagnosis and, and the diagnosis of cancer.

Peter Olivieri III, MD: So that's the primary means by which we screen for lung cancer. And really the only means at this point, which is the low dose CT. And what that basically involves is what people commonly refer to as a CAT scan. So this is, kind of an x-ray test that patients can undergo on an annual basis if they qualify for lung cancer screening.

And this can help us to detect the disease early so that we can diagnose it and treat it.

Host: Symptoms related to lung cancer. Or maybe talk a little bit about that and, what are the symptoms or are their symptoms?

Peter Olivieri III, MD: If the disease progresses enough, there will eventually be symptoms, and those can be things like a persistent cough that won't go away, chest pain or trouble breathing. Those are probably the most common. However, we want to diagnose patients long before they develop symptoms, and that's the key behind screening. If we wait for symptoms to develop, our options to cure the patient are going to be significantly reduced.

Host: So your advice would be for someone who has smoked for a period of time, if they're not symptomatic, they should still look into getting a screening.

Peter Olivieri III, MD: Absolutely. Typically by definition, screening is done in individuals that are asymptomatic, in all conditions. And that's certainly true with lung cancer as well.

 The United States Preventative Services Task Force currently recommends screening patients aged 50 to 80 years old who have at least a 20 pack year smoking history, and who currently smoke or have quit within the past 15 years. 20 pack year is calculated by multiplying the number of packs smoked per day times the number of years a patient has smoked for.

Now, what screening entails is essentially an annual CT scan, which is a low dose CT scan, and for patients where the scan finds a positive finding, further evaluation is sometimes needed in the form of further imaging or even a biopsy.

Host: Let's talk a little bit about who may be at risk other than smokers. You know, you talked about a variety of kind of possibilities from radon in the home to some other things. Are there some individuals that may be more at risk than others?

Peter Olivieri III, MD: Yes. So some of those things that you mentioned. So if you do have high level of exposure to radon, that would certainly be a risk factor. And that's something that people should look into in their homes and certainly when they buy new homes. If necessary, they should have mitigation systems installed to reduce those levels. Patients that have been in certain occupations.

So I briefly mentioned asbestos earlier, which is a building material that is not used much these days, but patients that have been exposed to this in the past may still be at risk for particular types of lung cancer. And I did mention family history, so if you have a first degree relative that has had lung cancer, it does place you at some increased risk and living in certain parts of the world where there are higher levels of air pollution, such as in East Asia, has been associated with a significant increase in rates of lung cancer.

The tricky part with this is that these individuals, while they may be at risk, are not currently going to qualify for lung cancer screening in the United States. Really the only thing that can qualify someone at present time is a history of smoking cigarettes.

Host: Misconceptions that you hear from patients related to screenings and to lung cancer.

Peter Olivieri III, MD: Definitely. One thing that I hear a lot is that frankly people are just afraid of what they might find if they go looking. So patients that have a history of smoking, most of the time they know they're at risk of lung cancer and they may have anxiety and fear about finding that. So that may be one, either conscious or perhaps subconscious reason that they may be avoiding screening.

But there are so many other things that we can do, as a medical community to help patients understand the benefits because some patients may just not understand that they qualify. As we mentioned earlier, they may be under the impression that the test should only be done if they have symptoms, and that couldn't be further from the truth.

So we need to make sure that we do a good job of educating our patients and our community on what the criteria are and what the qualifications are that would allow someone to have the screening, and patients need to understand that it will generally be covered by insurance. So that's another misconception. They may think that it's going to be costly.

Host: Even after a scan shows something, more testing may be needed. Maybe you could talk a little bit about what happens next after somebody has a screening and, and there may be something that's found.

Peter Olivieri III, MD: Yes, that's correct. When we screen, just to take a step back, what we're looking for is something called pulmonary nodules. Now this is a word that simply means small, abnormal spots in the lungs. A significant number of patients that undergo screening will be found to have at least one pulmonary nodule.

But what's important to understand is that most of these do not represent cancer. So additional testing that you referenced is often aimed at trying to determine which of these nodules may represent cancer. The simplest tests that would often be done if a nodule is found would simply be another CT scan.

And sometimes these need to be done a little bit more frequently than annually for a period of time, at least initially, to ensure that nodules are not growing. Because if they are growing, that's something that would often prompt additional testing, such as a biopsy. If there are nodules that are found that do look concerning based on their appearance or other patient characteristics, additional tests could include things like a PET scan. Which is a different type of scan, similar to a CT scan that can help give additional information or even a biopsy. And a biopsy is where we go in with a procedure that would take a small piece of the nodule so that it can be looked at under a microscope to determine whether or not it truly is cancer.

Host: Bronchoscopies is another tool that can be used. Maybe you could talk a little bit about that and also what we're hearing about, are robotic bronchoscopies. Maybe you could talk a little about those.

Peter Olivieri III, MD: Absolutely. Bronchoscopy is a procedure that's done often by pulmonologists, lung doctors like myself, where we insert a camera that goes in the mouth and down the windpipe so that we can gain access to the lungs to take various types of samples such as biopsies. Now, traditionally, this test has been pretty accurate for diagnosing larger cancers and cancers that have spread to the lymph nodes.

However, the advent of robotic bronchoscopy, which is simply using a robot to do the same procedure, but in a more accurate and precise way, has allowed us to now take accurate samples from very, very small lung nodules. And this has been a game changer in early diagnosis. Because it allows us to go after these nodules and these cancers when they're still at a very early stage, which as we've already discussed, has tremendous benefits to the patients in terms of their survival.

Host: For those that are listening and maybe worried about their risk or, or a loved one, what steps should they take?

Peter Olivieri III, MD: I think the first step is just talking about it openly. Again, I still think that there's still a lot of stigma associated with smoking. Patients may feel ashamed. They know that it's often bad for their health. However, having an open dialogue about the fact that many people do smoke or many people, people have had a history of smoking in the past, and again, even if they're not having any symptoms, or even if they have quit smoking, they may still benefit from lung cancer screening.

If they themselves have a history of smoking or if they have friends or family that do; they should be encouraged to talk to their doctors about screening and whether or not they may qualify for it.

Host: As we wrap up, you know, the big takeaway, and I think you may have just said it, but to give a chance to reiterate the one thing you'd really like people to take away from this conversation.

Peter Olivieri III, MD: Yes. I think, again, it's teamwork. We have to work together as a community to raise awareness. This is a problem that we can solve. While lung cancer is a terrible disease, and it is a disease that is still unfortunately the number one cause of cancer death worldwide; it's something that if we work together to diagnose it early, it is a curable disease.

So the key here is to work along those lines to find it early so that we can take care of this and solve this problem for our community.

Host: Dr. Peter Olivieri, a lot of great information. Thanks so much for joining us on the podcast today.

Peter Olivieri III, MD: My pleasure. Thanks again for having me.

Host: Find more shows just like this one at umms.org/podcast and on YouTube. This is Live Greater, a Health and Wellness Podcast, brought to you by the University of Maryland Medical System. Please share this on your social media channels, and we look forward to having you join us again.

Thanks for listening.