Lung Cancer Screening and Pulmonary Nodules
Smokers and former heavy smokers need lung care screenings to reduce risk for lung cancer. Dr. Troy Moritz, Director of Thoracic Surgery Director of Lung Cancer Screening and Pulmonary Nodule Clinic, discusses lung cancer and pulmonary nodules.
Featuring:
Dr. Moritz volunteers his time to serve as chair for the American Lung Association's Mid-Atlantic Executive Board as well as sits on the south central PA American Lung Association Leadership Board.
Troy Moritz, DO
Dr. Moritz completed his medical degree at Lake Erie College of Medicine. He continued his training as a general surgery resident at UPMC Pinnacle Community Osteopathic followed by cardiothoracic fellowship at Penn State Milton S. Hershey Medical Center. Dr. Moritz is board certified by the American Osteopathic Board of Surgery.Dr. Moritz volunteers his time to serve as chair for the American Lung Association's Mid-Atlantic Executive Board as well as sits on the south central PA American Lung Association Leadership Board.
Transcription:
Bill Klaproth (Host): If you’re a smoker between 55 and 78 years of age and a current or former heavy smoker; one of the best things you can do is get a lung cancer screening. We’re going to find out why with Dr. Troy Moritz, Director of Thoracic Surgery and Director of the Lung Cancer Screening and the Pulmonary Nodule Clinic at UPMC Pinnacle.
This is Healthier You, a podcast from UPMC Pinnacle. I’m Bill Klaproth. Dr. Moritz, let’s start with this. how prevalent is lung cancer?
Troy Moritz, DO, FACOS (Guest): Thanks for having me on. I do appreciate being here. Lung cancer is a significant problem. It is the number one cancer killer in the United States currently and surpasses other cancers that are more commonly heard about such as colon and prostate. It’s the number two most common cancer in men behind prostate and behind breast in women, but it actually kills more people than either one of those. And it actually kills twice as many people as breast cancer which is one of the most common cancers that we hear about. So, it’s a big problem with a large impact throughout the country.
Host: Wow, those are sobering statistics. I did not know of those and I would imagine many people that are listening to this right now may not know that lung cancer is the number one killer and the number two most common cancer. Did not know that. So, the next question is who does lung cancer strike or who is most at risk for lung cancer?
Dr. Moritz: People that are at risk, the most common risk factor is smoking. Traditionally we think of people in the high risk category is those who have smoked 30 pack years which is about a pack a day for 30 years. But you can be at risk less than that and people at 15 to 20 years are an additional risk factor certainly in the high risk category. And other things that are additional risk factors include exposure to diesel fume exhaust, high radon levels in your house, asbestos exposure and there’s a few other heavy metals and elements and things that you can breathe in that will damage the insides of your lungs that can lead to cancer as well.
Host: Right so, if you are in one of those categories that Dr. Moritz just said, is it important then, should someone be proactive and get a lung cancer screening?
Dr. Moritz: Yeah, if you meet the criteria, lung cancer screening is currently our best method of detecting lung cancer early when it’s best treatable. It’s way better to be treated when it is stage one, stage four less likely to be treated, more likely we are just going to palliate or try to relieve symptoms at that stage. Historically, people have the best chance of survival are the ones that sort of had their cancer found accidentally. And that would people that showed up at the ER maybe with a kidney stone or they fell off the ladder or something and they wound up getting an x-ray or a CAT scan that picked up their lung cancer and it was incidentally or accidentally found. And it was early stage and we were able to do something like surgery or aggressive radiation to treat those tumors.
So, lung cancer screening now is a way for us to go actively and proactively find those lung cancers while they are very early stage, before they are symptomatic and that’s one of the problems is once people become symptomatic; then the tumor is usually much larger and has invaded into the chest causing pain or it’s invaded the blood vessels and they cough up blood. Things that often mean that maybe we’re talking about a later stage cancer that’s no longer curable or much, much harder to cure. So, we like to find them early.
Host: Right. The best outcome. So, you were just talking about being symptomatic and you were mentioning chest pain, coughing up blood. Are there other symptoms that we should be aware of?
Dr. Moritz: Yeah, there’s some interesting symptoms such as clubbing of the fingernails. Sometimes people will have progressive shortness of breath that may be due to fluid buildup in their chest related to a tumor. But those are some of the more common ones that you would hear about.
Host: So, let’s talk about the screening then and this is different than a normal x-ray, correct? Tell us about this screening that you offer at UPMC.
Dr. Moritz: Yeah, so this screening, we follow the National Comprehensive Cancer Network Guidelines as well as the National Lung Cancer Screening Trial Guidelines and what they did was these are very, very low dose of radiation, much lower than a standard CAT scan. So, this is a CAT scan, image quality is degraded a little bit because of less radiation, however, it’s plenty good to find lung nodules so we can offer a diagnostic test with less harm in that regard. The test is a quick CAT scan.
You have to get a script from a physician to get it and you have to sort of go through what’s called shared decision making visit to talk about the risk of radiation, talk about the risk of what if we find a nodule, there’s sometimes anxiety associated with that and then sometimes you need to get a biopsy or another kind of a test which has some risks. So, we really like to talk to people up front before they enter into screening and it’s actually part of the Medicare Guidelines to have a shared decision making visit before providing that script to go get the CAT scan. And then typically it means that you are going to wind up with an annual CAT scan so there is some follow up down the road as well.
And obviously we like the opportunity to discuss smoking cessation if that’s still an active issue.
Host: Yeah, which is very important to discuss. So, this screening then is basically a regular CAT scan, people know what that is, but it is lower dose radiation.
Dr. Moritz: Yeah and it’s a great test for looking for lung nodules or early lung cancer but if you do have symptoms then really what a patient needs is a traditional normal CAT scan that has a much higher diagnostic quality to sort of figure out what the symptoms are from. So, this is for asymptomatic people.
Host: And then how long has UPMC Pinnacle been offering the lung cancer screenings?
Dr. Moritz: We’ve been offering lung cancer screenings since around 2012, that’s when the National Lung Cancer Screening Trial results were released and within a month or two, we got our program up and running so we have been doing it for quite some time.
Host: And then you are a Lung Cancer Screening Center of excellence. What does it mean to have that designation?
Dr. Moritz: Yeah, there are actually two different lung cancer screening center of excellence designations. We have both of them. One is by – was initially Lung Cancer Alliance which is now GO2 Foundation and their component is they look at your program as a whole. They make sure that you have got nurse navigators in place to sort of help deal with the patient population and make sure that patients do follow up scans. Just getting one random scan doesn’t really help. You really nee to follow up if there’s an abnormal finding and so we have all the mechanisms in place to offer a multidisciplinary lung cancer screening program and a pulmonary nodule clinic to deal with the results of that.
Then there’s the American College of Radiology’s accreditation and that’s mostly focused more on the actual CAT scanners and ensuring that they do deliver the lowest dose of radiation possible and that the radiologists that are reading these scans are all specifically trained in that. And so it kind of comes from both directions. And we currently have Center of Excellence from both.
Host: Well it’s great that we have a Lung Cancer Screening Center of Excellence right here in our backyard. Last question, we have heard, or it’s been hammered into our heads that when you turn 50, get that colonoscopy, get that colonoscopy. Should we be thinking the same thing if someone is in those high risk categories? Get in there and get that lung cancer screening. Should we all be thinking of that?
Dr. Moritz: Yeah. the task force on screening decided to make the age range 55 to 80. Medicare then came in and will pay for the screening 55 to 78. Some private insurances are carrying it up to 80. But that’s basically the age range is when you get to be 55. And the reason for that is that’s where the highest risk population is and when they wanted to do the screening, it’s not like a colonoscopy where everyone is supposed to get it or everyone is supposed to get a mammogram that’s female or everyone is supposed to get a prostate check when they are male. This is specifically targeted to high risk smokers and they narrowed that age range to 55 to 78.
Host: So, if you are in that high risk category, as with all cancers, as you said earlier, the best chance of survival is finding lung cancer in it’s earliest most curable stages. So, if you are in one of those high risk categories, get in there and get that screening is that right, Dr. Moritz?
Dr. Moritz: Absolutely. That is our best chance and hands down, if we can find it when it’s really small, then your odds of a successful surgery or successful radiation treatment go way up.
Host: Well this is really, really important information and thank you so much for sharing with us Dr. Moritz. We appreciate your time. Thank you.
Dr. Moritz: My pleasure.
Host: That’s Dr. Troy Moritz and you can learn more abut lung cancer screening online at www.upmcpinnacle.com/lungscreening. That’s www.upmcpinnacle.com/lungscreening. Go there to learn more and 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. This is Healthier You, a podcast from UPMC Pinnacle. I’m Bill Klaproth. Thanks for listening.
Bill Klaproth (Host): If you’re a smoker between 55 and 78 years of age and a current or former heavy smoker; one of the best things you can do is get a lung cancer screening. We’re going to find out why with Dr. Troy Moritz, Director of Thoracic Surgery and Director of the Lung Cancer Screening and the Pulmonary Nodule Clinic at UPMC Pinnacle.
This is Healthier You, a podcast from UPMC Pinnacle. I’m Bill Klaproth. Dr. Moritz, let’s start with this. how prevalent is lung cancer?
Troy Moritz, DO, FACOS (Guest): Thanks for having me on. I do appreciate being here. Lung cancer is a significant problem. It is the number one cancer killer in the United States currently and surpasses other cancers that are more commonly heard about such as colon and prostate. It’s the number two most common cancer in men behind prostate and behind breast in women, but it actually kills more people than either one of those. And it actually kills twice as many people as breast cancer which is one of the most common cancers that we hear about. So, it’s a big problem with a large impact throughout the country.
Host: Wow, those are sobering statistics. I did not know of those and I would imagine many people that are listening to this right now may not know that lung cancer is the number one killer and the number two most common cancer. Did not know that. So, the next question is who does lung cancer strike or who is most at risk for lung cancer?
Dr. Moritz: People that are at risk, the most common risk factor is smoking. Traditionally we think of people in the high risk category is those who have smoked 30 pack years which is about a pack a day for 30 years. But you can be at risk less than that and people at 15 to 20 years are an additional risk factor certainly in the high risk category. And other things that are additional risk factors include exposure to diesel fume exhaust, high radon levels in your house, asbestos exposure and there’s a few other heavy metals and elements and things that you can breathe in that will damage the insides of your lungs that can lead to cancer as well.
Host: Right so, if you are in one of those categories that Dr. Moritz just said, is it important then, should someone be proactive and get a lung cancer screening?
Dr. Moritz: Yeah, if you meet the criteria, lung cancer screening is currently our best method of detecting lung cancer early when it’s best treatable. It’s way better to be treated when it is stage one, stage four less likely to be treated, more likely we are just going to palliate or try to relieve symptoms at that stage. Historically, people have the best chance of survival are the ones that sort of had their cancer found accidentally. And that would people that showed up at the ER maybe with a kidney stone or they fell off the ladder or something and they wound up getting an x-ray or a CAT scan that picked up their lung cancer and it was incidentally or accidentally found. And it was early stage and we were able to do something like surgery or aggressive radiation to treat those tumors.
So, lung cancer screening now is a way for us to go actively and proactively find those lung cancers while they are very early stage, before they are symptomatic and that’s one of the problems is once people become symptomatic; then the tumor is usually much larger and has invaded into the chest causing pain or it’s invaded the blood vessels and they cough up blood. Things that often mean that maybe we’re talking about a later stage cancer that’s no longer curable or much, much harder to cure. So, we like to find them early.
Host: Right. The best outcome. So, you were just talking about being symptomatic and you were mentioning chest pain, coughing up blood. Are there other symptoms that we should be aware of?
Dr. Moritz: Yeah, there’s some interesting symptoms such as clubbing of the fingernails. Sometimes people will have progressive shortness of breath that may be due to fluid buildup in their chest related to a tumor. But those are some of the more common ones that you would hear about.
Host: So, let’s talk about the screening then and this is different than a normal x-ray, correct? Tell us about this screening that you offer at UPMC.
Dr. Moritz: Yeah, so this screening, we follow the National Comprehensive Cancer Network Guidelines as well as the National Lung Cancer Screening Trial Guidelines and what they did was these are very, very low dose of radiation, much lower than a standard CAT scan. So, this is a CAT scan, image quality is degraded a little bit because of less radiation, however, it’s plenty good to find lung nodules so we can offer a diagnostic test with less harm in that regard. The test is a quick CAT scan.
You have to get a script from a physician to get it and you have to sort of go through what’s called shared decision making visit to talk about the risk of radiation, talk about the risk of what if we find a nodule, there’s sometimes anxiety associated with that and then sometimes you need to get a biopsy or another kind of a test which has some risks. So, we really like to talk to people up front before they enter into screening and it’s actually part of the Medicare Guidelines to have a shared decision making visit before providing that script to go get the CAT scan. And then typically it means that you are going to wind up with an annual CAT scan so there is some follow up down the road as well.
And obviously we like the opportunity to discuss smoking cessation if that’s still an active issue.
Host: Yeah, which is very important to discuss. So, this screening then is basically a regular CAT scan, people know what that is, but it is lower dose radiation.
Dr. Moritz: Yeah and it’s a great test for looking for lung nodules or early lung cancer but if you do have symptoms then really what a patient needs is a traditional normal CAT scan that has a much higher diagnostic quality to sort of figure out what the symptoms are from. So, this is for asymptomatic people.
Host: And then how long has UPMC Pinnacle been offering the lung cancer screenings?
Dr. Moritz: We’ve been offering lung cancer screenings since around 2012, that’s when the National Lung Cancer Screening Trial results were released and within a month or two, we got our program up and running so we have been doing it for quite some time.
Host: And then you are a Lung Cancer Screening Center of excellence. What does it mean to have that designation?
Dr. Moritz: Yeah, there are actually two different lung cancer screening center of excellence designations. We have both of them. One is by – was initially Lung Cancer Alliance which is now GO2 Foundation and their component is they look at your program as a whole. They make sure that you have got nurse navigators in place to sort of help deal with the patient population and make sure that patients do follow up scans. Just getting one random scan doesn’t really help. You really nee to follow up if there’s an abnormal finding and so we have all the mechanisms in place to offer a multidisciplinary lung cancer screening program and a pulmonary nodule clinic to deal with the results of that.
Then there’s the American College of Radiology’s accreditation and that’s mostly focused more on the actual CAT scanners and ensuring that they do deliver the lowest dose of radiation possible and that the radiologists that are reading these scans are all specifically trained in that. And so it kind of comes from both directions. And we currently have Center of Excellence from both.
Host: Well it’s great that we have a Lung Cancer Screening Center of Excellence right here in our backyard. Last question, we have heard, or it’s been hammered into our heads that when you turn 50, get that colonoscopy, get that colonoscopy. Should we be thinking the same thing if someone is in those high risk categories? Get in there and get that lung cancer screening. Should we all be thinking of that?
Dr. Moritz: Yeah. the task force on screening decided to make the age range 55 to 80. Medicare then came in and will pay for the screening 55 to 78. Some private insurances are carrying it up to 80. But that’s basically the age range is when you get to be 55. And the reason for that is that’s where the highest risk population is and when they wanted to do the screening, it’s not like a colonoscopy where everyone is supposed to get it or everyone is supposed to get a mammogram that’s female or everyone is supposed to get a prostate check when they are male. This is specifically targeted to high risk smokers and they narrowed that age range to 55 to 78.
Host: So, if you are in that high risk category, as with all cancers, as you said earlier, the best chance of survival is finding lung cancer in it’s earliest most curable stages. So, if you are in one of those high risk categories, get in there and get that screening is that right, Dr. Moritz?
Dr. Moritz: Absolutely. That is our best chance and hands down, if we can find it when it’s really small, then your odds of a successful surgery or successful radiation treatment go way up.
Host: Well this is really, really important information and thank you so much for sharing with us Dr. Moritz. We appreciate your time. Thank you.
Dr. Moritz: My pleasure.
Host: That’s Dr. Troy Moritz and you can learn more abut lung cancer screening online at www.upmcpinnacle.com/lungscreening. That’s www.upmcpinnacle.com/lungscreening. Go there to learn more and 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. This is Healthier You, a podcast from UPMC Pinnacle. I’m Bill Klaproth. Thanks for listening.