Selected Podcast
Is Lung Cancer Screening Right For You?
Just like mammography and colonoscopy, there is lung cancer screening for individuals who qualify. Lung cancer screening is simple and painless and early detection is the best opportunity to beat this illness.
Featuring:
Troy Moritz, DO, FACOS
Dr. Moritz is chief of thoracic surgery at UPMC Esophageal and Lung Surgery Institute and director of the pulmonary nodule clinic and lung cancer screening program at UPMC. He is board certified by the American Osteopathic Board of Surgery in both general surgery and cardiothoracic surgery, and he is a fellow of the American College of Osteopathic Surgeons. Dr. Moritz achieved his medical degree at Lake Erie College of Osteopathic Medicine. Dr. Moritz completed general surgery training at UPMC Community Osteopathic Hospital followed by cardiothoracic fellowship at the Penn State Milton S. Hershey Medical Center. Transcription:
Bill Klaproth (Host): Lung cancer is the number one cause of cancer death in both men and women. So what are the risk factors? What are the symptoms and is lung cancer screening right for you? Well, let's learn more with Dr. Troy Moritz, Chief of Thoracic Surgery at UPMC in central Pennsylvania.
This is Healthier You, a podcast from UPMC. I'm Bill Klaproth. Dr. Moritz, thank you so much for your time. It's great to talk with you. So lung cancer is often viewed with a negative stigma. Why is that?
Troy Moritz, DO, FACOS (Guest): Yeah. Well, I appreciate you having me here. Thank you very much for giving me the time to talk about lung cancer. I think mostly the negative stigma comes from the fact that the data tells us that most lung cancer comes from smoking as a risk factor. So it's sort of seen as a smoker's disease. But there are other things that do attribute to lung cancer besides smoking.
Host: Yeah. So is it that if you get lung cancer, people look down on you, like you brought this on yourself, you must be a smoker. Is that part of the negative stigma?
Dr. Moritz: I think historically that was the case. As our society smoked heavily in the past. And now that we see people not smoking as often, and we're starting to appreciate that there's a larger population that does get lung cancer that doesn't smoke. Up to 20% of lung cancers are diagnosed in people that have never smoked.
Host: So let's talk more about that other than smoking, what are the other risk factors for lung cancer?
Dr. Moritz: The main things besides smoking that seem to attribute, when we look at the epidemiology is the people that are exposed to secondhand smoke and then also radon levels, which is a breakdown product that uranium that comes up through the soil and can be in people's houses. And so, you know, we always recommend people to get the radon level checked and mitigated if there's an elevated level, but then other things that are more commonly known about, but less impactful are things such as asbestos, diesel fume exhaust, a few other heavy metals and other environmental and occupational exposure.
Host: Yeah, we've heard certainly a lot more about radon in the recent past. Didn't know about diesel fume exhaust though. So interesting to learn that. And it's why we do these podcasts to try to inform and educate people of these potential risk factors for certain conditions. So when it comes to lung cancer, what symptoms should people be aware of?
Dr. Moritz: So lung cancer is like a lot of other cancers in the fact that we consider them sometimes silent killers. That just means that often, in the earliest stage, when they are the most treatable, there really are no symptoms. And when people do have symptoms, it's often middle or later in the disease process. But when we do hear about patients with symptoms, it tends to be things that are respiratory related. So things such as cough and maybe with coughing, there might be a coughing up of some blood streaked sputum. Sometimes changes to a voice. Some hoarseness can set in, shortness of breath or wheezing. Occasionally can be chest pain related to a tumor depending on its location.
Sometimes we'll see weight loss, unintentional weight loss that is, loss of appetite. You can have headaches, bone pain. And then a few other sort of vague symptoms. So you can see the list now that I described to you is a lot of vague symptoms that aren't specific to lung cancer and can be attributed to a lot of other things. So sometimes it's really difficult to pin those down and come up with a diagnosis.
Host: Well, I know that we've made vast improvements in screenings for cancers. What is the best chance for a cure though from lung cancer?
Dr. Moritz: The best chance for cure is early diagnosis. So we really try to find it as early as we can. When we consider it sort of stage one, then the cure rates are way up in the 90% range. When it, as each stage the disease is found in goes down, cure rates also go down.
So we try to advocate for screening these days. Fortunately in the last decade, we've developed a tool for that. And that's lung cancer screening with a CAT scan. And other malignancies have had screening modalities that people are aware of, a mammogram for breast cancer, colonoscopies for colon cancer, and prostate, the prostate specific antigen for that. And all those cancers have benefited from screening with a sort of reductions in death rates and mortality, because they found it earlier and were able to treat it more effectively.
So finally lung cancer has kind of come into that realm. And so in the last decade now, it's been proven that, a low dose, you know, non-contrast, you don't need IV contrast, a CT scan, is a great way to find lung cancer early. And historically we've found it sort of incidentally when people had CAT scans because they had kidney stones or had some other issue or fell off a ladder and got a CAT scan when they went to the ER, and we accidentally found it. Now we can look for it intentionally. So that's a huge bump in survival.
Host: So in the future, I know that the colonoscopy is the gold standard for finding colon cancer and that has saved countless lives, in the future might the CT technology do the same for lung cancer?
Dr. Moritz: Yeah, that's the hope. Differences between sort of a colonoscopy is colonoscopies are recommended for everyone over a certain age, not limiting it to a high risk group. With lung cancer screening, the early data suggests the best survival benefits have been in the high risk group. So initially we recommended screening only for people that had smoked 30 pack years or a pack a day for 30 years, and were over 55 and under 80. That has been sort of liberalized or expanded now. And now we recommend screening for people that are 50 to 77 years of age, that may have smoked a 20 pack years or more, so we've broadened out the definition of who fits into that high risk category, just so we can find and hopefully effectively treat lung cancer.
Host: Yeah. So early detection is only as good as early treatment. Can you talk about what you do at UPMC? We have a pulmonary nodule clinic bringing together specialists who formulate the best possible plan, if a nodule is found, can you talk about that?
Dr. Moritz: I personally think that that's a key parts of the whole process. If you're going to screen for lung cancer, you really need a good process in place for when you find things. When it comes to nodules, they're just spots that we see on a CAT scan. Many of them turn out to be benign. They're hamartomas, granulomas, scar tissue. There's a lot of things that you can see on a CAT scan that are basically small spots that we call nodules. What we really need to do, is pull together a group of people with expertise and figure out which one of that group of patients has a higher risk and warrants, maybe a biopsy.
And then we want to pick out those patients that do actually have cancer out of that group and be able to effectively treat them. So that's basically what we do. We see those patients that have nodules, we offer a lot of reassurance because a lot of times they're not cancer. And so people do get a little excited when they get a nodule found on a CT. So a good bit of what we do is educate people and then we try to filter through them and figure out who needs biopsies. And then run them through that process as safely and effectively as we can.
If you have a nodule and it's not very suspicious, we'll often put you into what we consider surveillance, and that means you'll get additional CAT scans over a period of time. Depending on the kind of nodule that you have, that may be a two year period, or it may be as long as three to five years.
Host: So if a nodule is found your specialists there, evaluate the nodule and then monitor it for changes over time. Is that right?
Dr. Moritz: Yeah, we're looking for changes, either becoming more dense or getting larger. That would raise some suspicion and then warrant a biopsy. But we certainly don't want to biopsy every nodule that comes through because we would biopsy lots of patients that had benign nodules that didn't need a biopsy that would just introduce extra risk to people.
Host: And you said they have opened the window for eligible screening. Now it's 50 to 77 years of age. Is that right? Or current or former heavy smokers? Is that correct?
Dr. Moritz: Yep. And that's in the last year that process has sort of gone through with the recommendation. And then that goes to Medicare and then Medicare approves it, and then it sort of filters out to the other insurance providers nationally. So that process is almost completed. Most insurance companies currently are expanding the coverage to that age group and that lesser pack year history of smoking, just so we can offer it to more people.
Host: So as we talked about advances in screening, what is new in treating lung cancer? Can you share that information with us?
Dr. Moritz: Yeah. This is something I love to talk about. You can sum it up as to the last five years has been more productive. And there's been more innovation in the world of lung cancer, than there was in the prior 50 years. And that goes to sort of all gamuts of how we treat it, from surgical interventions, which is where my expertise is, to the medical oncologists, to the radiation oncologists, and diagnostic colleagues in pulmonary as well. And so it's, it's sort of a Renaissance time for us and it's shown great strides, as far as outcomes go.
So some of the technology that we have, over about a year and a half ago, we acquired navigational bronchoscopy with a robotic system. And so it's enabled us to be even more accurate when we go out into the lung with a very small catheter and steerable, allows us to get to these small nodules, smaller size and further out than we once could. We're happy to offer that and it's really shown some advancements for us with a little bit less risk on than we previously had, so that's one of our newer advances. We try to do most of our surgery, if it comes to that, with robotic technology so we can hopefully offer surgical resection of people's lung cancer with curative intention, with less pain, less morbidity, less recovery time. And if patients do need say chemotherapy after surgery, hopefully they can get to that sooner, which also improves outcomes.
Host: So this bronchoscopy is available at UPMC West Shore. This is an ultra thin, ultra maneuverable catheter that allows you to kind of, layman's terms, steer around inside the lung to find potential suspicious areas. Is that kind of it?
Dr. Moritz: Yeah. And we're able to take the CT scan and pair it up with the software, draw a pathway through the airways to the lesion. And then essentially once we put the patient to sleep, put a breathing tube in and we were able to take that scope down through that tube, down into the main airway and then follow the pathway out into the lung and to the target. And it's very small. It's very maneuverable and gives us a high degree of accuracy.
Host: Yeah. Wow. This is really interesting, well, thank you for de-stigmatizing lung cancer for us, Dr. Moritz. As we wrap up, is there anything you want to add for our discussion about lung cancer today?
Dr. Moritz: I've been doing this for quite some time and it's been sort of wonderful over the years to see lung cancer move away from that stigma. And, initially it was thought of as just a disease of smokers and it was also thought of as a cancer that didn't have a lot of hope or optimism around it.
And that's changed quite a bit over the years. And so as a person who deals with lung cancer on a regular basis, it's nice know that we can offer patients a lot more hope, a lot more optimism, a lot more improvement in survival and not just survival, but quality survival. So it's been a nice ride over the time that I've been in my career to see that all evolve. It's been great partnering with UPMC. Part of that too, because that's also offered some extra innovation and research protocols and things that we can offer here locally in our market.
Host: Absolutely. Well, Dr. Moritz, thank you so much for your time. This has really been informative. We appreciate your time. Thanks again.
Dr. Moritz: No, I appreciate you too having me here. Thank you.
Host: And once again, that's Dr. Troy Moritz and for more information about lung cancer screening in central Pennsylvania, please log on to upmc.com/centralpalcs. That's upmc.com/centralpalcs. 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. I'm Bill Klaproth. Thanks for listening.
Bill Klaproth (Host): Lung cancer is the number one cause of cancer death in both men and women. So what are the risk factors? What are the symptoms and is lung cancer screening right for you? Well, let's learn more with Dr. Troy Moritz, Chief of Thoracic Surgery at UPMC in central Pennsylvania.
This is Healthier You, a podcast from UPMC. I'm Bill Klaproth. Dr. Moritz, thank you so much for your time. It's great to talk with you. So lung cancer is often viewed with a negative stigma. Why is that?
Troy Moritz, DO, FACOS (Guest): Yeah. Well, I appreciate you having me here. Thank you very much for giving me the time to talk about lung cancer. I think mostly the negative stigma comes from the fact that the data tells us that most lung cancer comes from smoking as a risk factor. So it's sort of seen as a smoker's disease. But there are other things that do attribute to lung cancer besides smoking.
Host: Yeah. So is it that if you get lung cancer, people look down on you, like you brought this on yourself, you must be a smoker. Is that part of the negative stigma?
Dr. Moritz: I think historically that was the case. As our society smoked heavily in the past. And now that we see people not smoking as often, and we're starting to appreciate that there's a larger population that does get lung cancer that doesn't smoke. Up to 20% of lung cancers are diagnosed in people that have never smoked.
Host: So let's talk more about that other than smoking, what are the other risk factors for lung cancer?
Dr. Moritz: The main things besides smoking that seem to attribute, when we look at the epidemiology is the people that are exposed to secondhand smoke and then also radon levels, which is a breakdown product that uranium that comes up through the soil and can be in people's houses. And so, you know, we always recommend people to get the radon level checked and mitigated if there's an elevated level, but then other things that are more commonly known about, but less impactful are things such as asbestos, diesel fume exhaust, a few other heavy metals and other environmental and occupational exposure.
Host: Yeah, we've heard certainly a lot more about radon in the recent past. Didn't know about diesel fume exhaust though. So interesting to learn that. And it's why we do these podcasts to try to inform and educate people of these potential risk factors for certain conditions. So when it comes to lung cancer, what symptoms should people be aware of?
Dr. Moritz: So lung cancer is like a lot of other cancers in the fact that we consider them sometimes silent killers. That just means that often, in the earliest stage, when they are the most treatable, there really are no symptoms. And when people do have symptoms, it's often middle or later in the disease process. But when we do hear about patients with symptoms, it tends to be things that are respiratory related. So things such as cough and maybe with coughing, there might be a coughing up of some blood streaked sputum. Sometimes changes to a voice. Some hoarseness can set in, shortness of breath or wheezing. Occasionally can be chest pain related to a tumor depending on its location.
Sometimes we'll see weight loss, unintentional weight loss that is, loss of appetite. You can have headaches, bone pain. And then a few other sort of vague symptoms. So you can see the list now that I described to you is a lot of vague symptoms that aren't specific to lung cancer and can be attributed to a lot of other things. So sometimes it's really difficult to pin those down and come up with a diagnosis.
Host: Well, I know that we've made vast improvements in screenings for cancers. What is the best chance for a cure though from lung cancer?
Dr. Moritz: The best chance for cure is early diagnosis. So we really try to find it as early as we can. When we consider it sort of stage one, then the cure rates are way up in the 90% range. When it, as each stage the disease is found in goes down, cure rates also go down.
So we try to advocate for screening these days. Fortunately in the last decade, we've developed a tool for that. And that's lung cancer screening with a CAT scan. And other malignancies have had screening modalities that people are aware of, a mammogram for breast cancer, colonoscopies for colon cancer, and prostate, the prostate specific antigen for that. And all those cancers have benefited from screening with a sort of reductions in death rates and mortality, because they found it earlier and were able to treat it more effectively.
So finally lung cancer has kind of come into that realm. And so in the last decade now, it's been proven that, a low dose, you know, non-contrast, you don't need IV contrast, a CT scan, is a great way to find lung cancer early. And historically we've found it sort of incidentally when people had CAT scans because they had kidney stones or had some other issue or fell off a ladder and got a CAT scan when they went to the ER, and we accidentally found it. Now we can look for it intentionally. So that's a huge bump in survival.
Host: So in the future, I know that the colonoscopy is the gold standard for finding colon cancer and that has saved countless lives, in the future might the CT technology do the same for lung cancer?
Dr. Moritz: Yeah, that's the hope. Differences between sort of a colonoscopy is colonoscopies are recommended for everyone over a certain age, not limiting it to a high risk group. With lung cancer screening, the early data suggests the best survival benefits have been in the high risk group. So initially we recommended screening only for people that had smoked 30 pack years or a pack a day for 30 years, and were over 55 and under 80. That has been sort of liberalized or expanded now. And now we recommend screening for people that are 50 to 77 years of age, that may have smoked a 20 pack years or more, so we've broadened out the definition of who fits into that high risk category, just so we can find and hopefully effectively treat lung cancer.
Host: Yeah. So early detection is only as good as early treatment. Can you talk about what you do at UPMC? We have a pulmonary nodule clinic bringing together specialists who formulate the best possible plan, if a nodule is found, can you talk about that?
Dr. Moritz: I personally think that that's a key parts of the whole process. If you're going to screen for lung cancer, you really need a good process in place for when you find things. When it comes to nodules, they're just spots that we see on a CAT scan. Many of them turn out to be benign. They're hamartomas, granulomas, scar tissue. There's a lot of things that you can see on a CAT scan that are basically small spots that we call nodules. What we really need to do, is pull together a group of people with expertise and figure out which one of that group of patients has a higher risk and warrants, maybe a biopsy.
And then we want to pick out those patients that do actually have cancer out of that group and be able to effectively treat them. So that's basically what we do. We see those patients that have nodules, we offer a lot of reassurance because a lot of times they're not cancer. And so people do get a little excited when they get a nodule found on a CT. So a good bit of what we do is educate people and then we try to filter through them and figure out who needs biopsies. And then run them through that process as safely and effectively as we can.
If you have a nodule and it's not very suspicious, we'll often put you into what we consider surveillance, and that means you'll get additional CAT scans over a period of time. Depending on the kind of nodule that you have, that may be a two year period, or it may be as long as three to five years.
Host: So if a nodule is found your specialists there, evaluate the nodule and then monitor it for changes over time. Is that right?
Dr. Moritz: Yeah, we're looking for changes, either becoming more dense or getting larger. That would raise some suspicion and then warrant a biopsy. But we certainly don't want to biopsy every nodule that comes through because we would biopsy lots of patients that had benign nodules that didn't need a biopsy that would just introduce extra risk to people.
Host: And you said they have opened the window for eligible screening. Now it's 50 to 77 years of age. Is that right? Or current or former heavy smokers? Is that correct?
Dr. Moritz: Yep. And that's in the last year that process has sort of gone through with the recommendation. And then that goes to Medicare and then Medicare approves it, and then it sort of filters out to the other insurance providers nationally. So that process is almost completed. Most insurance companies currently are expanding the coverage to that age group and that lesser pack year history of smoking, just so we can offer it to more people.
Host: So as we talked about advances in screening, what is new in treating lung cancer? Can you share that information with us?
Dr. Moritz: Yeah. This is something I love to talk about. You can sum it up as to the last five years has been more productive. And there's been more innovation in the world of lung cancer, than there was in the prior 50 years. And that goes to sort of all gamuts of how we treat it, from surgical interventions, which is where my expertise is, to the medical oncologists, to the radiation oncologists, and diagnostic colleagues in pulmonary as well. And so it's, it's sort of a Renaissance time for us and it's shown great strides, as far as outcomes go.
So some of the technology that we have, over about a year and a half ago, we acquired navigational bronchoscopy with a robotic system. And so it's enabled us to be even more accurate when we go out into the lung with a very small catheter and steerable, allows us to get to these small nodules, smaller size and further out than we once could. We're happy to offer that and it's really shown some advancements for us with a little bit less risk on than we previously had, so that's one of our newer advances. We try to do most of our surgery, if it comes to that, with robotic technology so we can hopefully offer surgical resection of people's lung cancer with curative intention, with less pain, less morbidity, less recovery time. And if patients do need say chemotherapy after surgery, hopefully they can get to that sooner, which also improves outcomes.
Host: So this bronchoscopy is available at UPMC West Shore. This is an ultra thin, ultra maneuverable catheter that allows you to kind of, layman's terms, steer around inside the lung to find potential suspicious areas. Is that kind of it?
Dr. Moritz: Yeah. And we're able to take the CT scan and pair it up with the software, draw a pathway through the airways to the lesion. And then essentially once we put the patient to sleep, put a breathing tube in and we were able to take that scope down through that tube, down into the main airway and then follow the pathway out into the lung and to the target. And it's very small. It's very maneuverable and gives us a high degree of accuracy.
Host: Yeah. Wow. This is really interesting, well, thank you for de-stigmatizing lung cancer for us, Dr. Moritz. As we wrap up, is there anything you want to add for our discussion about lung cancer today?
Dr. Moritz: I've been doing this for quite some time and it's been sort of wonderful over the years to see lung cancer move away from that stigma. And, initially it was thought of as just a disease of smokers and it was also thought of as a cancer that didn't have a lot of hope or optimism around it.
And that's changed quite a bit over the years. And so as a person who deals with lung cancer on a regular basis, it's nice know that we can offer patients a lot more hope, a lot more optimism, a lot more improvement in survival and not just survival, but quality survival. So it's been a nice ride over the time that I've been in my career to see that all evolve. It's been great partnering with UPMC. Part of that too, because that's also offered some extra innovation and research protocols and things that we can offer here locally in our market.
Host: Absolutely. Well, Dr. Moritz, thank you so much for your time. This has really been informative. We appreciate your time. Thanks again.
Dr. Moritz: No, I appreciate you too having me here. Thank you.
Host: And once again, that's Dr. Troy Moritz and for more information about lung cancer screening in central Pennsylvania, please log on to upmc.com/centralpalcs. That's upmc.com/centralpalcs. 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. I'm Bill Klaproth. Thanks for listening.