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Why Screen for Lung Cancer and Overcoming Any Fears
Dr. Alden Maier discusses the importance of lung cancer screenings and tips on overcoming any fears.
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Learn more about Alden Maier, MD, FACS, FACCP
Alden Maier, MD, FACS, FACCP
Dr. Maier specializes in minimally invasive thoracic surgery, which mainly involves surgical procedures of the lungs and esophagus, as well as other types of surgical procedures within the chest. She believes providing personal, detailed care for each patient is the key to delivering exceptional care. She finds gratitude in helping patients through their health crisis and putting them on the road to better health. Dr. Maier is also an advocate for providing patients with clear communication and easier-to-understand clinical education in order to achieve positive outcomes.Learn more about Alden Maier, MD, FACS, FACCP
Transcription:
Why Screen for Lung Cancer and Overcoming Any Fears
Caitlin Whyte: Low lung cancer screening rates are multifactorial, but many patients have a fear that there may be a finding or are in denial, that there is no benefit in even being screened. By discussing these fears, diagnosing early is the best prospect for being cured and understanding the minimally invasive interventions available. Dr. Alden Maier is a physician at WakeMed Heart and Vascular and hopes to help current and past smokers reconsider this lifesaving screening. She joins us today. This is WakeMed Voices, a podcast by WakeMed Health and Hospitals. I'm your host, Caitlin Whyte. So Dr. Maier, let's talk about this fear of screening. What are most people scared of?
Dr. Maier: So, I think it's a combination of factors, some of which relate to the screen itself, radiation dosing, and, you know, the things that, you know, might physically be harmful to them. But I think that's a smaller part. I think a bigger part of it is the fear of what we may find. And there are two categories of that. There is, you know, the fear of, well I've smoked for all these years, so they're probably going to find a lung cancer and then I'm going to, you know, find out that I'm going to die. Then the other category is finding something that's not a lung cancer, but they end up having a bunch of tests. And there are a lot of expenses and procedures and, you know, sometimes procedures that are invasive or, you know, can cause discomfort. And then ultimately it not being a lung cancer and having gone through all of that for nothing.
And I think that's a smaller piece of it because a lot of times patients wouldn't know that ahead of time until they show up and they get their pre prescreen counseling, which we do for all of our lung cancer screening patients. So I think the biggest piece is the, I guess you could call it denial or just the fear of a finding. And I think, you know, that's what I really think we as lung surgeons, and lung doctors and cancer doctors need to increase in terms of awareness, is that the benefit, you know, of finding something small and early is a total game changer. As opposed to not having a screen and then ending up with metastatic lung cancer in two or three years, that's a much, much less curable situation than somebody who could have a minimally invasive surgery be out of work for two weeks and then be cured of a lung cancer, which is the goal of lung screening.
Host: That leads me into my next question. You kind of dived into it already, but why is early intervention so important?
Dr. Maier: Three-Fourths of lung cancers when they present are stage three or four, which is not curable. So detecting them early is very hard because there are symptoms and the early cases are the ones that we can cure. So we don't know about the ones that we can cure without a scan. And that's why the guidelines are potentially a game changer, but the patients that meet criteria for lung screening, the number that actually get lung screening scans is a tiny fraction of people who would qualify. So it's, and I think a lot of it has to do with the fear factor.
Host: Well, you mentioned that, you know, some of these symptoms, I guess, are asymptomatic. I mean, how would I know if I'm at risk and that I should get tested?
Dr. Maier: So right now, the guidelines are based on smoking history and age. So if you have smoked and we quantify smoking based on what we call pack years, which is one pack a day for five years is five pack years or a half a pack a day for 10 years is also five-pack years. So it's a multiplier of those two. So you have to have smoked at least 30 pack years to qualify for lung screening scan and be between the ages of 55 and 77, which is the current age range. And there are initiatives in some organizations that have slightly different age guidelines. But the ones that are generally are used are between the ages of 55 and 74. And those are active smokers. If people that have quit have to have quit within the last 15 years. So there are a lot of ongoing studies and discussions and organizations looking at broadening those guidelines so that we include younger patients, older patients, other risk factors, family history, things like that. But right now the most well accepted guidelines are 55 to 74, at least 30 pack years and quit within the last 15 years.
Host: So, getting back to that fear, I mean, how do we get more people to come in for their screenings?
Dr. Maier: Well, I think, you know, things like this are hopefully beneficial, WakeMed, this is lung cancer awareness month right now. And we have several initiatives where we're just kind of going out to the public and trying to inform our community. Some of it is, you know, informing our primary care network and our primary care doctors are, you know, obviously they're up to date on all the latest screening guidelines, but I think what they don't always have a full grasp on is how the surgical tools and technologies that we have, have improved in our enhanced recovery after surgery pathways have really made a big difference in terms of how quickly people can get back to their baseline and their level of, you know, their previous level of functioning.
So, when you have a stage one lung cancer, it gets diagnosed. You have a robotic or minimally invasive lung resection. Most people are out of work no more than two weeks, sometimes three weeks, but usually it's around two weeks and they're up on their feet really quickly. And the pain is very well controlled by a lot of different methods. So we have a handful of patients that we've asked to tell their story about that. So, I mean, it's just awareness. I think it's just trying to increase awareness around, you know, lung surgery used to be done with giant incisions and lots of pain and months out of work. And so those days are gone, but a lot of people don't realize that.
Host: Now, if something does pop up on a screening, I mean, where do we start there? What are some of the less invasive interventions available?
Dr. Maier: So, if something pops up, we have a multidisciplinary group that's made up of radiologists, pulmonologists, thoracic surgeons, and other oncologists who review everything. It's not always black and white. So we review all the scans together, the ones that have a finding and we determine what's the next best step based on what it looks like, how big it is, what the location is and then how healthy the patient is and what their, you know, whether they're leaning toward having a procedure or not. Sometimes we'll do another scan to see if it's growing. Sometimes we'll go ahead with the surgery upfront, because if it looks like a lung cancer and they've got the risk factors, then, you know, taking it out as you is sometimes the best first step, sometimes we'll do a biopsy through the wind pipe with a camera. And that's something that capability that we have at WakeMed. So, you know, there are ways to get information prior to undergoing a lung surgery, but it's really a case by case a very individualized process. Once there's a finding.
Host: Well, Dr. Maier wrapping up here, is there anything else you'd like to add?
Dr. Maier: This is something that is a passion of mine because, you know, curing people of lung cancer is obviously, you know, a great thing about what I do and what you know, those in my field are able to do. We just don't get that opportunity as much as we'd like and lung cancer, as you know, is the leading cancer killer and very common. So there's just a huge opportunity here. And I think awareness is really the key to it. And so I appreciate your, you know, doing that, being able to do this and other efforts to try to make people aware of this potentially lifesaving screening tool.
Host: Absolutely. Well, thank you for joining us, Dr. Maier, and for sharing this information. I hope we get some more of those who qualify into their screenings to learn more about lung and chest health services offered at WakeMed visit wakemed.org/lung-health. That's wakemed.org/lung-health. I'm Caitlin Whyte with WakeMed Voices brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina. Stay well.
Why Screen for Lung Cancer and Overcoming Any Fears
Caitlin Whyte: Low lung cancer screening rates are multifactorial, but many patients have a fear that there may be a finding or are in denial, that there is no benefit in even being screened. By discussing these fears, diagnosing early is the best prospect for being cured and understanding the minimally invasive interventions available. Dr. Alden Maier is a physician at WakeMed Heart and Vascular and hopes to help current and past smokers reconsider this lifesaving screening. She joins us today. This is WakeMed Voices, a podcast by WakeMed Health and Hospitals. I'm your host, Caitlin Whyte. So Dr. Maier, let's talk about this fear of screening. What are most people scared of?
Dr. Maier: So, I think it's a combination of factors, some of which relate to the screen itself, radiation dosing, and, you know, the things that, you know, might physically be harmful to them. But I think that's a smaller part. I think a bigger part of it is the fear of what we may find. And there are two categories of that. There is, you know, the fear of, well I've smoked for all these years, so they're probably going to find a lung cancer and then I'm going to, you know, find out that I'm going to die. Then the other category is finding something that's not a lung cancer, but they end up having a bunch of tests. And there are a lot of expenses and procedures and, you know, sometimes procedures that are invasive or, you know, can cause discomfort. And then ultimately it not being a lung cancer and having gone through all of that for nothing.
And I think that's a smaller piece of it because a lot of times patients wouldn't know that ahead of time until they show up and they get their pre prescreen counseling, which we do for all of our lung cancer screening patients. So I think the biggest piece is the, I guess you could call it denial or just the fear of a finding. And I think, you know, that's what I really think we as lung surgeons, and lung doctors and cancer doctors need to increase in terms of awareness, is that the benefit, you know, of finding something small and early is a total game changer. As opposed to not having a screen and then ending up with metastatic lung cancer in two or three years, that's a much, much less curable situation than somebody who could have a minimally invasive surgery be out of work for two weeks and then be cured of a lung cancer, which is the goal of lung screening.
Host: That leads me into my next question. You kind of dived into it already, but why is early intervention so important?
Dr. Maier: Three-Fourths of lung cancers when they present are stage three or four, which is not curable. So detecting them early is very hard because there are symptoms and the early cases are the ones that we can cure. So we don't know about the ones that we can cure without a scan. And that's why the guidelines are potentially a game changer, but the patients that meet criteria for lung screening, the number that actually get lung screening scans is a tiny fraction of people who would qualify. So it's, and I think a lot of it has to do with the fear factor.
Host: Well, you mentioned that, you know, some of these symptoms, I guess, are asymptomatic. I mean, how would I know if I'm at risk and that I should get tested?
Dr. Maier: So right now, the guidelines are based on smoking history and age. So if you have smoked and we quantify smoking based on what we call pack years, which is one pack a day for five years is five pack years or a half a pack a day for 10 years is also five-pack years. So it's a multiplier of those two. So you have to have smoked at least 30 pack years to qualify for lung screening scan and be between the ages of 55 and 77, which is the current age range. And there are initiatives in some organizations that have slightly different age guidelines. But the ones that are generally are used are between the ages of 55 and 74. And those are active smokers. If people that have quit have to have quit within the last 15 years. So there are a lot of ongoing studies and discussions and organizations looking at broadening those guidelines so that we include younger patients, older patients, other risk factors, family history, things like that. But right now the most well accepted guidelines are 55 to 74, at least 30 pack years and quit within the last 15 years.
Host: So, getting back to that fear, I mean, how do we get more people to come in for their screenings?
Dr. Maier: Well, I think, you know, things like this are hopefully beneficial, WakeMed, this is lung cancer awareness month right now. And we have several initiatives where we're just kind of going out to the public and trying to inform our community. Some of it is, you know, informing our primary care network and our primary care doctors are, you know, obviously they're up to date on all the latest screening guidelines, but I think what they don't always have a full grasp on is how the surgical tools and technologies that we have, have improved in our enhanced recovery after surgery pathways have really made a big difference in terms of how quickly people can get back to their baseline and their level of, you know, their previous level of functioning.
So, when you have a stage one lung cancer, it gets diagnosed. You have a robotic or minimally invasive lung resection. Most people are out of work no more than two weeks, sometimes three weeks, but usually it's around two weeks and they're up on their feet really quickly. And the pain is very well controlled by a lot of different methods. So we have a handful of patients that we've asked to tell their story about that. So, I mean, it's just awareness. I think it's just trying to increase awareness around, you know, lung surgery used to be done with giant incisions and lots of pain and months out of work. And so those days are gone, but a lot of people don't realize that.
Host: Now, if something does pop up on a screening, I mean, where do we start there? What are some of the less invasive interventions available?
Dr. Maier: So, if something pops up, we have a multidisciplinary group that's made up of radiologists, pulmonologists, thoracic surgeons, and other oncologists who review everything. It's not always black and white. So we review all the scans together, the ones that have a finding and we determine what's the next best step based on what it looks like, how big it is, what the location is and then how healthy the patient is and what their, you know, whether they're leaning toward having a procedure or not. Sometimes we'll do another scan to see if it's growing. Sometimes we'll go ahead with the surgery upfront, because if it looks like a lung cancer and they've got the risk factors, then, you know, taking it out as you is sometimes the best first step, sometimes we'll do a biopsy through the wind pipe with a camera. And that's something that capability that we have at WakeMed. So, you know, there are ways to get information prior to undergoing a lung surgery, but it's really a case by case a very individualized process. Once there's a finding.
Host: Well, Dr. Maier wrapping up here, is there anything else you'd like to add?
Dr. Maier: This is something that is a passion of mine because, you know, curing people of lung cancer is obviously, you know, a great thing about what I do and what you know, those in my field are able to do. We just don't get that opportunity as much as we'd like and lung cancer, as you know, is the leading cancer killer and very common. So there's just a huge opportunity here. And I think awareness is really the key to it. And so I appreciate your, you know, doing that, being able to do this and other efforts to try to make people aware of this potentially lifesaving screening tool.
Host: Absolutely. Well, thank you for joining us, Dr. Maier, and for sharing this information. I hope we get some more of those who qualify into their screenings to learn more about lung and chest health services offered at WakeMed visit wakemed.org/lung-health. That's wakemed.org/lung-health. I'm Caitlin Whyte with WakeMed Voices brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina. Stay well.