Lung Cancer Screening & Smoking Cessation
Dr. Kevin Davidson discusses the the stages and treatment of lung cancer, and the importance of screening tests in modern medicine.
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Learn more about Kevin Davidson, MD
Kevin Davidson, MD
Dr. Kevin Davidson is a board-certified physician in four disciplines: internal medicine, pulmonary disease, critical care, and interventional pulmonology. He joined the WakeMed team after training at University of Colorado and National Jewish Health, a top ranked Pulmonary & Critical Care fellowship. He completed additional fellowship subspecialty training in Interventional Pulmonology.Learn more about Kevin Davidson, MD
Transcription:
Lung Cancer Screening & Smoking Cessation
Alyne: Lung cancer is the deadliest form of all cancers. Seventy-five percent of patients are only diagnosed when the cancer has already progressed into a fatal condition. So early detection is vital to survival. Here to talk about the importance of lung cancer screening is Dr. Kevin Davidson, a pulmonologist at WakeMed.
This is WakeMed Voices, a podcast by WakeMed Health and Hospitals. I'm Alyne Ellis. Welcome, Dr. Davidson
Dr Kevin Davidson: Yes. Thank you so much for having me.
Alyne: So getting regular screening tests such as a mammogram or a colonoscopy for example are just routine now with modern medicine. So let's begin with talking first about why screenings are so safe.
Dr Kevin Davidson: I think this is an important topic. So in medicine, we have many tools to diagnose and try to treat problems. But we know that there's a great deal that can be afforded when we find a problem early. And so when it comes to lung health, screening patients who are at higher risk for developing lung cancer has emerged as a very important tool, so that if someone is to develop lung cancer, we can hopefully catch it at a sooner stage.
The staging is the term we use that if someone were to develop a cancer, stages range from I through IV. Stage I would mean that there's a nodule, that's a cancer, but it has not spread. Then as it progresses, it might spread to the lymph nodes in the area or what we call local spread and then regional spread. And then unfortunately, it might spread to other distant parts of the body. And we know that we're able to find and cure patients when we find them at early stages.
Alyne: So that's really stage one and stage two.
Dr Kevin Davidson: That's correct.
Alyne: So getting back though for a second to the safety of these tests, what tests do we use to screen for lung cancer and what do they allow the doctor to see? And tell us a little bit about the safety at the same time.
Dr Kevin Davidson: Certainly. So there's been a desire to try to find a good screening tool for lung cancer for decades. And it actually wasn't until 2010, so actually quite recently, that low-dose CT scans or what we call CAT scans have been proven to be an effective tool in screening patients at higher risk for lung cancer. This involves a CAT scan; a patient would lay flat on a table and get a scan in only about five minutes. That gives a whole series of images looking from the top to the bottom of the lungs. And that can find these nodules. And there is a relatively low dose of radiation involved in the scan, but it's otherwise a non-invasive study.
Alyne: So you've talked a little bit about who should get screened for lung issues. And I want to dig into that more deeply. So for example, if I'm a non-smoker, but I have a persistent cough and it hasn't been diagnosed as an allergy or something like that, or that's been ruled out, am I the kind of person who should get this screening?
Dr Kevin Davidson: No. In that case, you may end up getting a series of additional tests to work up your cough. And that may at some point culminate in a CAT scan, but really the people who we're trying to screen for lung cancer are those that we know are at particularly high risk. So that's been defined through studies as smokers in a particular age group.
And so for right now, we try to screen a very specific population. It's those who are men and women aged 55 to 78 who have been at least moderate smokers in their lives. And we use kind of an uncommon term, we talk about pack years. This is how many packs per day people who've been smoking for years.
So for example, someone who smokes a pack a day, and they've been doing that for 10 years, we call that a 10-pack-year smoker. So it's people who've smoked 30-pack years in their lives beginning at ages 55 to 78, that would be considered for screening. And the reason this was selected is because these patients are at particularly higher risk of developing lung cancer. And so it was proven that screening this population actually decreased their chances of dying from lung cancer.
Alyne: And you might not have any symptoms, even if you're in that category and you've developed, for example, one of these nodules.
Dr Kevin Davidson: That's absolutely right. One of the dangers of lung cancer is that it oftentimes doesn't cause symptoms until it's at a more advanced stage. In this screening regimen that's been recommended, patients are screened not only just once, but they have an annual screen. Meaning if the first time they have their CT scan, it does not find any concerning nodules, we actually would recommend a follow-up scan annually while they're still in that risk group to ensure that they don't develop any new nodules.
Alyne: And what is pre-screen counseling that many patients can go through to find out if they should be a candidate for the screening?
Dr Kevin Davidson: That's a good question. So we absolutely review the criteria for screening in terms of the age, the pack years. We also, no matter what, will try to counsel patients on stopping smoking and ensuring that we're addressing any other risk factors for a lung cancer that they may have.
And then if a patient is exhibiting any signs of cancer or has other symptoms, they may need further evaluation regardless of the screening scan. The other thing that should be mentioned is that anyone that we screen, we need to know that there are possible false positives and that may be that we find a benign nodule or something that's not a lung cancer and it still may need further evaluation. And that's just something to know about. That's also a risk with other kinds of screening tests such as colonoscopy and mammography.
Alyne: And if you're a non-smoker, but living with a smoker for this long period of time, then does that mean that it would be good to get pre-screen counseling?
Dr Kevin Davidson: So it would still be good to see your primary care doctor to talk about reducing your risks. But in terms of the current lung cancer screening guidelines, these CT scans are not being offered for patients who have only been exposed to secondhand smoke. We do know that there's other risk factors for cancer, radon exposure, asbestos, certain occupational exposures. But it's really smoking that is the primary driver for most cases of lung cancer.
Alyne: So once one is diagnosed with lung cancer, what new treatments are being developed to offer relief and hope to patients?
Dr Kevin Davidson: Thank you. Yeah, that's been a very promising area of study. It was said that for decades, the mortality rates among patients burdened with lung cancer had remained static and that has all changed recently. That's been because. in addition to kind of what's been termed standard chemotherapy, there's a whole revolution of newer targeted therapies where the actual mutation and vulnerabilities of these cancers now have therapeutics and medicines that are being used. And some of them are quite effective. It's really been the combination of growing screening, newer therapies and really incentivizing the public to decrease the incidence of smoking that have all been helpful in curbing the blight of lung cancer in our society.
Alyne: So let's pick up on the curbing smoking for a minute, and I know that smokers can get help to stop. And I'm wondering if you could go over some of the ways that that can be achieved. And that of course includes trying to deemphasize the cravings you have when you give it up.
Dr Kevin Davidson: Yes. Smoking for many of our patients has been cultural and longstanding and, you know, intense social pressure. And it is among one of the harder habits to quit. We emphasize a multimodal approach of, for some patients, counseling, social support, nicotine replacement and that might be nicotine gum or nicotine patches or lozenges. And there's a variety of other methods. There are some pharmaceuticals that we prescribed through our clinics. And these are medicines like buproprion, which is known as Zyban or varenicline, which is known as Chantix. And some of those are very effective in select patients. But really, the most important thing is that the person really desires to quit.
And so we often talk about short-term and long-term goals about picking a quick date and really trying to let the family around them know what their intent is. Smokers who live in other households and in social circles where there's many other people smoking are unfortunately commonly exposed to all those pressures that got them to smoke in the first place and find a harder time quitting. And so we try to set people up for success by talking about all the ways that we might help them decrease their chances of smoking again.
Alyne: Yeah, you know, one thing that comes to mind for me is how much you want to do something with your hands or what a routine thing it is for example to smoke right after dinner. So I guess your suggestion would be to start on something else that you can hold like a cup of coffee or something?
Dr Kevin Davidson: That's a commonly discussed just kind of behavior. And social circumstances too, people will mention it's a behavior pattern, same thing in the first thing in the morning. So, yeah, for some of these circumstances, individual strategies like the kind of way we do nicotine replacement, gum, for example, just for having something kind of to chew on is helpful for certain people. And no one method is necessarily the perfect method for any given patient. It really takes kind of counseling and time to figure out what we think is going to be most effective.
Alyne: No, I know, WakeMed and other places like WakeMed offer the kind of help you're talking about. I wonder if you could just give us a little pointer about how to seek help for all of this.
Dr Kevin Davidson: So within North Carolina, there is a quit line. It's 1-800-QUIT-NOW or 1-800-784-8669. There are smoking cessation clinics that are staffed by tobacco smoking cessation treatment specialists, who really spend their time counseling patients on the most effective strategies to quit. When medications are helpful, prescribing these medications as well, although that's not necessarily the best strategy for everybody. And we think that curbing smoking is one of the most important ways in helping reduce the incidence of lung cancer.
Alyne: Is there anything else you'd like to add?
Dr Kevin Davidson: Well, I'd like to thank you for having me on. We think that education to the public is one of the most important things. And certainly, there are excellent resources online to read about smoking cessation and lung cancer screening. And we appreciate you having us on the podcast.
Alyne: Well, it was a pleasure. Thank you very much.
Dr Kevin Davidson: Thank you.
Alyne: Dr. Kevin Davidson is a pulmonologist at WakeMed. To learn more about WakeMed services and locations, please visit WakeMed.org. I'm Alyne Ellis with WakeMed Voices brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina. Stay well.
Lung Cancer Screening & Smoking Cessation
Alyne: Lung cancer is the deadliest form of all cancers. Seventy-five percent of patients are only diagnosed when the cancer has already progressed into a fatal condition. So early detection is vital to survival. Here to talk about the importance of lung cancer screening is Dr. Kevin Davidson, a pulmonologist at WakeMed.
This is WakeMed Voices, a podcast by WakeMed Health and Hospitals. I'm Alyne Ellis. Welcome, Dr. Davidson
Dr Kevin Davidson: Yes. Thank you so much for having me.
Alyne: So getting regular screening tests such as a mammogram or a colonoscopy for example are just routine now with modern medicine. So let's begin with talking first about why screenings are so safe.
Dr Kevin Davidson: I think this is an important topic. So in medicine, we have many tools to diagnose and try to treat problems. But we know that there's a great deal that can be afforded when we find a problem early. And so when it comes to lung health, screening patients who are at higher risk for developing lung cancer has emerged as a very important tool, so that if someone is to develop lung cancer, we can hopefully catch it at a sooner stage.
The staging is the term we use that if someone were to develop a cancer, stages range from I through IV. Stage I would mean that there's a nodule, that's a cancer, but it has not spread. Then as it progresses, it might spread to the lymph nodes in the area or what we call local spread and then regional spread. And then unfortunately, it might spread to other distant parts of the body. And we know that we're able to find and cure patients when we find them at early stages.
Alyne: So that's really stage one and stage two.
Dr Kevin Davidson: That's correct.
Alyne: So getting back though for a second to the safety of these tests, what tests do we use to screen for lung cancer and what do they allow the doctor to see? And tell us a little bit about the safety at the same time.
Dr Kevin Davidson: Certainly. So there's been a desire to try to find a good screening tool for lung cancer for decades. And it actually wasn't until 2010, so actually quite recently, that low-dose CT scans or what we call CAT scans have been proven to be an effective tool in screening patients at higher risk for lung cancer. This involves a CAT scan; a patient would lay flat on a table and get a scan in only about five minutes. That gives a whole series of images looking from the top to the bottom of the lungs. And that can find these nodules. And there is a relatively low dose of radiation involved in the scan, but it's otherwise a non-invasive study.
Alyne: So you've talked a little bit about who should get screened for lung issues. And I want to dig into that more deeply. So for example, if I'm a non-smoker, but I have a persistent cough and it hasn't been diagnosed as an allergy or something like that, or that's been ruled out, am I the kind of person who should get this screening?
Dr Kevin Davidson: No. In that case, you may end up getting a series of additional tests to work up your cough. And that may at some point culminate in a CAT scan, but really the people who we're trying to screen for lung cancer are those that we know are at particularly high risk. So that's been defined through studies as smokers in a particular age group.
And so for right now, we try to screen a very specific population. It's those who are men and women aged 55 to 78 who have been at least moderate smokers in their lives. And we use kind of an uncommon term, we talk about pack years. This is how many packs per day people who've been smoking for years.
So for example, someone who smokes a pack a day, and they've been doing that for 10 years, we call that a 10-pack-year smoker. So it's people who've smoked 30-pack years in their lives beginning at ages 55 to 78, that would be considered for screening. And the reason this was selected is because these patients are at particularly higher risk of developing lung cancer. And so it was proven that screening this population actually decreased their chances of dying from lung cancer.
Alyne: And you might not have any symptoms, even if you're in that category and you've developed, for example, one of these nodules.
Dr Kevin Davidson: That's absolutely right. One of the dangers of lung cancer is that it oftentimes doesn't cause symptoms until it's at a more advanced stage. In this screening regimen that's been recommended, patients are screened not only just once, but they have an annual screen. Meaning if the first time they have their CT scan, it does not find any concerning nodules, we actually would recommend a follow-up scan annually while they're still in that risk group to ensure that they don't develop any new nodules.
Alyne: And what is pre-screen counseling that many patients can go through to find out if they should be a candidate for the screening?
Dr Kevin Davidson: That's a good question. So we absolutely review the criteria for screening in terms of the age, the pack years. We also, no matter what, will try to counsel patients on stopping smoking and ensuring that we're addressing any other risk factors for a lung cancer that they may have.
And then if a patient is exhibiting any signs of cancer or has other symptoms, they may need further evaluation regardless of the screening scan. The other thing that should be mentioned is that anyone that we screen, we need to know that there are possible false positives and that may be that we find a benign nodule or something that's not a lung cancer and it still may need further evaluation. And that's just something to know about. That's also a risk with other kinds of screening tests such as colonoscopy and mammography.
Alyne: And if you're a non-smoker, but living with a smoker for this long period of time, then does that mean that it would be good to get pre-screen counseling?
Dr Kevin Davidson: So it would still be good to see your primary care doctor to talk about reducing your risks. But in terms of the current lung cancer screening guidelines, these CT scans are not being offered for patients who have only been exposed to secondhand smoke. We do know that there's other risk factors for cancer, radon exposure, asbestos, certain occupational exposures. But it's really smoking that is the primary driver for most cases of lung cancer.
Alyne: So once one is diagnosed with lung cancer, what new treatments are being developed to offer relief and hope to patients?
Dr Kevin Davidson: Thank you. Yeah, that's been a very promising area of study. It was said that for decades, the mortality rates among patients burdened with lung cancer had remained static and that has all changed recently. That's been because. in addition to kind of what's been termed standard chemotherapy, there's a whole revolution of newer targeted therapies where the actual mutation and vulnerabilities of these cancers now have therapeutics and medicines that are being used. And some of them are quite effective. It's really been the combination of growing screening, newer therapies and really incentivizing the public to decrease the incidence of smoking that have all been helpful in curbing the blight of lung cancer in our society.
Alyne: So let's pick up on the curbing smoking for a minute, and I know that smokers can get help to stop. And I'm wondering if you could go over some of the ways that that can be achieved. And that of course includes trying to deemphasize the cravings you have when you give it up.
Dr Kevin Davidson: Yes. Smoking for many of our patients has been cultural and longstanding and, you know, intense social pressure. And it is among one of the harder habits to quit. We emphasize a multimodal approach of, for some patients, counseling, social support, nicotine replacement and that might be nicotine gum or nicotine patches or lozenges. And there's a variety of other methods. There are some pharmaceuticals that we prescribed through our clinics. And these are medicines like buproprion, which is known as Zyban or varenicline, which is known as Chantix. And some of those are very effective in select patients. But really, the most important thing is that the person really desires to quit.
And so we often talk about short-term and long-term goals about picking a quick date and really trying to let the family around them know what their intent is. Smokers who live in other households and in social circles where there's many other people smoking are unfortunately commonly exposed to all those pressures that got them to smoke in the first place and find a harder time quitting. And so we try to set people up for success by talking about all the ways that we might help them decrease their chances of smoking again.
Alyne: Yeah, you know, one thing that comes to mind for me is how much you want to do something with your hands or what a routine thing it is for example to smoke right after dinner. So I guess your suggestion would be to start on something else that you can hold like a cup of coffee or something?
Dr Kevin Davidson: That's a commonly discussed just kind of behavior. And social circumstances too, people will mention it's a behavior pattern, same thing in the first thing in the morning. So, yeah, for some of these circumstances, individual strategies like the kind of way we do nicotine replacement, gum, for example, just for having something kind of to chew on is helpful for certain people. And no one method is necessarily the perfect method for any given patient. It really takes kind of counseling and time to figure out what we think is going to be most effective.
Alyne: No, I know, WakeMed and other places like WakeMed offer the kind of help you're talking about. I wonder if you could just give us a little pointer about how to seek help for all of this.
Dr Kevin Davidson: So within North Carolina, there is a quit line. It's 1-800-QUIT-NOW or 1-800-784-8669. There are smoking cessation clinics that are staffed by tobacco smoking cessation treatment specialists, who really spend their time counseling patients on the most effective strategies to quit. When medications are helpful, prescribing these medications as well, although that's not necessarily the best strategy for everybody. And we think that curbing smoking is one of the most important ways in helping reduce the incidence of lung cancer.
Alyne: Is there anything else you'd like to add?
Dr Kevin Davidson: Well, I'd like to thank you for having me on. We think that education to the public is one of the most important things. And certainly, there are excellent resources online to read about smoking cessation and lung cancer screening. And we appreciate you having us on the podcast.
Alyne: Well, it was a pleasure. Thank you very much.
Dr Kevin Davidson: Thank you.
Alyne: Dr. Kevin Davidson is a pulmonologist at WakeMed. To learn more about WakeMed services and locations, please visit WakeMed.org. I'm Alyne Ellis with WakeMed Voices brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina. Stay well.