At Roswell Park, more than 70 percent of patients who are diagnosed with lung cancer at an early stage (Stage I) survive five years. Our Lung Cancer Screening Program is designed to detect lung cancer early — when it is most curable — by screening and monitoring ("surveillance") the people most likely to develop the disease, especially smokers.
Here to tell us about the importance of lung cancer screening for early detection of lung cancer is Dr.Mary Reid, she is the Director of Cancer Screening and Survivorship at Roswell Park Comprehensive Cancer Center.
Selected Podcast
What to Expect: Lung Cancer Screening
Featured Speaker:
Learn more about Mary Reid, MSPH, PhD
Mary Reid, MSPH, PhD
Mary Reid, MSPH, PhD is the Director of Cancer Screening and Survivorship at Roswell Park Comprehensive Cancer Center and a key member of the Roswell Park team that is collaborating with Cuban scientists on Cimavax. She is also currently a Professor of Oncology in the Department of Medicine. As Director of Cancer Screening and Survivorship, Dr. Reid has worked to expand Roswell Park’s pioneering Lung Cancer Screening program and develop other cancer screening initiatives within the Institute, working with clinical departments to increase the colon and breast screening programs.Learn more about Mary Reid, MSPH, PhD
Transcription:
What to Expect: Lung Cancer Screening
Bill Klaproth (Host): The Lung Cancer Screening Program at Roswell Park Cancer Institute is designed to detect lung cancer early when it’s most curable. Here to talk with us about lung cancer screening as part of the What to Expect series, is Dr. Mary Reid, Director of Cancer Screening and Survivorship at Roswell Park Comprehensive Cancer Center. Dr. Reid, thank you so much, for your time. Can you first give us a quick overview of the Lung Cancer Screening Program at Roswell Park Comprehensive Cancer Center?
Dr. Mary Reid (Guest): Well, the Lung Cancer Screening is based on a low-dose CT, and it’s a scan that takes about three minutes to complete. You lay on a table, and they do the CT. What really makes our program unique is the – we also have a Nurse Practitioner backed up by physician experts in a clinic. Patients who are getting screening, we make sure first that they’re eligible for screening, which means that they are between 55 and 80 years old, they’ve smoked approximately 30 years, one pack a day of cigarettes, and that they’ve smoked actively in the last fifteen years. As you get ready to come into Roswell, we ask those criteria several times to make sure that you’re eligible. Eligibility means that insurance will cover the cost of the screening.
We like to have people come in for an appointment first to talk to our nurse practitioner. That way the test can be explained and what the results will mean. The CT is then scheduled and we review the CT results with the person either over the phone or in person just to make sure that they understand whether they found any small nodules, or they want to have them come back to work up anything that looks suspicious, or that they’re clear and we don’t need to see them for a year. And that’s essentially what happens.
Bill: That criteria you just named, basically over the years you’ve learned those risk factors – those people are most at risk for developing lung cancer?
Dr. Reid: Yes, a very big study was done, of 50,000 men and women. That criteria – based on that criteria -- 55 to 80, 30 years of smoking one pack a day, and having smoked within the last 15 years -- we found that having a CT reduced actual mortality from lung cancer and that the cancers that were picked up were earlier, meaning that they were more survivable. That study compared CT to chest X-ray, which we’ve known for a long time is not a good a way to screen for lung cancer, and this study proved that again. But really, having a CT on an annual basis, if you meet those criteria, can actually reduce your risk of dying from lung cancer, and if you do have lung cancer – and this is the really important thing – the lung cancer gets picked up earlier where you can have curative treatment.
What we’ve known for years is that obviously smoking is the biggest risk factor for lung cancer -- how much you smoked, and how long you smoked -- is a risk factor. We also know other things like having obstructive lung disease is a risk factor. Being exposed to asbestos, being exposed to radon, having a family history -- they are also risk factors. The cleanest way of doing this is to actually go by age because older people get more cancer, and how much people smoked and if it was a recent smoke.
Now, that is the criteria right now. Insurance covers it. All insurances really cover it. There is some variation between the copays, but it is covered by insurance, and I think as we go forward we’re going to be able to fine tune other risk factors that may also be put into this mix, but for right now, it’s really clear that if you’ve smoked for 30 years, you’re between 55 and 80, and you’ve smoked actively in the last 15 years -- even a cigarette a day – if you’ve smoked within the last 15 years, you’re eligible for screening. With lung cancer, it’s a deadly disease. This is the first big break that we’ve had. We’re really changing how people can live with lung cancer. We’ve got some better drugs, but still, we want to shift the majority of people to be diagnosed early where you can have surgery, maybe chemo, and radiation, but then you really can have many, many years of a good quality of life.
Bill: Early is the key when it’s most curable then. Speaking of the screening, you say it takes about three minutes – this low-dose chest CT, this is non-invasive then, right?
Dr. Reid: It’s non-invasive. You don’t have to drink anything beforehand. The low-dose part is important because it reduces the exposure to radiation because it’s still a scan and we want to have that exposure be the lowest because some people may come in early and they may have twenty years of an annual CT. We really want to reduce that risk. People are concerned about that, and that’s one of the things that in research and in surveys of eligible people they have a concern about radiation exposure.
The radiation from these scans is nothing compared to the risk of having smoked. There’s no comparison. That’s why we’re really focused on people who have had a smoking history because we know they are the most likely people to develop lung cancer. Frankly, in Buffalo, having smoked for 30 years, one pack a day, is the low end of the scale. We see a lot of people who smoke two packs a day for 30 years, and that exposure is much higher.
There are a lot of people in our community who are actually at greater risk and really are the ones who absolutely need to have a CT. It’s fast. You’re on a table, you’re in and out very quickly, and it’s effective. There are some issues with the results, and that’s why we’re really committed to making sure people understand before they have the test and afterward so that they understand what the results mean when they get it.
Bill: And what happens if something is found?
Dr. Reid: The most common thing to be found is something we call a nodule. It’s a small, usually round, very small, little opaqueness on the CT. The CT can pick up really small lesions – the head of a – the end of a pen. They can pick up lesions very small, which is why it’s such an effective test. They’re most likely to have a small nodule, or a few nodules, or an area where there may be a cluster of nodules. Those are the most common results, and the majority of those are so small that we really don’t think that they’re related to cancer, but we watch them over time. That’s why if you do find something like a nodule it’s important you’ll be told when you need to come back. It may be three months, it may be six months, it may be another year, and we want to make sure that that little nodule stays stable.
If it were cancer it would change. It would change its shape. You might grow more of them. It might get bigger. It might get more solid looking. The margins of it could change. We really want to watch those nodules carefully. Even then, the majority of those nodules are not cancer. One of the things that’s great about Roswell – because we have been doing this for so long is that we feel confident about knowing when to do further testing. We like it when we can just monitor by CT because it’s easy.
Bill: This time after the screening then, is known as surveillance, so when you talk about surveillance, that’s what this is because you’re watching it over time to see how it develops?
Dr. Reid: Right, we’re watching to see because if after a couple of years, it doesn’t change then we stop being focused on that particular nodule. It goes from being a screening CT to one where it’s really a follow-up, where we’re really tracking something. Again, and this happens all the time, people say, “Well, I had a nodule.” Well, it’s not likely to be cancer, but we want to make sure that we watch it because lung cancer can grow fast, and you could come back in a year, and your nodule could be twice the size where you could have cancer. That’s why it’s so important that when you get the results of the CT, you talk with the provider who will either call you or in person to go over the results of it to tell you when you need to come back. The best case scenario, of course, is that you come back in a year and have another one.
Bill: And everything looks good, right. Your program diagnoses 70% of cancers at Stage zero, one, and two compared to current trends that detect 70% of lung cancers in advanced stages. Is this screening program – is that what sets Roswell Park Cancer Institute apart?
Dr. Reid: The thing that really sets us apart is that we have been doing this for such a long time. There are two things you want to worry about. One is that you have somebody who is too anxious to sample a nodule, so we want to watch – we want to be careful about how many people we do further tests and take a biopsy of because biopsies have their own problems. We want to make sure we have observed this nodule long enough so that when we do take a biopsy, we’re pretty sure it’s starting to change possibly into cancer and so we’ve got a lot of experience.
The other thing is that we have a multidisciplinary team. We have radiologists who have been looking at nodules for twenty years. We have thoracic oncologists or surgeons here so that if it does need to be sampled, our team is very experienced with sampling a small nodule anywhere in the lung. If it does require surgery or it does require chemo or radiation, we’re all part of the same time. The advantage of actually monitoring a nodule and doing something about it, testing it, and treating it is all done in the same place by people who you already trust because you’ve been coming – patients have been coming here for years.
I would say, people who have survived lung cancer; they also need to continue to be monitored so that we can catch any recurrence very early and treat it. The key with lung cancer is very, very consistent screening and very rapid response if it turns into cancer. We know that improves peoples’ survival, screening, and really responding to it if it seems to transform.
Bill: Screening and rapid response, absolutely. Well, Dr. Reid, thank you for your time today. For more information, you can visit RoswellPark.org, that’s RoswellPark.org. You’re listening to Cancer Talk with Roswell Park Comprehensive Cancer Center. I’m Bill Klaproth. Thanks for listening.
What to Expect: Lung Cancer Screening
Bill Klaproth (Host): The Lung Cancer Screening Program at Roswell Park Cancer Institute is designed to detect lung cancer early when it’s most curable. Here to talk with us about lung cancer screening as part of the What to Expect series, is Dr. Mary Reid, Director of Cancer Screening and Survivorship at Roswell Park Comprehensive Cancer Center. Dr. Reid, thank you so much, for your time. Can you first give us a quick overview of the Lung Cancer Screening Program at Roswell Park Comprehensive Cancer Center?
Dr. Mary Reid (Guest): Well, the Lung Cancer Screening is based on a low-dose CT, and it’s a scan that takes about three minutes to complete. You lay on a table, and they do the CT. What really makes our program unique is the – we also have a Nurse Practitioner backed up by physician experts in a clinic. Patients who are getting screening, we make sure first that they’re eligible for screening, which means that they are between 55 and 80 years old, they’ve smoked approximately 30 years, one pack a day of cigarettes, and that they’ve smoked actively in the last fifteen years. As you get ready to come into Roswell, we ask those criteria several times to make sure that you’re eligible. Eligibility means that insurance will cover the cost of the screening.
We like to have people come in for an appointment first to talk to our nurse practitioner. That way the test can be explained and what the results will mean. The CT is then scheduled and we review the CT results with the person either over the phone or in person just to make sure that they understand whether they found any small nodules, or they want to have them come back to work up anything that looks suspicious, or that they’re clear and we don’t need to see them for a year. And that’s essentially what happens.
Bill: That criteria you just named, basically over the years you’ve learned those risk factors – those people are most at risk for developing lung cancer?
Dr. Reid: Yes, a very big study was done, of 50,000 men and women. That criteria – based on that criteria -- 55 to 80, 30 years of smoking one pack a day, and having smoked within the last 15 years -- we found that having a CT reduced actual mortality from lung cancer and that the cancers that were picked up were earlier, meaning that they were more survivable. That study compared CT to chest X-ray, which we’ve known for a long time is not a good a way to screen for lung cancer, and this study proved that again. But really, having a CT on an annual basis, if you meet those criteria, can actually reduce your risk of dying from lung cancer, and if you do have lung cancer – and this is the really important thing – the lung cancer gets picked up earlier where you can have curative treatment.
What we’ve known for years is that obviously smoking is the biggest risk factor for lung cancer -- how much you smoked, and how long you smoked -- is a risk factor. We also know other things like having obstructive lung disease is a risk factor. Being exposed to asbestos, being exposed to radon, having a family history -- they are also risk factors. The cleanest way of doing this is to actually go by age because older people get more cancer, and how much people smoked and if it was a recent smoke.
Now, that is the criteria right now. Insurance covers it. All insurances really cover it. There is some variation between the copays, but it is covered by insurance, and I think as we go forward we’re going to be able to fine tune other risk factors that may also be put into this mix, but for right now, it’s really clear that if you’ve smoked for 30 years, you’re between 55 and 80, and you’ve smoked actively in the last 15 years -- even a cigarette a day – if you’ve smoked within the last 15 years, you’re eligible for screening. With lung cancer, it’s a deadly disease. This is the first big break that we’ve had. We’re really changing how people can live with lung cancer. We’ve got some better drugs, but still, we want to shift the majority of people to be diagnosed early where you can have surgery, maybe chemo, and radiation, but then you really can have many, many years of a good quality of life.
Bill: Early is the key when it’s most curable then. Speaking of the screening, you say it takes about three minutes – this low-dose chest CT, this is non-invasive then, right?
Dr. Reid: It’s non-invasive. You don’t have to drink anything beforehand. The low-dose part is important because it reduces the exposure to radiation because it’s still a scan and we want to have that exposure be the lowest because some people may come in early and they may have twenty years of an annual CT. We really want to reduce that risk. People are concerned about that, and that’s one of the things that in research and in surveys of eligible people they have a concern about radiation exposure.
The radiation from these scans is nothing compared to the risk of having smoked. There’s no comparison. That’s why we’re really focused on people who have had a smoking history because we know they are the most likely people to develop lung cancer. Frankly, in Buffalo, having smoked for 30 years, one pack a day, is the low end of the scale. We see a lot of people who smoke two packs a day for 30 years, and that exposure is much higher.
There are a lot of people in our community who are actually at greater risk and really are the ones who absolutely need to have a CT. It’s fast. You’re on a table, you’re in and out very quickly, and it’s effective. There are some issues with the results, and that’s why we’re really committed to making sure people understand before they have the test and afterward so that they understand what the results mean when they get it.
Bill: And what happens if something is found?
Dr. Reid: The most common thing to be found is something we call a nodule. It’s a small, usually round, very small, little opaqueness on the CT. The CT can pick up really small lesions – the head of a – the end of a pen. They can pick up lesions very small, which is why it’s such an effective test. They’re most likely to have a small nodule, or a few nodules, or an area where there may be a cluster of nodules. Those are the most common results, and the majority of those are so small that we really don’t think that they’re related to cancer, but we watch them over time. That’s why if you do find something like a nodule it’s important you’ll be told when you need to come back. It may be three months, it may be six months, it may be another year, and we want to make sure that that little nodule stays stable.
If it were cancer it would change. It would change its shape. You might grow more of them. It might get bigger. It might get more solid looking. The margins of it could change. We really want to watch those nodules carefully. Even then, the majority of those nodules are not cancer. One of the things that’s great about Roswell – because we have been doing this for so long is that we feel confident about knowing when to do further testing. We like it when we can just monitor by CT because it’s easy.
Bill: This time after the screening then, is known as surveillance, so when you talk about surveillance, that’s what this is because you’re watching it over time to see how it develops?
Dr. Reid: Right, we’re watching to see because if after a couple of years, it doesn’t change then we stop being focused on that particular nodule. It goes from being a screening CT to one where it’s really a follow-up, where we’re really tracking something. Again, and this happens all the time, people say, “Well, I had a nodule.” Well, it’s not likely to be cancer, but we want to make sure that we watch it because lung cancer can grow fast, and you could come back in a year, and your nodule could be twice the size where you could have cancer. That’s why it’s so important that when you get the results of the CT, you talk with the provider who will either call you or in person to go over the results of it to tell you when you need to come back. The best case scenario, of course, is that you come back in a year and have another one.
Bill: And everything looks good, right. Your program diagnoses 70% of cancers at Stage zero, one, and two compared to current trends that detect 70% of lung cancers in advanced stages. Is this screening program – is that what sets Roswell Park Cancer Institute apart?
Dr. Reid: The thing that really sets us apart is that we have been doing this for such a long time. There are two things you want to worry about. One is that you have somebody who is too anxious to sample a nodule, so we want to watch – we want to be careful about how many people we do further tests and take a biopsy of because biopsies have their own problems. We want to make sure we have observed this nodule long enough so that when we do take a biopsy, we’re pretty sure it’s starting to change possibly into cancer and so we’ve got a lot of experience.
The other thing is that we have a multidisciplinary team. We have radiologists who have been looking at nodules for twenty years. We have thoracic oncologists or surgeons here so that if it does need to be sampled, our team is very experienced with sampling a small nodule anywhere in the lung. If it does require surgery or it does require chemo or radiation, we’re all part of the same time. The advantage of actually monitoring a nodule and doing something about it, testing it, and treating it is all done in the same place by people who you already trust because you’ve been coming – patients have been coming here for years.
I would say, people who have survived lung cancer; they also need to continue to be monitored so that we can catch any recurrence very early and treat it. The key with lung cancer is very, very consistent screening and very rapid response if it turns into cancer. We know that improves peoples’ survival, screening, and really responding to it if it seems to transform.
Bill: Screening and rapid response, absolutely. Well, Dr. Reid, thank you for your time today. For more information, you can visit RoswellPark.org, that’s RoswellPark.org. You’re listening to Cancer Talk with Roswell Park Comprehensive Cancer Center. I’m Bill Klaproth. Thanks for listening.