Smilow Shares Trumbull and Bridgeport: Should you be Screened for Lung Cancer? Ask about your Options

November 20, 2020

Information

Presentations by: Michael Cohenuram, MD, Vincent Mase, Jr., MD, and Daniel Rudolph, MD

ID5914

To CiteDCA Citation Guide

00:00So we're live now.
00:03Yes alright hello everybody,
00:04thanks for joining
00:05us tonight. You know on Thursday
00:08night at 6:30 for Smilow shares,
00:10should you know or be
00:12screened for lung cancer?
00:14We have a great panel.
00:16Tonight we got Doctor Mike Conair M
00:19as well as myself and Doctor Rudolph
00:22who hopefully over the next little
00:25bit are just going to educate you a
00:28little bit about lung cancer screening
00:30about lung cancer in general.
00:32About smoking cessation.
00:34And answer any questions you
00:36have and really the goal.
00:38At the end of this is that you're all
00:41subject matter experts when it comes
00:43to being screened for lung cancer,
00:46and it certainly made it.
00:47Maybe it doesn't apply to you,
00:50but if you have a loved one or friend,
00:53you can certainly go out and educate
00:55them and tell them what you learn.
00:58Today I'm just going to talk a
01:00little bit about the folks that are
01:03going to be talking to us today.
01:05Doctor Mike is medical oncologist,
01:07trained at Mount Sinai?
01:09What did his fellowship at the
01:11Yale School of Medicine and also
01:14did his residency up at?
01:16Brown has multiple awards with
01:18the Castle Connolly top Dr,
01:20as well as in Connecticut's
01:22magazine top Dr and you know,
01:24currently has his practice in Park
01:27Ave as well as in Fairfield and
01:30sees folks at Bridgeport Hospital.
01:32The other panelists that we
01:34have is Doctor Rudolph.
01:36Doctor Rudolph has been a community
01:38pulmonary physician now practicing in
01:40Fairfield County for over 30 years.
01:42I specialize in the evaluation
01:44and treatment of respiratory
01:46diseases to include COPD,
01:47asthma and lung cancer,
01:48and he does have a special interest.
01:51Actually, nicotine addiction,
01:52which I think he's going to talk
01:55a little bit about.
01:57He went to the medical medical
01:58school then why you did his
02:01pulmonary critical care fellowship?
02:03Albert Einstein montefiore.
02:04So I guess what will do is get started.
02:08I think one of the things I want
02:11to do is if you can see it,
02:14I'm going to open it up and
02:17then share my screen.
02:18There is a link in your.
02:24You cannot start sharing. Hey Jean,
02:27do you mind if I share for 2nd?
02:44There is a link in your, um,
02:46I can't seem to get it right now,
02:48but there's a link in your chat box
02:51that if you click on it is a story
02:53that came out just recently about
02:55one of the success stories with lung
02:57cancer screening someone that all of
02:59us here are treated just last year.
03:01And if you can't get the link, let me know.
03:04Unroll Ruth, send it out.
03:05So, Gene, if you want to go
03:07back to sharing your slides.
03:18Doctor Rudolph will start with his
03:21will start off with Doctor Rudolph.
03:25Do you want to unmute yourself, Dan?
03:54Are you able
04:04to hear me?
04:15Yes.
04:18OK, I don't see my visual.
04:21OK.
04:31Good evening. Are the road to lung cancer
04:35screening very often starts in the primary
04:39care office and the office home and Ologist?
04:43The taking of of a history includes
04:47trying to evaluate the degree of risk that
04:52includes how much each individual smokes.
04:56Every primary care doctor and
04:59pulmonologist spends time in this.
05:03Anne tries to evaluate whether patients
05:06are at risk or candidates for screening.
05:11As most of the medical profession knows,
05:14people who smoke a pack a day
05:17for 30 years are at risk.
05:19An are sent for screening.
05:22The problem of nicotine
05:24addiction is enormous.
05:26Most of our patients with a nicotine
05:29addiction problem are carefully
05:31interviewed and evaluated when
05:34their first seen in our office.
05:37The degree of their problem very often
05:41lies in their addiction to nicotine,
05:44which is a chemical addiction.
05:47Many people don't understand this problem
05:50well or understand the possible solutions.
05:54Screening is obviously one of the
05:57more important tools we have in
06:00evaluating whether their addiction
06:02will lead to medical problems,
06:04including chronic lung disease,
06:06heart disease, or malignancy.
06:10We have a number of tools
06:12available to help these patients.
06:14That includes pharmacology,
06:17medical therapy, and counseling.
06:21We have to be very careful when we take
06:24the histories to make certain that we get
06:27accurate histories of their addiction.
06:29Very often it's not that simple.
06:31People are not very forthright and
06:34giving us accurate information
06:35about the degree of their addiction.
06:38But if time is spent in the initial visits.
06:43Carefully understanding the
06:44severity of addiction,
06:46then proper steps can be taken to
06:49try to help and correct an treat.
06:52Their addiction,
06:53recognizing that it's a chemical
06:56addiction is the first priority.
06:58Referring them to sub specialist to
07:01treat the possible complications of
07:04their addiction is also critical
07:06in my practice.
07:08I found over many years that one of the
07:11primary treatments of their addiction
07:14include nicotine supplements or medication.
07:17It's very difficult to conquer
07:20addiction of nicotine without
07:22the support of medical therapy.
07:24Also,
07:25the addition of of counseling has
07:27been found to be very useful.
07:30It's a pleasure to be working with
07:33a group of physicians and smilow
07:35to try to treat these patients in
07:38a collaborative fashion.
07:40The center is offered counseling
07:43programs and screening programs.
07:46There are critical and trying
07:49to address this serious problem.
07:52In my 30 years of practice,
07:55I have to say over the past years couple
07:58years since the development of this program,
08:02we've been able to collaborate and
08:04focus on the treatment of these
08:07patients an refer them to the
08:09screening program for lung cancer,
08:11which is critical in preventing.
08:14Life threatening malignancy's
08:16in our patient population.
08:19The cigarette smoking is probably
08:22one of the leading preventable
08:25causes of death in our community.
08:28The risks are enormous.
08:30Obviously the risks of medical
08:32issues regarding heart disease,
08:35chronic lung disease,
08:36which I face in my office,
08:40and malignancy, particularly lung cancer,
08:42are the most common problems they face.
08:48Next line.
08:52This slide just focuses on the
08:55problem of nicotine addiction,
08:57which is basically the problem where
09:00nicotine attaches to a receptor in the brain,
09:03causing neurotransmitters or chemicals
09:05that lead to a calm sensation,
09:08making it very difficult to break.
09:11This pattern of cycle the cycle cycling
09:15pattern that causes people to smoke.
09:19Nicotine replacement therapies
09:20and medical therapies have been
09:23very useful and are critical.
09:25As I mentioned in addressing the problem.
09:29Next slide.
09:33The reason that we're
09:34here tonight is because of
09:37the American smoke out.
09:39The problem of of smoking in
09:43this community is enormous.
09:45The new problems related to vaping in
09:49our adolescent population has grown
09:52and has become a serious problem.
09:54The American Cancer Society has
09:56allowed us to have the opportunity
09:59to get together tonight and talk
10:01a little bit about this program.
10:04This problem and the programs
10:06devoted to address the problem.
10:08Community recognition Is primarily
10:11one of the most important ways that
10:16we can focus on this problem and
10:20address the severe complications
10:23that occur with this addiction.
10:31I'll move on to allow my colleagues
10:34to speak about the details of the
10:37cancer screening program and some
10:39of the issues relating lung can't
10:42really related to lung cancer.
10:46Yeah, that was great.
10:48That was really a nice overview of
10:50some nicotine addiction and
10:51some of the efforts that go on.
10:53You know, both in your practice and you know,
10:55throughout the County to help people
10:57quit smoking in your in your 30 years.
10:59What what have you notice has
11:01been the most successful that's
11:02helped people either you know,
11:04cut back or quit. My
11:07personal experience is that to
11:10allow patients to understand that
11:13this is a chemical addiction.
11:15It is one of the primary challenges as a.
11:20Health care provider.
11:21A lot of people don't realize
11:24that nicotine addiction is
11:26basically a chemical addiction,
11:28and if they are able to understand
11:30it as a chemical addiction,
11:33the more apt to be able to accept
11:36medical treatment, which I think.
11:39With medications including
11:40Chantix or nicotine,
11:42supplements are required to conquer.
11:44The addiction is very difficult
11:47and I haven't seen a lot of people
11:51who quote go cold Turkey and are
11:54able to stay away from relapse,
11:57which leads to continued smoking.
11:59So recognizing it as an addiction,
12:02knowing that it's really a chemical problem,
12:06is the only there's one of the
12:09things I've learned many years.
12:11The man used to practice.
12:14No, that's great.
12:15I think you know Amy put a
12:17question in the chat box for you
12:19and I for any of the attendees.
12:21Please use the chat box if you
12:23have some questions.
12:24We're happy to feel them as they come in,
12:26she says.
12:27Do you find that there are a
12:28lot of side effects from the
12:30medications given to patients
12:32that are used to assist with
12:34stopping them from smoking?
12:35The
12:36nicotine supplements have very few
12:39side effects because basically they're
12:43delivering nicotine in a different form.
12:46That includes gum lozenge yours or
12:49trans dermal applications of nicotine,
12:52so nicotine supplements are
12:54unlikely to cause side effects.
12:56Unfortunately the other medications which
12:59include a drug called well buitron with his,
13:03which is basically an antidepressant,
13:05can have side effects and so can chant X,
13:10which is well known for mood disorders.
13:14But I find that the rarity of these
13:19drug complications. He is not.
13:22Excluding people from drug trials,
13:25I do think everybody who is faced
13:28with this addiction should be given
13:30the opportunity for a drug trial.
13:33An one of the more important
13:35things is to follow up.
13:37See these patients after their placed
13:39on medications on a monthly basis,
13:42not let them go and return a year later
13:45but return in a monthly fashion really
13:48reassess their response to medicine.
13:50And there was an their ability
13:52to cut down on cigarettes.
13:55Very often it's a slow process.
13:57It occurs over a long period of time,
13:59cutting down from one pack to 1/2
14:01pack to five cigarettes to eliminate
14:03ING cigarettes is the strategy that
14:06I very often use when dealing with
14:08somebody who's addicted to nicotine
14:10and smoking more in the pack a day.
14:15Now that's great.
14:16That was a great question Amy.
14:17And then you know Dan.
14:19Just one more question for you.
14:21You know what?
14:22Any do you have like a a
14:24success story that's memorable
14:25of someone you were able to.
14:27You know help quit smoking where and
14:29any you know recent or you know,
14:32long range success stories
14:33that you that you remember. It
14:36it it happens. It's funny because
14:39people don't usually have a dramatic
14:43time where they quit. It's a process,
14:46so it occurs over over years time.
14:50Unfortunately, the ones I remember
14:52of our people that are facing
14:55illnesses that are caused by nicotine
14:58addiction and force them to quit.
15:01But I try very.
15:03I usually apply a lot of pressure
15:06on the younger patients that I have.
15:10And I'd say that of all
15:12the patients that I have,
15:14the most memorable are the adolescents.
15:16If I can get an adolescent
15:18to stop vaping nicotine.
15:19And understand the risks of complications
15:22or medical problems in the future,
15:24and I feel that's the most rewarding type
15:27of intervention I have at my disposal.
15:30The younger population are the most
15:32vulnerable and I my memories are of
15:35those those patients and I don't have
15:38a lot of my practice 'cause I take
15:41care of respiratory diseases except
15:43a young patient with have asthma who
15:46are able to have quit smoking and
15:48their numbers are the most rewarding.
15:50Experiences I've had.
15:57Alright, now that's great. Thanks a lot,
15:59Dan. That was very informative.
16:00I think we're going to go on.
16:02I'm going to talk a little bit about what
16:05lung cancer screening looks like in 2020.
16:07My name is Vinny.
16:08I'm one of the thoracic surgeons at Yale,
16:11and you know, basically covered down
16:13at Park Ave as well as at Bridgeport,
16:15then you know affiliated now for
16:17just over two years and I'm going
16:20to talk a little bit about lung
16:22cancer screening in 2020. Gene,
16:24I'm going to try and take over if I can.
16:27If you cannot share,
16:28I'm going to see if I can do this this time.
16:32Yeah.
16:48Can you guys see my screen?
16:56Jean, can you see the screen?
16:58Yes, alright, great. So we're going to
17:00talk about lung cancer screening in 2020.
17:02I'm just going to talk a little bit
17:04about some local health statistics.
17:06The efficacy of lung cancer screening
17:08now versus back in the 70s and 80s.
17:11And really, you know what's important to you.
17:13Some basic things, like you know how to
17:16read a chest X Ray as a chest X-ray,
17:18helpful for lung cancer screening?
17:20How to read a chest CT talk a
17:22little bit about the metric system?
17:24It's funny.
17:25Just yesterday I saw a patient with a
17:272 centimeter nodule and she said well.
17:30How big is 2 centimeters and the risks
17:33and benefits you know to you with regards
17:37to screening and what you can see here.
17:40This is the cancer statistics for 2010
17:43for the state of Connecticut and at
17:46least in the state of Connecticut,
17:49lung cancer is the third leading
17:52cause of newly diagnosed cancers.
17:54You can see here. And is the most lethal.
17:58It accounts for over 25% of
18:01deaths in 2010 from cancer.
18:04And what's interesting is you know,
18:06prostate cancer and breast cancer
18:08are the 1st and 2nd leading cause
18:12of newly diagnosed cancers.
18:14And there's a robust screening program
18:17in place for both of those organs.
18:21But one of the reasons why is because
18:24you know lung cancer is a silent disease.
18:27It's often found in more advanced
18:28stages and up until just recently
18:30there hasn't been an effective
18:32screening tool to identify patients,
18:34typically at an earlier stage.
18:38You know,
18:38and basically this is kind of a
18:40pie chart just to demonstrate some
18:42of the volume with regards to the
18:45multiple large large control trials
18:47that have been done.
18:48You know you can see here that in
18:51the American trial the national lung
18:53cancer trial that was done just
18:56a little over a decade ago,
18:58there were over 53,000 patients and
19:00that showed that lung cancer screening
19:02with a CAT scan has a significant
19:05impact in mortality at 20% benefit.
19:07There is another trial in Europe that was
19:10just recently published actually this year.
19:13We had some preliminary data at the year 2
19:16prior and that was over 15,000 patients.
19:19That again showed that lung cancer
19:22screening with a CAT scan a low
19:26dose CAT scan can reduce mortality.
19:29And when we compare lung cancer screening,
19:31low dose chest.
19:33See T to other known health screens
19:35that you're familiar with,
19:37and you probably may have had you
19:39know the number needed to screen
19:42with regards to low dose chest.
19:44See T is to prevent one.
19:46Death is about 320 when you look at
19:49mammography for breast cancer screening,
19:51the number needed to screen to
19:54prevent one death ranges in terms of
19:57literature anywhere from 780 to 2000.
19:59And colonoscopy for colon cancer screening.
20:01The number needed to screen to
20:03prevent one death is about 12:50.
20:05So what you can see is you know it's
20:08compareable with regards to some of
20:11the other screening systems that
20:13we have in place,
20:14which is great news actually.
20:16You know when we look at the state
20:19of cancer lung cancer in 2020,
20:22particularly in the state
20:24of Connecticut, you know,
20:254 out of 49 can wind up getting surgery.
20:2919 out of 49 can be picked up by screening,
20:33and the survival, and you know,
20:35I think Doctor Mike's going to
20:38talk about that a little bit with
20:40some of the treatment options
20:42that have been really far,
20:45far advanced now recently.
20:46And then when we come down
20:48to what you need to know,
20:50it's really important that some of
20:51the things I talked about in the past
20:53couple of slides is content, you know.
20:55But it's really just.
20:56It's not as important.
20:58You know what that content is,
20:59it's how it's delivered so
21:01that you can understand it.
21:02Figure out how it applies to you,
21:04to see whether or not low dose a CAT
21:06scan for you or one of your loved ones
21:09is something that you may want to undergo.
21:12And I think one of the biggest things
21:15that I'd like to drive home is that
21:18when we look at lung cancer risk,
21:21it's really driven by two factors.
21:24One is smoking and another one is your age.
21:27And what you can see is that if
21:30you look at people that if you
21:33look at Packers here as the number
21:36of cigarettes you smoke goes up.
21:39Your risk.
21:40Your six year lung cancer risk.
21:42Significantly goes up as well as your age
21:45goes up your lung cancer risk goes up,
21:49so age and smoking status are really
21:51the two things that impact things.
21:54We can't do much about age,
21:56but like Dan talked about smoking
21:59status and working to decrease
22:01that can certainly be helpful.
22:04Chest X Ray versus cat scan.
22:06You know here on the left you
22:08can see that there's this is a
22:10chill with chest X Ray looks like
22:13it's basically a single beam of.
22:15Like that gets shined through and
22:17we really what we rely on when we
22:19look at a CAT scan is just shadows.
22:21You can see that the detail is not as good.
22:24It is with roller.
22:25With regards to the CAT scan to
22:27the right and I think the biggest
22:29thing that I'm going to try and
22:31drive home as if you wind up in
22:33the ER you know or we go to your
22:36doctor and get a chest X Ray whether
22:38you had flu like symptoms,
22:40that's you know that's not good
22:42enough to try and detect or you
22:44know screen for lung cancer.
22:45It's really the CAT scan that
22:47is shown to be beneficial,
22:48and the way we look at a CAT scan.
22:51And I'll talk about this in
22:52a little bit is it's.
22:54Again,
22:54multiple Rays of light of
22:55beams that get shine through,
22:57not just one,
22:57and it gets reconfigured to
22:58create a little bit more of
23:00a dimensional representation
23:01of your body in the organs,
23:03in your chest and the way we look at it is.
23:06It's like you're lying on your back and we're
23:08standing at your feet and your being sliced.
23:10Kind of like a loaf of bread and we can
23:13see a lot of the different structures
23:15and I'll talk about that shortly.
23:17An X Ray certainly does give
23:19us a lot of information.
23:21You know you can see here from the
23:23cartoon that we can see your heart.
23:26We can see some of the blood
23:28vessels coming off your heart.
23:30We can see your airway.
23:31We can see your bones.
23:33We can also see your spine as well as
23:36some some of the contents in your abdomen.
23:39So it does provide some helpful information,
23:41but it's still in today's day and age.
23:44Test for lung cancer.
23:46You know this happens to be.
23:49An X Ray that shows that this
23:51person has a 2 centimeter nodule
23:52and I kind of picked this so that
23:54we can talk a little bit about the
23:56metric system so that you can,
23:58you know,
23:59have a in your brain away to reconfigure
24:01that cause a lot of you have access
24:03to my chart and you might read some
24:05of these studies that talk about
24:06either a 5 millimeter nodule or a 2
24:08centimeter nodule an you know the way.
24:10I kind of like to explain it is
24:12a 5 millimeter nodule is about
24:14the size of the pencil.
24:15The eraser on a pencil.
24:1810 millimeter 1 centimeter nodule
24:20is about the size of a cheerio.
24:232 centimeter nodules about the size
24:25of a penny Anna 4 centimeter nodule
24:27is about the size of a golf ball,
24:29and that's kind of how I you know,
24:32you know.
24:32Put it into reference for for folks.
24:35Now when we look at a CAT scan,
24:38you can see that there's a lot
24:40more detail that we can see.
24:42We can see the details of the major
24:44vessels that come off the heart.
24:46We can see multiple different areas of
24:48the long to include the vasculature
24:50and it really provides us a lot more
24:53information and the studies that I've
24:55talked about it showing that you
24:57know this can benefit you to try and
25:00detect lung cancer at an earlier stage.
25:03This is just an example that or
25:05just to show that the seat the chest
25:08see T isn't effective screening
25:09test and this person has a small
25:11nodule on the left lobe.
25:13Who is eligible for screening
25:15Eunos? Milos committed that integrated
25:18network throughout the system with
25:20regards to lung cancer screening an has a
25:24multidisciplinary comprehensive you know
25:26team to include the people on this panel.
25:28You know Dan and Mike,
25:30you know we actually meet frequently
25:33to kind of talk about the lung cancer
25:36screening in Fairfield County and
25:39the people that benefit our adults
25:41between the ages of 55 and 80.
25:44If you have a 30 pack year smoking
25:46history and if you the way we
25:49talked about what a pack here is.
25:51If you smoke a pack a day.
25:53For a year, that's one pack here.
25:55So if you smoke a pack a day for 30 years,
25:58that's 30 pack years.
25:59There's 20,
26:00there's 20 cigarettes in a pack,
26:02so he took smoke 10 cigarettes
26:04a day or half a pack.
26:06It take you about 60 years to
26:08have a 30 pack year history.
26:10You have to either be a current smoker
26:13or someone who's quit smoking within
26:15the past 15 years have no symptoms
26:17and you know being somewhat decent
26:19health to be able to tolerate either
26:22surgery or some sort of oncologic tree.
26:25And you can see the.
26:28Link there in case you need access to that.
26:32So what are the risks?
26:36I'm just going to talk a little bit
26:38about what a false positive is.
26:40That's identifying Legion.
26:41That's not a cancer.
26:42You know,
26:43when you scan,
26:44you scan from the bottom top very bottom
26:46of the neck to the top of the abdomen,
26:49and you know you can sometimes
26:51identify a lesion that you've had,
26:52maybe for your entire life.
26:54That's not not cancer,
26:55it's a lesion that's really not
26:58a threat to you.
26:59Radiation harm I'm going to review
27:01a little bit in the next slide so
27:03they know that comes up a lot.
27:05There's all the procedure risk.
27:06Which is you?
27:07If you do have a lesion and we work
27:09to interrogate that lesion or find
27:11out what it is you know there is
27:14a risk of about your surgery and
27:15that risk is much less than 1%.
27:17It's a fraction of 1%.
27:20Because we're scanning from the
27:22neck to the abdomen,
27:23there's something called incidental findings.
27:25With that means is even though we're
27:27looking for lung cancer, the chest.
27:29See T also looks at your thyroid.
27:31It looks at your a little bit of
27:34your abdomen, your adrenal glands.
27:35It looks at your bones,
27:37and sometimes we might find
27:38something that not necessary.
27:40You know,
27:40one of us would be able to help you with,
27:44but you may need to see either an
27:46EMT surgeon or an E&T doctor or
27:48someone to just review that finding.
27:50A thyroid nodule happens to be,
27:52you know, common lesion that we identify.
27:57The radiation risk the radiation
27:58exposure from a low dose CAT
28:00scans less than one this this
28:02is abbreviated for milli.
28:03Sieverts is just the way
28:05we measure the radiation.
28:06For comparison.
28:07The background radiation in New York City is
28:10about 3 millisieverts an you know the
28:12way I like to explain it is airline
28:14people that work in the airline industry.
28:16We take a flight from New
28:18York to California and back.
28:20You've been exposed to more radiation at
28:22that altitude and getting a low dose chest.
28:24See T. So the radiation harms very low.
28:30Now benefit versus risk.
28:32How do we weigh that?
28:33All those large studies kind of work to,
28:36you know, put that into quantify that for us.
28:40So I already talked about the
28:42number needed to screen is 320.
28:44When we looked at those complications
28:46that I talked about,
28:48the number needed to harm the number of
28:50people that you needed to screen to,
28:53you know, cause harm to an
28:55individual is 10 times about 3815.
28:57So the the benefit certainly favors you know.
29:00Obtain a CAT scan.
29:02You know if you're in that
29:04eligibility criteria.
29:09And just some of the main points,
29:11the eligibility criteria
29:12again or adults 55 to 80.
29:15And it's a 30 pack year smoking history,
29:18current smoker.
29:18Or if you quit in the past 15
29:21years no signs or symptoms of lung
29:24cancer and in good enough health
29:26to undergo some sort of treatment.
29:29What you can expect if you have a
29:31discussion with your primary care doctor,
29:34is to expect to visit.
29:35Going over those risks and
29:37benefits that we talked about so
29:39you can ask questions and that
29:41they'll be a team of experts that
29:43will be involved in your care.
29:46The lung cancer screening.
29:47Or what's my Lowe's committed to is
29:50that it's really not just the see T
29:52it is a multi disciplinary approach
29:54above and beyond that cats can you
29:57know with regards to your care.
29:59And then our kind of stop sharing
30:02and see if there's been any
30:04questions in the chat box,
30:06or if anybody has any questions.
30:16And that gene, if you want to
30:18turn it over to Doctor to Mike,
30:20will turn it over.
30:22So there is, uh, so hold on a second.
30:26Karen asked the question,
30:27why don't you screen until age 55?
30:30And that's really a good question.
30:32What we what we have found is in
30:35order to demonstrate a benefit.
30:38You have to identify those high
30:40risk patients and because we
30:42know that age and smoking status
30:44are the two biggest risk factors
30:46when they did those studies,
30:48they certainly did.
30:50There have been some some studies
30:53that looked at if you can go to 50
30:55or if you can go to 45 and it turns
30:59out that at least right now below 55,
31:02the number needed to screen would
31:04be much higher and there is not
31:06necessarily a mortality benefit
31:08for people underneath that age.
31:10So that's why we don't screen
31:11people underage 55.
31:12And that's that's really great.
31:13Great question.
31:14I don't know if Dan wants to
31:15talk a little bit about that.
31:17'cause I'm sure the damn sure
31:18you get a lot of questions
31:20about that in your practice.
31:21Honestly,
31:22I individualized treatment
31:23for different patients.
31:25I know there's criteria for screening.
31:29But my personal feeling is that
31:31there are some high risk patients.
31:34An A younger patient population.
31:38Particularly those who
31:39are working in factories,
31:41exposed other irritants or toxins
31:44that might amplify the risk.
31:47So I look at each individual
31:49patient and decide if they are
31:52candidate for screening based on
31:53not only the number of cigarettes,
31:56But the other environmental
31:58risks that they might have.
32:00Certain patient populations
32:02are also at higher risks,
32:04which we have to make certain that we
32:08recognize patients with family histories,
32:10unusual family histories of malignancy's,
32:13even if they aren't meeting the full
32:16criteria should be considered for screening.
32:19So although there are criteria for screening.
32:23I try to broaden the criteria
32:25for each individual patient.
32:28No,
32:28I think that's a great point.
32:30I mean, I think if you if you look at
32:33you know where lung cancer screening is
32:35in 2020 versus even just 40 years ago,
32:38we've learned a lot.
32:39And I think that your point about
32:41taking into factor other risk factors,
32:43as well as exposures and family history is
32:46certainly something that is being looked at,
32:48and it may very well be that you know,
32:51that's why I think that that's
32:53a valid point without it down.
32:55Are there any other?
32:56Yeah God.
32:57The only other concern
32:59I have is that although we've
33:01set up criteria for screening,
33:03we're still not meeting the
33:05criteria in the community.
33:07It is known that only about 5 or 10%,
33:10maybe less of patients who really
33:12should be screened for lung
33:14cancer are getting screened.
33:16So one of our challenges going forward
33:19as physicians and the community.
33:21Is to try to promote screening to
33:24both the primary care for providers
33:27and the patients themselves.
33:29That's why forms like this are
33:31so important to try to educate
33:34the community physicians,
33:36including the physicians,
33:37an the critical need for
33:39screening going forward.
33:42Not valid points.
33:43I think we got some other questions.
33:46This is great.
33:47Appreciate people using the chat box.
33:49Tomass is their current screening
33:51criteria for vaping or a formula
33:53for tobacco for tobacco and
33:55vaping to calculate Packers I
33:57have to say I don't know how
33:59vaping calculates in the Packers.
34:01Did Mike to Dan do you guys know?
34:04Now that means only been around
34:06for five years, so we haven't
34:09really quantitative quantitative.
34:10We haven't been able to quantitate the risk.
34:13Of that type of exposure,
34:15although other types of lung
34:17diseases are known to occur in
34:20the patients that are vaping.
34:22But in terms of lung malignancies,
34:24it hasn't been around long enough.
34:28To really determine that risk.
34:31Yeah, and I think that you know
34:34Martina asked has a two part question.
34:36I'll take the first one and then Mike.
34:39I'm going to have you take the second one.
34:42How often should a person be screened?
34:44You know, right now the recommendation
34:46is to do it every year if you're
34:48in that eligibility criteria that
34:50has something that's going to
34:52continue to evolve because those
34:54studies did five annual screenings,
34:55you know they didn't wind up following
34:57those people with screenings longer
34:59than five years, so we're still.
35:01You know, looking into what the
35:04ideal timeline is for how often,
35:07but right now the United States Preventive
35:10Tag Task Force recommends annually.
35:13So Mike, I don't know what your
35:15thoughts are when you talk to your
35:18folks about how fast does lung cancer
35:20grow and how big should it be to beta
35:23tech detected with regards to growth.
35:25I mean, how do you?
35:27I mean, it's hard to
35:28explain what. How do you think
35:30about growth for lung cancer?
35:32I you know, I think it's so different.
35:35I mean, some lung cancers are very
35:37slow growing and creepy crawly,
35:39and they may have been around for
35:41years and largely stay contained an.
35:43Other cancers can grow incredibly quickly.
35:46Obviously, I think screening has more
35:48utility for slow growing cancers,
35:50because things won't necessarily
35:51change into 12 month interval,
35:53and you won't necessarily see the
35:55spread that you can sometimes see,
35:58but it there's really an entire
36:00spectrum of its behavior.
36:02Yeah, no, I agree.
36:03The growth kinetics can can vary
36:06with regards to how big should it
36:08be to be detected. The cat scan?
36:11Can, you know, get down to you know?
36:14Your size lesion, so it actually can be,
36:17you know, somewhat small, and that's
36:19one of the advantages of the screening
36:22and what it shown in those trials is.
36:25It really identifies people
36:26in the earlier stages.
36:27Stage one and stage two,
36:29and at least when you look at
36:32those studies you saw the stage
36:34for more advanced cancers actually
36:36decrease to detect it earlier.
36:38So I'm going to turn it over to you now,
36:43Mike, for Mike's going to talk
36:45a little bit now Jeannie wants share
36:48the slides or I so actually I decided
36:51not to use any slides because I
36:54think ultimately really the goal of.
36:57Um screening is to stay away from me.
37:01I think really the slides that
37:05I created, probably or not,
37:08really germane if we screened,
37:10and we do this successfully.
37:14You know, I think you brought up the fact
37:17that we have made unbelievable strides
37:20in lung cancer care, and that's true.
37:23But we look back the cure rates
37:25and the long term survival.
37:27Have you know,
37:29changed tremendously in a positive direction?
37:31And it's for two reasons.
37:33One is, we have much better treatments.
37:36But the other is through screening efforts.
37:39Hopefully we're detecting this disease
37:42at much earlier stages.
37:44And really,
37:45the goal of screening is to catch it at an
37:49early stage where the cancer can be cured,
37:52and hopefully if that is the case
37:55you will not meet someone like me
37:58and the chemotherapy that I have.
38:01Again, if the hope is that you
38:03catch it in stage one or stage two,
38:06stage one would be.
38:07It's a basically a solid ball in
38:10that issue with the long stage
38:12two is if it's gone to lymph nodes
38:14or what they call the hilum,
38:16which is where the long attaches
38:18to the center of the chest.
38:20But both of those can be cured.
38:23Stage one and stage two,
38:25definitely with surgery,
38:26but stage one we will sometimes
38:29find a patient either is not
38:31physically able or does not want to
38:34go through surgery and we actually
38:36have non surgical options including
38:39what they call stereotactic body
38:41radiotherapy which is basically a
38:43very short accelerated course of
38:45radiation where the beams kind of
38:47come in from all these different
38:49angles and basically burn the tumor.
38:52I don't know that it's quite.
38:54As good as surgery,
38:56but some of the data actually shows
38:58that the same rates of cure it five years.
39:02It it does risk not fully stating
39:05people because when Doctor Meist uh
39:07surgery he also looks at all the lymph nodes.
39:11An really that we make sure that
39:14we're not missing what maybe
39:16slightly more advanced disease.
39:18But Sir,
39:19but after radiosurgery
39:20is definitely an option.
39:22And then there's even what they
39:23call a blade of techniques.
39:26The interventional radiologists and we
39:28have some excellent physicians in the
39:30area can actually insert want into the tumor,
39:33and they can either create an
39:35ice ball and freeze the tumor,
39:37or they can microwave it in those
39:40again are two ways that we can cure
39:43early stage cancers in patients
39:45were surgery is not an option.
39:47Um, there are times where patients are
39:50quarterly enough through screening,
39:52but it has still spread to the
39:55lymph nodes where doctor,
39:56Mace or Doctor Rudolph may send
39:59you a patient to me.
40:01Because if the cancer has
40:03spread to the lymph nodes,
40:05the thought is that.
40:07While the patient is probably cured,
40:10no matter what,
40:10there is a high enough risk of
40:12the cancer further spreading in coming
40:14back later on that we can give them
40:17a very short course of chemotherapy,
40:19just over a period of a couple of months,
40:22and it's basically it's
40:23like using weed killer.
40:24If you imagine just one or two cancer
40:27cells that are floating out there.
40:29And if we're able to kill them before
40:31they grow into big enough collection
40:33that they can start to cause problems,
40:36we further add to the rate of cure that
40:39Doctor Mace is already given them.
40:42Um? I you know again,
40:44the whole point of this is to prevent,
40:47or at least decrease the chance of the
40:49cancer has progressed to an advance
40:51enough stage where we can get into
40:53some of the newer immune therapies and
40:56targeted therapies that have really
40:58become such a big part of our Arsenal.
41:00But I guess you know what I
41:03would say is if God forbid.
41:05The cancer is more advanced.
41:08There's not.
41:09I really never want people to lose hope.
41:11There is just so much more than we could
41:14do that what we could do several years ago.
41:17So I just thought I,
41:18I always feel that I can sit down with the
41:21patient and say no matter what we find,
41:24I can guarantee that we can help you.
41:27I think that's about all I have to say
41:30from a medical oncology's standpoint.
41:34No, I think that's great.
41:36That's some helpful insight with regards
41:39to where we're at and appreciate your.
41:42Your comments in your perspective, I think
41:44we have another question from Natasha.
41:46Once the screening is complete
41:47and there is a negative result,
41:49do you work with the individual
41:51who is an active smoker to
41:53stop getting absolutely 100%?
41:54You know, you know,
41:55I think we all take the approach that you
41:58know we're going to take care of you.
42:00Whether you're smoking,
42:02whether you're not smoking and at least
42:04you know from at least I don't take it.
42:06As you know,
42:07when you're coming in to talk to me,
42:10we're going to spend a long time about,
42:12you, know, the.
42:13Fact that you need to stop smoking.
42:15I think in most people know that
42:18we just try and make sure that the
42:20resources are there so that you can.
42:23You know on your journey to either
42:25cut back or to quit that you have
42:28all the resources at your disposal.
42:30No.
42:33And then you said,
42:35I'm thinking of ways to get
42:38this messaging into the community,
42:40and I think that's great.
42:43Well, I think you know unless
42:45there is no other questions.
42:47I appreciate everyone's
42:48time for joining us tonight.
42:50You know, Mike and Dan.
42:52Thank you very much for your time
42:55and wisdom and I hope you guys have
42:58a wonderful Thursday evening. Thank
43:01you then thank you, Benny.
43:04And thank you Gene for putting
43:06this program together. Welcome.