Lung cancer is the number one cause of cancer-related deaths in America, but lung cancer CT screening is an effective way to diagnose lung cancer in its early stages, when treatment is more effective.
Bradley Icard, D.O., Pulmonologist at Pinehurst medical Clinic and Medical Director of FirstHealth's Lung Screening program, joined the FirstHealth and Wellness Podcast to discuss the importance of screening and how FirstHealth is working to expand access.
Episode Transcript
Host: We're going to talk about lung cancer screening and what that means and what's involved and who might want to consider it and all of that. So let's start there. What exactly does that mean? What is lung cancer screening and who among us should be thinking about it?
Icard: Lung cancer screening is currently approved for patients that are high risk for the development of lung cancer. And that particular group are normally folks that have had history of tobacco abuse and have either smoked for approximately, what's considered a 20 pack year history, which would be like one pack of cigarettes daily for 20 years, or two packs of cigarettes daily for 10 years.
So that's how you would calculate a pack year history. A 20 pack year history, the age of 50 to 80 years old, and either are current smokers or have quit within the past 15 years. And these are patients that are considered high risk for the development of lung cancer.
Host: I talk a lot about colonoscopies and mammograms and, and with good reason, of course, but it doesn't seem like we don't talk as much about lung cancer screenings, and I'm wondering what your sense of that is. Why is that? Why don't we talk about this more despite the fact that you and I are talking about it now?
Icard: Unfortunately, lung cancer is somewhat stigmatized amongst that patient population, especially with a history of tobacco use. But when you look at effectiveness of lung cancer screening compared to other options such as mammograms or colonoscopies, lung cancer screening is much more effective.
It takes nearly 1,500 to 1,800 colonoscopies on healthy screening adults to find a colon cancer to save one person's life. It takes nearly 900 mammograms to do the same for ladies that are getting screened for breast cancer for the first time, but lung cancer screening, it only takes 320 lung cancer screening CTs to save a person's life.
Host: So let's talk more then about the low dose screenings, you know, whether they catch cancer earlier, what sort of impact do they have on our care ultimately, if we're diagnosed?
Icard: Ideally, you know, if we can catch lung cancer early, it's curable, which puts patients at a major advantage for minimally invasive surgeries for resection, or radiation treatments that are potentially curable in comparison to receiving chemotherapy and treatments which can sometimes be curable in lung cancer, but, often not. The leading cause of cancer related deaths in the United States is lung cancer.
So if you look at colon cancer, breast cancer and prostate cancer and combine the number of deaths related to those compared to lung cancer; it doesn't even reach the total number of people that are affected by lung cancer every year in the United States.
Host: What does the screening involve? Is it painful?
Icard: No, uh, lung cancer screening is completely painless and takes honestly less than 10 minutes. Patients would come in for a low dose CT scan, CT standing for computed tomography, where patients would lay down on a table, pass themselves through the CT scanner and takes pictures of somebody's lungs. And those images are read by a radiologist. And then are usually transmitted to a person like myself for somebody on the thoracic imaging team that would take a look and help decide whether or not patient is at risk for lung cancer. And usually what we find on those scans are something called lung nodules or a pulmonary nodule. And if we find those, that's what leads to early diagnosis of lung cancer.
Host: So then doctor, when we think about lung cancer screening, who qualifies and you know, how do they know?
Icard: Patients to qualify for lung cancer screening, the US Preventative Services task force, as well as others such as the American Cancer Society and NCCN or National Cancer Care Network have guidelines for screening recommendations and those patients right now considered high risk are age 50 to 80 years old, either are current or former smokers, have a 20 pack year history and, if they have quit, would've quit within the past 15 years. And so those are patients that qualify for lung cancer screening and should talk to their provider about an option for screening.
Host: Yeah. And is that just generally how it works, doctor? That we can speak with our providers and say, listen, I smoked for 10 years, I smoked for 20 years. I think I qualify and I'd like to have this screening. Is that usually how the process works?
Icard: Yes. Normally they can discuss this just like at their regular annual visits or follow up appointments with their primary care providers, or if they happen to see a pulmonologist, you know, I, even get them, referrals from ladies that are seeing their OBGYN for their annual follow up. And they may be ordering a mammogram and a lung cancer screening CT done at the same time.
Host: Yeah. The one stop shopping, right. While I'm here, doc. How about these other screenings? Of course. And we know how important they are. Just want to give you a chance here at the end, doctor, maybe you can share some examples of, you know, the early detection success stories and just the, maybe the broader impact of early detection.
Icard: Yeah, absolutely. You know, early detection of lung cancer allows us to find very small lesions in the chest. And when you compare an early stage one lung cancer, that would be less than 10 millimeters in size, those patients have a near 95% five-year survival rate. Now you compare that to a patient that has an advanced stage lung cancer, all comers for those categories, 85% of those patients die within five years despite treatments. So if we are able to catch an early malignancy, they can have a surgical resection, removal and live on their life. I'm reminded on a daily basis, I'm an advanced bronchoscopist and do biopsies on very small nodules using a robotic system.
And now as technology advances, we're able to access smaller and smaller lesions in the chest, and so we're able to do that safely with no cuts, no stitches, no pain. Patients have an outpatient procedure. Go home the same day. And if we can catch it early, then those folks are able to live out their life and my team and I, at FirstHealth, you know, on average we're doing at least 20 plus, bronchoscopies and biopsies for small lesions every single month. And so we're able to see a significant difference in our outcomes for early stage lung cancer.
Host: Yeah, I speak with a lot of cancer folks, cancer docs, professionals, experts, and there's a common thread, of course, that early diagnosis is best, but that sounds especially true from what we're hearing from you today when it comes to lung cancer. So, appreciate your time and your expertise. Thanks so much.
Bradley Icard, D.O.: Anytime. I appreciate it. Thanks for having me.
Host: And for more information, go to firsthealth.org/lung
