Lung Cancer Screening

Lung cancer screening is vital to detecting cancer early, when it is easier to treat and more likely to be cured. Interventional Pulmonologist, Preeti Patel, MD, explains how the screening works and who should be getting this potentially life-saving test.

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So early-stage lung cancer is completely asymptomatic, so you don't think about it. But those are the people that I want to just show up, just show up. We'll do all the work for you. So, but because if you just come for a quick scan, we can literally go through everything, get it taken care of, and it's like it never happened. 

Hello and welcome to this edition of Health Styles. I'm your host, Lori Banks. Lung cancer is the second most common cancer in both men and women in the United States.Did you know there's a relatively easy scan that can be done to detect cancer early, when it's easier to treat? Because lung cancer has few symptoms in early stages. It's out of sight, out of mind for many people. When symptoms do present themselves, they cancer has most likely advanced, and treatment is more challenging. So, who should get screened? Interventional Pulmonologist Dr. Preeti Patel explains the criteria and the process involved.

She'll also talk about advances using robotic technology for lung biopsies. Stay tuned. Dr. Patel has a lot of vital information to share. 

At Sarah Bush Lincoln Regional Cancer Center. We believe in more than just treatment. We believe and care that goes beyond medicine, care that supports you emotionally and physically, care that uses the latest technology and the best minds in the field, and care that celebrates every victory at Sarah Bush Lincoln. Your fight is our fight. This is our promise. And these are the physicians and health care professionals at Sarah Bush Lincoln.

Welcome to the podcast, Dr. Patel. Great to have you here. Thank you so much for having me, Lori. So, you're an interventional pulmonologist? For people who are unfamiliar with that specialty. Just give us a quick elevator speech about what that is and what it entails. So, pulmonology in general is the study of lungs. And interventional pulmonology focuses more on procedures related to lung. So, we focus on bronchoscopy, which is a procedure where we go in with a camera and take a look at the inside of your lungs, and specifically do procedures related to that. So more advanced procedures like doing biopsies or taking pieces of tissue of certain areas and use specialized tools, like biopsies of the lungs, and then using different techniques to try to get answers for you. We also work on areas around the lung in the plural space, if there's fluid or any area around there to help out. All right. Well, our focus today is going to be on the importance of lung cancer screening. And I know you're so passionate about that. So how important is screening in catching lung cancer early. Because so often it's detected in the later stages and someone's like “oh I'm short of breath.” I have a cough that doesn't, doesn't stop. Why is that early intervention so important? So, lung cancer screening is one of the most important things because unfortunately, we catch lung cancer too late. We almost always catch it at stage four. And we're realizing more and more that it's extremely, extremely important to just get screened earlier. So, if we can get people to realize this, then we can get scans done sooner, we can identify things faster and we can actually take care of them. So it is so, so important. We talk about colon cancer and breast cancer, but we don't really talk about lung cancer as much. And that's why I'm here today, to tell everybody the importance of early screening for lung cancer.  

All right. So, we're familiar with, breast cancer or, mammography when you should get that, when you should get your colonoscopy.

What are the criteria for screening for lung cancer? 

So, for lung cancer, any person that's between the ages of 50 and 80 who have smoked one pack per day and a pack per day, is defined as 20 cigarettes or one pack of cigarettes for 20 years. So, either one pack a day for 20 years, or half a pack a day for 40 years, or any sort of iteration of that, for 20 years that currently smokes or has quit within the last 15 years is eligible for lung cancer screening.

So, what about for someone who doesn't smoke? But maybe they lived with the smoker. They worked in an environment with a lot of smoke. Can they get screened as well? 

So unfortunately, right now those people are not eligible for lung cancer screening per se, based on insurance guidelines. But my recommendation for those people are to keep a very close eye on any types of symptoms that they have and be very vigilant with following up with their primary care doctors and for any sort of respiratory system symptoms to, discuss potentially seeing their seeing a pulmonologist. If you see a pulmonologist and you have any symptoms that would warrant a CT scan, that would also be something I would be looking for to check for any spots in the lungs. 

So, tell us what's involved in a lung cancer screening.  

So, for lung cancer screening the main test that we do is a low dose CT scan. So, this is not like an MRI which is a closed system which could be a little bit scary with a loud noise. This is actually a very very simple test. It is. You will come in about 20 minutes before your appointment. There is no IV contrast or any dye. It is very low dose so radiation levels for this are extremely low. Lungs show up very good on scans. So, you don't require really very much radiation. It's pretty low level. Pretty much very close to equivalent to the background radiation you just acquire. Just living in the world, actually. So, you will show up to your appointment usually about 20 minutes before, they will put you in a hospital gown. You will come back to the room; the technologist puts you on the table. You lay flat on your back; you lift your arms above your head, and you go through a donut shaped machine. It's open in the front of it, in the back of it. And you just go through that machine in less than 60s so it's less than one minute. That's how quick that scan is. It's not too loud and they just zip you through. They may ask you to hold your breath for a couple of seconds while they do that scan. And again, there's no I.V. dye or anything, so you don't have to worry about your kidneys or any of your, your heart function, kidney function, anything like that. Then the technician will tell you you're all done. The whole thing takes about 30 minutes, and it's pretty painless.  

All right, so you as the pulmonologist, what do the results look like for positive or negative when you get those scans back? Are they spots on the lungs? What does it look like? 

So, the main thing we're looking for is something called nodules.

Nodules are just fancy words for spots. And that doesn't necessarily mean that it's something bad. So again, this is going to be a black and white picture of the lungs. It's just a little bit more detailed than an X-ray. And for me as a pulmonologist, it's going to take some interpretation based on your history and your workplace exposures and a lot of other factors. So, the way our system works is our radiologist will interpret the results based on the image. I will personally look at the image and compare it to any old images you have, and then make a decision about how suspicious it is and give it a classification with the radiologist in terms of how risky it is based on your history and based on the location, the size, the appearance and your risk factors for lung cancer. Based on all of those criteria, we will make a decision about what to do next. 

All right. So, if something does that next steps say you're concerned, or you see something concerning what's the next step for these people.

So, the normal process would be if you get a scan and everything is normal, we will give you a call and say congratulations, you got a normal scan. Screening is normally done every year. So once a year you do this painless test, and we schedule it for you. Insurance almost always covers this without any issue. And we've got a great team that will call insurance and help you out if they're giving you any trouble. We've got people that love to do that, so you don't have to worry. So, most of the time that's what you're going to get, because a lot of times it's just going to be, hey, you got your scan, show up, get it done, get a phone call, and you're good to go. If for some reason we see anything that looks like it needs further evaluation, you'll get a call from us and say, hey, Dr. Patel saw something that she wanted to talk to you about. That is not necessarily something bad. That just means there's something we need to talk about. So, then we get you an appointment, usually within a week or two. We've we have less than 14 days that we get you into the office. Then we sit down and talk. We like to go over the pictures as well as the report in detail, because there's a lot of fancy words and a lot of confusing things in there, and we want to break everything down to explain it. We go through everything in detail, compare any of the old pictures to the new pictures, and together we come up with a plan. If there is anything that looks like it's suspicious, we have a couple of options. We will either repeat a scan in a shorter time frame, maybe three months, six months. We can do a more advanced test called a Pet scan, where we add some dye and look for anything that is showing any activity. Or we can do something called a biopsy. 

So that might sound a little alarming, a little scary to people. Is this the robotic bronchoscopy?

Yes. So, there are two there are two ways to get a biopsy. And me and the interventional radiology team will work together to figure out what is the safest, best approach for you to get a biopsy. So my team and their team work together with in a conference that we have, which is a multidisciplinary conference where we sit down and we will discuss what types of approaches we should take in terms of what patients should get what. And we will work on based on the location and the size and and what is the safest approach we will get. 

Basically, we need tissue. So, we will find out how should we get that tissue in the safest and most effective manner. So, one way will be to put a tiny needle in and get tissue from the outside. Robotic bronchoscopy, which is the procedure we do, is where we put you completely asleep. We put a breathing tube in, we use a camera, and we go from the inside using a navigation system, and we go from the inside to get pieces of tissue and use tiny tools to get pieces of tissue. Both techniques. The tissue was sent to the pathologist, where they will look at it on a slide and give us an idea of what it is. 

All right, so I had the pleasure of actually watching this in action with you back, I think in the spring, and it's really something to see this all happening because a pathologist is right there in the room. Correct?  

Yes. We have a cyto tech in the room. So, the cyto tech in the room and that that is very helpful for us. So, we have somebody in the room that will so they will not be able to tell us if it's cancer or not. Cancer really what they tell us is we in the right location and are we getting tissue or are we getting blood or are we getting some other form of, bronchial cells, meaning just lung tissue? They can only really say does it look normal or abnormal. So, I can't quite tell exactly what it is, but it gives me an idea. Is my location where it should be? A lot of times, because these scans again, are just fancy black and white pictures, it's going to pick up all sorts of spots. Spots can be anything. They can be cancer, they can be infection, they can be scars. So, a lot of times we will do this, and we will find things we didn't expect. So, we found fungal infections. We found bacteria. We have even found a peanut one time when we went in there. So, it's pretty surprising the things you can find, when you're, when you're looking for doing a biopsy. So, the good thing is we have somebody in the room that can tell us we're in the right location, and then we get that tissue, and then we always need to confirm with our pathologist. That's why we send that tissue down. It takes about 3 to 5 days from the time that you get your biopsy to get a preliminary result and some of the final results, which may need to be sent out to Mayo Clinic or Cleveland Clinic or some of our outside labs, those may take a little bit longer.

So, if it does come back, is cancer. Do you go in with the same robotic equipment and like cut that out or how does that work? 

So no, that team that I was talking about our interdisciplinary team, they are always involved. So, the one thing that we do here at Sarah Bush that we really pride ourselves in is we like to take each patient's approach as a team approach. So we work together as a group, our oncology team, our radiation oncology team, our cardiothoracic surgery team, our radiology team, our pathology team, and our interventional pulmonology team. We like to talk to each other so good. We got each other's cell phone numbers and we like to communicate about people. So, we will sit down and we will talk. 

So, if as soon as we get a result, that is something that happens to be a cancer or something that happens to need some sort of intervention, even our infectious disease doctor has been involved in these, if anything needs any further evaluation. That is what we excel at. So, we have an entire system in place where we will take all of the responsibility and the set up for you, and you just don't need to worry about it. So, we set up your appointments, give you all the next steps, and literally print out a paper and highlight where you need to be and what you need to do, and then go through all of those steps in an appointment for you. So, we've talked different times, and you're very passionate about saying that in its early stages, lung cancer is very treatable. But often people wait till stage four when it's maybe not as treatable. 

Can you talk about that early-stage intervention and why that's so important? 

So smoking is what it is. So, it's it's there. And you know, cigarettes were very advertised. People got hooked to them. It's very hard to quit smoking once you've started smoking. And we do a lot of smoking cessation. And I am I'm passionate about quitting smoking, but the reality of it is it's a hard thing to do. It's very, very, very tough. I mean, there are studies that prove that quitting smoking is probably one of the hardest things in the world to do. So, to be honest with you, picking up a pack of cigarettes and smoking, that's probably going to happen in the general population. So what I'm really passionate about is if I can't get you to quit smoking, I don't want to focus on that as much. I want to focus on what can I do to help you now? And that is to show up, to get a scan. Because if I find a small spot in the lung and you're not short of breath, you're going about your day, you're working, you're spending time with your family, you're taking care of your life, you feel fine, and you smoke, or you quit smoking and you're feeling better, but you quit smoking five years ago, ten years ago. You feel fine. It doesn't bother you just come and get a scan. Because if I find a small spot, I do a quick biopsy. We can do things to get rid of this and you never have to worry about it again. It will have minimal to no impact on your life whatsoever if you just get it looked at.

The reason people don't notice is because they don't have symptoms. So early-stage lung cancer is completely asymptomatic, so you don't think about it. But those are the people that I want to just show up, just show up. We'll do all the work for you. So, but because if you just come for a quick scan, we can literally go through everything, get it taken care of, and it's like it never happened. Stage one, early stage two. Those do not really require anything. They they can, depending on your lung function, either that area can be wedged out, just completely cut out by surgery, and the remaining lung tissue can be kept intact with minimal effect to your breathing. Or we can do sbrt, which is single beam radiation therapy, which is very targeted laser beam to that cancer area where it kills off only the cancer cells and not the cells around it. And we just zap it with a little laser beam and preserve the rest of your lung tissue. And it's like it never existed. So, the early, early stages of lung cancer, the ones that you don't feel we can just get rid of those, but those are the ones we miss. Unfortunately, most of the time, because you don't feel them. And those are the ones I really want people to know about, because those are the ones we can help from progressing. Unfortunately, the ones that show up the most are the ones where you feel so short of breath. You're coughing up blood, you feel tired, you've lost some weight by the time you have a lot of symptoms.

Unfortunately, that is usually a sign where it's probably moved or done something else to cause you some trouble. That doesn't mean you don't come in. I can still probably do something to stop that, but it's a little bit harder on us, to help with those. So, the screening is extremely important to us because if you're feeling good, just remember, if you smoked in the last 15 years and smoked 20 pack years, don't forget that that still might have caused some lung damage. And at least let us take a look. All right. That's sounds that is the best advice ever. So, if you are that person or you love someone, who is that person, we can only say, please, please have them do this simple scan. It is so easy, won't take very much of your time. And you know, hopefully we can catch it early 

Dr. Patel, is there anything else you wanted to say before we sign off? 

Nope. Just come get screened and we will take care of you. All right with that, thank you so much for coming in today. And thank you for listening to Health Styles. Thank you.

 If you think you meet the criteria for a lung cancer screen, start by talking to your primary care provider who can help you navigate the process. For more information about Dr. Patel, visit our website at Sarah bush.org under Find a doctor. Remember that Sarah with an H. Thanks for spending time with us today, and we hope Doctor Patel's information changes the way you think about lung cancer screening, and why early intervention could be a life saver for Health Styles. This is Lori Banks. Have a great day.