Transcription:

Melanie Cole: Screening for lung cancer means testing for cancer before there are any symptoms, and screening for some types of cancer has reduced deaths by early detection and treatment. My guest is Dr. Juan Olazagasti. He's a board-certified radiologist at UVA Health System who specializes in thoracic imaging including the lungs. Welcome to the show, Dr. Olazagasti. So who should get screened for lung cancer?

Dr. Juan Olazagasti: The eligibility criteria includes patient with a strong smoking history and we count that as 30-pack years of smoking. That can be thought of as either 30 years smoking one pack a day or 15 years smoking two packs a day or anything similar that would account for that pack-year history. Patient should be between 55 and 79 years of age and if they are a current smoker or a former smoker that quit within the last 15 years.

Melanie: So why are we screening? Is this something new that's being done?

Dr. Olazagasti: There was a large study called the national lung cancer screening trial that was performed over eight years and over 50,000 patients comparing chest x-ray or chest radiographs and CT and we did find a 20 percent decrease in mortality related to lung cancer by utilizing CT. The basis of this is the fact that lung cancer is usually diagnosed at a late stage or is usually not treatable and not curable. We have found that if we do find lung cancer early in stage one, it's much, much easier to treat and cure.

Melanie: Doctor, do you find that people are honest with you about their past history of smoking so that you have a better clearer picture of whether you should do a CT scan to screen for lung cancer?

Dr. Olazagasti: I believe most patients, when it comes to their health, tend to be honest. We have ways of asking questions to try to obtain the most accurate information and be able to be reliable.

Melanie: So what does the lung cancer screening involve? Is it strictly a CT scan? I mean I would imagine x-rays don't show that much, but what's involved?

Dr. Olazagasti: Patient comes in, does not need much more than just to answer some questions and lay on the CT scanner, does not need an intravenous line or a catheter placed in their arms, and they just lay on a machine that looks like a big donut literally. The scan takes only a few minutes. There's no true significant complication regarding the procedure that would make them to be scared or not want to do it. The results will then be reported and a letter will be sent to the referring physician for follow-up.

Melanie: So what would be the results? Will they see very, very early lung cancer? Will there be spots and things that you might see that you would know are not going to turn cancerous? Because there's a lot of testing going on today, you know, genetic testing and various things that could scare people but this one could really save a life. So what do the results entail?

Dr. Olazagasti: We're trying to do a screen study if there's either a finding that is concerning for lung cancer or there's not, and we're trying to make it as simple as possible for the referring physician and for the patient. Sometimes there are incidental findings as we scan through the lungs. There's going to be other areas that we're going to see including the heart, some organ pieces, at least part of some organs such as the liver, adrenal glands, the kidneys and we do find sometimes what we call incidental findings. We're going to follow guidelines that tell you which of those findings are important and need to be worked up further and which ones are not.

Melanie: So if somebody gets a result that says negative, this does not mean that they absolutely do not have lung cancer or never will get it, correct? I mean is this something that you do on a regular basis once every five years or three years or something if you are any of those risk factors that you discussed?

Dr. Olazagasti: The actual recommendation from that study and the American College of Radiology as well as many other chest and thoracic institutions, including surgery and pulmonology, is that this study is performed yearly for the life of the study with this patient between 55 and 79 years of age. We have found significant amount of cancers on the first scan but at the same time many patients actually develop the findings on CT on their third, fourth, fifth scan. So it's very important that the patients understand that this is not one-time study but that they need to continue coming to the routine follow-ups on a yearly basis.

Melanie: And is this something that insurance is jumping on board with this type of screening? Might it be considered part of a wellness screening if you were a current or former smoker or fit in to any of those categories?

Dr. Olazagasti: Yes, actually the United States Preventive Task Force just did a full recommendation, grade B recommendation for this study. There are several insurance companies that are paying for them—right here in Virginia, for example, Anthem is—but we expect that the government will pay for the study as of January 2015.

Melanie: And what might a suspicious result tell us, Doctor, that would send somebody maybe to see an oncologist, or what would be the next step if somebody gets a suspicious result?

Dr. Olazagasti: Hopefully we find one that the patient does not need to go directly to the oncologist but can actually go to a surgeon. If we find it on a stage one and the patient is a good surgical candidate, and that's to be obviously evaluated thoroughly, these tumors can be removed early enough surgically and they can actually be considered cured, which the words 'cured in lung cancer' for as far as I've been practicing were not something we would say in the same sentence.

Melanie: So maybe if they're a good candidate for surgery, they go and get that. And then would they keep having these tests to see if anything has changed? Because that would be quite scary to get a suspicious result of something like this if you were a smoker in college or something along those lines?

Dr. Olazagasti: Yes, definitely. And once it's taken out, the recommendation is that the patient continues and goes back into the regular follow-up by their thoracic surgeon or oncologist whoever is their primary care at that time. There is known risk factors in a patient that already has lung cancer to develop a second lung cancer. So the follow-up continues basically through their lifetime.

Melanie: Is there a genetic component to lung cancer?

Dr. Olazagasti: We believe there is and that relates to the question I was just mentioning. There's actually a study from Europe and we're finding that patients that smoke that have this significant smoking history we talked at the beginning and have a family history of lung cancer have a much higher incidence of also developing lung cancer. So there are certain other factors as many of the diseases are that we find that is not just the smoking but other things that can also predispose patients for lung cancer. The strongest predictor as of now is smoking by itself. In no means I want to transfer information to the population that they believe that if they don't have a family history of lung cancer and they're smokers that they should not get screened. That just adds to the risk factor but the most strong factor at this time in the literature is smoking in itself.

Melanie: In the last 30 seconds doctor, why should a patient consider UVA for their lung cancer screening?

Dr. Olazagasti: We have a comprehensive medical team including pulmonologists which will assist the patient for smoking cessation, thoracic surgeons that are purely dedicated and trained in the removal of lung cancer and thoracic malignancies and dedicated thoracic oncologists as well as thoracic radiologists or medial imager, which is what I do, where our focus is purely on the lungs. That does finally give better results for patients.

Melanie: Thank you so much. You're listening to UVA Health System Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks for listening.