Lung cancer accounts for about 27 percent of all cancer deaths and is the leading cause of cancer death among both men and women. Each year, more people die of lung cancer than of colon, breast, and prostate cancers combined.
Listen in to learn more about preventing and treating this disease from Dr. Michael Hanley, a UVA expert.
Lung Cancer: Screening Can Save Your Life
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Learn more about Dr. Michael Hanley
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Michael Hanley, MD
Dr. Michael Hanley serves as the medical director of UVA's comprehensive lung cancer screening program.Learn more about Dr. Michael Hanley
Learn more about UVA Health System
Transcription:
Melanie Cole (Host): Lung cancer counts for about 27% of all cancer deaths and is the leading cause of cancer death among both men and women. Each year, more people die of lung cancer than of colon, breast, and prostate cancers combined. My guest today is Dr. Michael Hanley. He’s the medical director of UVA’s Comprehensive Lung Cancer Screening Program. Welcome to the show, Dr. Hanley. How common is lung cancer? Are you seeing a rise in it these days?
Dr. Michael Hanley (Guest): Thanks for having me. Yes, as you mentioned, lung cancer is the leading cause of cancer related death. We have seen an increase in the patients that we see for lung cancer, both partly because of our growth but also because of the region that we’re in. The rates have been coming down for men but they’ve actually been increasing for women, which is concerning.
Melanie: So, then, tell us a little bit about lung cancer and the risk factors that you look for.
Dr. Michael Hanley: Sure. Smoking is attributable to about 90% of lung cancer. There are other environmental risk factors: radon exposure, occupational exposure, things you may have been exposed to in the environment but, again, 90% are about smoking. The reason that the risks for men are coming down is because of very aggressive anti-smoking campaigns but the risks for women are increasing because we see a little bit of a lag from in the late 70’s and early 80’s when there was a lot of targeted advertising to women.
Melanie: So when you’re speaking about the lung cancer risk factors, is there a genetic component to lung cancer?
Dr. Michael Hanley: There certainly is. It’s not one of the cancers that we know an exact gene and we can’t test for it, much like we can test for the breast cancer gene. We know that it does run in families so while we don’t know the gene exactly, we do assume there is some genetic component.
Melanie: Is there a screening tool available for lung cancer?
Dr. Michael Hanley: People have been looking at how to catch lung cancer early for years. One of the major problems with lung cancer is that about 80% of patients diagnosed with lung cancer get diagnosed in later stages where surgery is not curative. There have been people that have looked at a variety of different things. They started out looking at annual chest x-rays. So, if you just come in for your annual exam to see your doc you would get a chest x-ray. They looked at that very carefully and they found that actually wasn’t very helpful. They’ve looked at things where you would spit in a cup and they would look at that under a microscope and see if they could detect cancer early. That didn’t really pan out. There are blood tests in development and a few other things that are kind of in development, but what really came out of the last couple years is should we use CT scans to detect early cancers? We know that CT scans do an excellent job of taking up early nodules. We see nodules on quite a high percentage of studies that we look at for other reasons, but what we are trying to look at is should we use that tool to look at very high risk patients? That’s what the lung cancer screening trials have shown us in the last couple years--that annual low radiation dose CT scans are helpful in detecting early lung cancers.
Melanie: Who is a candidate for this type of screening?
Dr. Michael Hanley: Generally, looking at heavy smokers between 55 and 77 years old and heavy smokers are really defined as a 30 pack year history. So, if you take someone who smoked one pack a day for 30 years that would equal 30 pack years, or two packs a day for 15 years, or some equivalent thereof. We also want people to be free from symptoms of other cancers. If patients are having severe symptoms where they and their doctor think that they’re worried about something and they need a CT scan, they may need a CT scan but probably don’t want to be part of our screening process.
Melanie: So, then, the screening takes place how often?
Dr. Michael Hanley: It’s an every year low radiation dose CT scan. It takes just a few minutes to have it done but here at UVA we also couple that visit with a visit with our nurse practitioner. What our nurse practitioner will do is talk about smoking cessation for patients that are still smoking. They could prescribe cessation medications, if needed, and really be a great resource for patients going through what could be one of the hardest things they’ve ever gone through. As many smokers know, it is very, very hard to quit.
Melanie: Dr. Hanley, do insurance companies recognize this particular type of screening?
Dr. Michael Hanley: They do. It’s all insured. Because of the Affordable Care Act, all insurers must provide this coverage without co-pay.
Melanie: Now, if somebody is worried about lung cancer, are there some symptoms – people think of coughing, they think of sputum, any of these kinds of things – are there any symptoms to watch out for?
Dr. Michael Hanley: There are. One of the things that is kind of tricky with lung cancer is that many smokers have a chronic cough. So, you don’t want to say, “Well, if you cough then it must be cancer,” because there’s a lot of other reasons to have a cough. But, if that cough gets worse or doesn’t go away and is worse than the normal smoker’s cough, that is something that could be worrisome and you should see your physician about. Other things like coughing up blood or chest pain and shortness of breath are other things that we would ask about. Weight loss is also something that’s concerning for cancer and a lot of different cancers share those symptoms.
Melanie: So, if you do diagnose somebody, that can be the most scary diagnosis to hear. What do you tell them to give them some hope and what are some treatment options available?
Dr. Michael Hanley: Sure. Again, the reason that we want to catch cancer early is because that’s when there are curative cancer treatments. Say, for example, a patient comes and they have a cancer that’s the size of a dime that we detect on a CT scan, they would be able to undergo resection of that. They could see a surgeon, have that cut out, and they would effectively be cured, and that’s really what we’re going for. We want to avoid what is the current state most of the time – again, 80% of the time – when we diagnosis people with lung cancer, it’s done at a state where it’s already spread to other areas, which then just leaves chemotherapy as effective treatment options.
Melanie: So then if people go through this, and what do you tell them about obviously life style modifications, is there anything else besides quitting smoking that you like them to do after treatment?
Dr. Michael Hanley: Actually, quitting smoking-- they’ve actually been looking at quitting smoking even after someone’s been diagnosed because there’s a lot of sentiment of our patients that they say, “Well, it’s a stressful time when they get diagnosed and they’ve already been diagnosed with cancer so why should I quit now?” And they’ve actually done a lot of research looking at patients who quit smoking at the time of their diagnosis and patients that don’t quit, that continue to smoke during their treatment, and patients who quit smoking after they get diagnosed do much, much better through their treatment. Really, that’s something that we definitely focus on. Again, it’s a very, very hard thing to quit so we want to make sure that we give the patients all the support that we can to not only to physically get through and emotionally get through a diagnosis of cancer, but also the smoking component.
Melanie: Dr. Hanley, tell us about UVA’s Comprehensive Lung Cancer Screening Program and tell us about your team.
Dr. Michael Hanley: Sure, we’re very lucky to have a team that-- what our real goal is, is to try to provide a full service for patients that are undergoing this exam. The CT scan is really just a part of it. We’ve partnered with the cancer center to hire a nurse practitioner. She’s really the focus of our program where she sees the patients; she develops lasting relationships with our patients; she can help them quit smoking, as I mentioned; and then, also, when patients are due for their annual study, we work on making sure that we get in touch with those patients. We don’t want anybody falling through the cracks, so having someone that can help coordinate the program is really essential. We also have a great team including thoracic surgeons, thoracic oncologists, and all of our other treatment specialists who, when patients are identified, we can make sure that they’re seen quickly and with great specialists.
Melanie: Thank you so much, Dr. Hanley. It’s great information. For more information on UVA’s Comprehensive Lung Cancer Screening Program, you can go to www.uvahealth.com. That’s www.uvahealth.com. You’re listening to UVA Health Systems Radio. This is Melanie Cole. Thanks so much for listening.
Melanie Cole (Host): Lung cancer counts for about 27% of all cancer deaths and is the leading cause of cancer death among both men and women. Each year, more people die of lung cancer than of colon, breast, and prostate cancers combined. My guest today is Dr. Michael Hanley. He’s the medical director of UVA’s Comprehensive Lung Cancer Screening Program. Welcome to the show, Dr. Hanley. How common is lung cancer? Are you seeing a rise in it these days?
Dr. Michael Hanley (Guest): Thanks for having me. Yes, as you mentioned, lung cancer is the leading cause of cancer related death. We have seen an increase in the patients that we see for lung cancer, both partly because of our growth but also because of the region that we’re in. The rates have been coming down for men but they’ve actually been increasing for women, which is concerning.
Melanie: So, then, tell us a little bit about lung cancer and the risk factors that you look for.
Dr. Michael Hanley: Sure. Smoking is attributable to about 90% of lung cancer. There are other environmental risk factors: radon exposure, occupational exposure, things you may have been exposed to in the environment but, again, 90% are about smoking. The reason that the risks for men are coming down is because of very aggressive anti-smoking campaigns but the risks for women are increasing because we see a little bit of a lag from in the late 70’s and early 80’s when there was a lot of targeted advertising to women.
Melanie: So when you’re speaking about the lung cancer risk factors, is there a genetic component to lung cancer?
Dr. Michael Hanley: There certainly is. It’s not one of the cancers that we know an exact gene and we can’t test for it, much like we can test for the breast cancer gene. We know that it does run in families so while we don’t know the gene exactly, we do assume there is some genetic component.
Melanie: Is there a screening tool available for lung cancer?
Dr. Michael Hanley: People have been looking at how to catch lung cancer early for years. One of the major problems with lung cancer is that about 80% of patients diagnosed with lung cancer get diagnosed in later stages where surgery is not curative. There have been people that have looked at a variety of different things. They started out looking at annual chest x-rays. So, if you just come in for your annual exam to see your doc you would get a chest x-ray. They looked at that very carefully and they found that actually wasn’t very helpful. They’ve looked at things where you would spit in a cup and they would look at that under a microscope and see if they could detect cancer early. That didn’t really pan out. There are blood tests in development and a few other things that are kind of in development, but what really came out of the last couple years is should we use CT scans to detect early cancers? We know that CT scans do an excellent job of taking up early nodules. We see nodules on quite a high percentage of studies that we look at for other reasons, but what we are trying to look at is should we use that tool to look at very high risk patients? That’s what the lung cancer screening trials have shown us in the last couple years--that annual low radiation dose CT scans are helpful in detecting early lung cancers.
Melanie: Who is a candidate for this type of screening?
Dr. Michael Hanley: Generally, looking at heavy smokers between 55 and 77 years old and heavy smokers are really defined as a 30 pack year history. So, if you take someone who smoked one pack a day for 30 years that would equal 30 pack years, or two packs a day for 15 years, or some equivalent thereof. We also want people to be free from symptoms of other cancers. If patients are having severe symptoms where they and their doctor think that they’re worried about something and they need a CT scan, they may need a CT scan but probably don’t want to be part of our screening process.
Melanie: So, then, the screening takes place how often?
Dr. Michael Hanley: It’s an every year low radiation dose CT scan. It takes just a few minutes to have it done but here at UVA we also couple that visit with a visit with our nurse practitioner. What our nurse practitioner will do is talk about smoking cessation for patients that are still smoking. They could prescribe cessation medications, if needed, and really be a great resource for patients going through what could be one of the hardest things they’ve ever gone through. As many smokers know, it is very, very hard to quit.
Melanie: Dr. Hanley, do insurance companies recognize this particular type of screening?
Dr. Michael Hanley: They do. It’s all insured. Because of the Affordable Care Act, all insurers must provide this coverage without co-pay.
Melanie: Now, if somebody is worried about lung cancer, are there some symptoms – people think of coughing, they think of sputum, any of these kinds of things – are there any symptoms to watch out for?
Dr. Michael Hanley: There are. One of the things that is kind of tricky with lung cancer is that many smokers have a chronic cough. So, you don’t want to say, “Well, if you cough then it must be cancer,” because there’s a lot of other reasons to have a cough. But, if that cough gets worse or doesn’t go away and is worse than the normal smoker’s cough, that is something that could be worrisome and you should see your physician about. Other things like coughing up blood or chest pain and shortness of breath are other things that we would ask about. Weight loss is also something that’s concerning for cancer and a lot of different cancers share those symptoms.
Melanie: So, if you do diagnose somebody, that can be the most scary diagnosis to hear. What do you tell them to give them some hope and what are some treatment options available?
Dr. Michael Hanley: Sure. Again, the reason that we want to catch cancer early is because that’s when there are curative cancer treatments. Say, for example, a patient comes and they have a cancer that’s the size of a dime that we detect on a CT scan, they would be able to undergo resection of that. They could see a surgeon, have that cut out, and they would effectively be cured, and that’s really what we’re going for. We want to avoid what is the current state most of the time – again, 80% of the time – when we diagnosis people with lung cancer, it’s done at a state where it’s already spread to other areas, which then just leaves chemotherapy as effective treatment options.
Melanie: So then if people go through this, and what do you tell them about obviously life style modifications, is there anything else besides quitting smoking that you like them to do after treatment?
Dr. Michael Hanley: Actually, quitting smoking-- they’ve actually been looking at quitting smoking even after someone’s been diagnosed because there’s a lot of sentiment of our patients that they say, “Well, it’s a stressful time when they get diagnosed and they’ve already been diagnosed with cancer so why should I quit now?” And they’ve actually done a lot of research looking at patients who quit smoking at the time of their diagnosis and patients that don’t quit, that continue to smoke during their treatment, and patients who quit smoking after they get diagnosed do much, much better through their treatment. Really, that’s something that we definitely focus on. Again, it’s a very, very hard thing to quit so we want to make sure that we give the patients all the support that we can to not only to physically get through and emotionally get through a diagnosis of cancer, but also the smoking component.
Melanie: Dr. Hanley, tell us about UVA’s Comprehensive Lung Cancer Screening Program and tell us about your team.
Dr. Michael Hanley: Sure, we’re very lucky to have a team that-- what our real goal is, is to try to provide a full service for patients that are undergoing this exam. The CT scan is really just a part of it. We’ve partnered with the cancer center to hire a nurse practitioner. She’s really the focus of our program where she sees the patients; she develops lasting relationships with our patients; she can help them quit smoking, as I mentioned; and then, also, when patients are due for their annual study, we work on making sure that we get in touch with those patients. We don’t want anybody falling through the cracks, so having someone that can help coordinate the program is really essential. We also have a great team including thoracic surgeons, thoracic oncologists, and all of our other treatment specialists who, when patients are identified, we can make sure that they’re seen quickly and with great specialists.
Melanie: Thank you so much, Dr. Hanley. It’s great information. For more information on UVA’s Comprehensive Lung Cancer Screening Program, you can go to www.uvahealth.com. That’s www.uvahealth.com. You’re listening to UVA Health Systems Radio. This is Melanie Cole. Thanks so much for listening.