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Lung Cancer Screening
Lung cancer is by far the leading cause of cancer death, making up almost 25% of all cancer deaths. Early diagnosis is key in trying to prevent or possibly cure it. Dr. Jonathan Waxman, a board-certified general and thoracic surgeon discusses lung cancer, lung cancer screening, and the benefits of low-dose CT scans.
Featured Speaker:
Dr. Waxman’s strives to provide state-of-the-art thoracic oncology care in a comprehensive manner, ensuring good communication with all the physicians involved in the care of his patients. His clinical interests include minimally invasive thoracic/foregut surgery, robotic and video-assisted surgery. He is a member of the Society of Thoracic Surgeons, the American College of Chest Physicians and is a fellow of the American College of Surgeons. He speaks fluent Spanish and Hebrew. Dr. Waxman is affiliated with St. Joseph’s Hospital.
Learn more about Dr. Jonathan Waxman
Jonathan Waxman, MD
Dr. Jonathan Waxman is board certified in general surgery and thoracic surgery. He earned his Doctor of Medicine from Universida Anahuac in Mexico City, Mexico. He continued his medical education by completing a surgery internship and residency at Harvard Medical School, Beth Israel Deaconess Medical Center in Boston, Massachusetts. He then completed a cardio thoracic surgery fellowship at the University of Tennessee in Memphis, Tennessee, and then a minimally invasive surgery fellowship at the University of Pittsburgh Medical Center in Pittsburgh, Pennsylvania.Dr. Waxman’s strives to provide state-of-the-art thoracic oncology care in a comprehensive manner, ensuring good communication with all the physicians involved in the care of his patients. His clinical interests include minimally invasive thoracic/foregut surgery, robotic and video-assisted surgery. He is a member of the Society of Thoracic Surgeons, the American College of Chest Physicians and is a fellow of the American College of Surgeons. He speaks fluent Spanish and Hebrew. Dr. Waxman is affiliated with St. Joseph’s Hospital.
Learn more about Dr. Jonathan Waxman
Transcription:
Scott Webb: Welcome to BayCare HealthChat. I'm Scott Webb. And I invite you to listen as we discuss lung cancer, lung cancer screening, and the benefits of low-dose CT scans. And joining me today is Dr. Jonathan Waxman. He's board-certified in general surgery and thoracic surgery.
Doctor, thanks so much for your time today. We're going to talk about lung cancer and primarily screening and screening options. But before we get there, just as a baseline, who's at the highest risk for lung cancer?
Dr. Jonathan Waxman: Thank you for having me. First and foremost, active smokers are the patient population that are at the highest risk. As we know, smoking is the number one risk factor for developing lung cancer. Patients with a family history of lung cancer also should be concerned about the possibility of them having cancer.
Scott Webb: Yeah, and I know there's probably some other risk factors too. So how common is lung cancer?
Dr. Jonathan Waxman: Well, lung cancer is the second most common cancer in men after prostate and in women after breast cancer. Having said that, it's the number one cancer-related death in both sexes.
Scott Webb: Yeah, it definitely is. So, obviously, early diagnosis would be key in trying to prevent it or stop it or cure it possibly. So, let's talk about that then. Let's talk about the screening options. What are they for lung cancer?
Dr. Jonathan Waxman: Up until recently, and that's about 10 or 15 years ago, we found out through a lot of research that low-dose CT scans are the best tool to screen for lung cancer and diagnose it early. Before, we used to rely on chest x-rays, but we found that there're really not reliable. And about 11 years ago, there was a very important trial comparing x-rays with low-dose CT scans in a high-risk patient population. And those patients that underwent low-dose CT scan had a decreased mortality by as much as 20%. So that's the tool that we use now to recommend for lung cancer screening.
Scott Webb: Yeah. So, that's what you recommend. Obviously, I know there are some other options, as you say. So when a patient is trying to decide working with someone like yourself, their health care providers, medical providers, is there really a choice to be made? Are there any times when one of the other options might be best for them or really is it the low-dose CT scan?
Dr. Jonathan Waxman: It's really the low-dose CT scan, the one test that has shown being useful in trying to identify cancer at an earlier stage and try to decrease mortality from this really bad disease. So, we really don't recommend any other test for lung screening other than the low-dose CT scan. And whenever we discuss this screening modality with our patients, obviously, we do it in what we call a shared decision-making process because we have to explain the benefits and the cons of undergoing such a screening process.
Scott Webb: So then, let's talk about who can get a low-dose CT scan.
Dr. Jonathan Waxman: Those patients who are eligible for lung screening are those who are between 50 and 80 years of age, current or former smokers who have at least a 20-pack year history, if they are former smokers that have quit within the last 15 years and they don't have any documented case of lung cancer within the past five years.
Scott Webb: All right. So, it does sound like the low-dose CT scan is becoming the gold standard, if it's not already. And you've given us a sense there who's eligible anyway to get the scan. Let's talk some more about the benefits of the low-dose CT scan.
Dr. Jonathan Waxman: Well, low-dose CT scan is a very easy technique first of all. It only takes probably less than five minutes to have a CT scan. There are no needles, there are no injections, and they're done on a regular CT scan machine, that's particularly important for those patients who may have problems with claustrophobia for example. So, it's really very easy to administer. And the benefits are that it offers us the opportunity to identify lung cancers at an earlier stage. The majority of lung cancers by the time they give symptoms are usually found at an advanced stage. And that's one of the reasons why lung cancer is so lethal. And the majority of early-stage lung cancers are found by accident or in asymptomatic patients. So by doing lung cancer screening with low-dose CTs, it offers us an opportunity to catch these cancers at an earlier stage, meaning they're much smaller, contained only to one part of the lung, therefore offering the possibility of offering meaningful curative treatments to our patients.
Scott Webb: Yeah. And so when we think about it, because it's hard to have conversations about medicine without talking at least a little bit about insurance. So, what's the process for someone to get screened? Is it something that they can request? Is it based on family history and other factors like smoking? Does it have to come from your medical provider? Maybe you can just take us through that a little bit. How does that actually happen?
Dr. Jonathan Waxman: The most important factor is to recognize those patients who are at risk of lung cancer and, particularly, that meet current accepted lung cancer screening criteria, such as people between the ages of 50 and 80, current or former smokers, and if there are former smokers that have quit within the last 15 years and no documented case of lung cancer within the past five years. Once a patient meets those criteria, the referring provider can order a low-dose CT scan usually covered by most insurances.
Scott Webb: I see what you mean. So, as long as you fit the criteria, then the order can be put in. And as you say, it's relatively quick and certainly painless, and for anybody who's claustrophobic. So, it sounds like a lot of benefits. Good stuff today, doctor. As we wrap up here, what are your final thoughts whether it's to encourage people to quit smoking or be screened if they fit the criteria? I'll leave it to you.
Dr. Jonathan Waxman: Thank you. One of the most important elements of lung cancer screening also includes patient education in regards to smoking cessation. It's important to have this conversation with patients as this is the one modifiable risk factor that we can change to try to decrease the incidence of lung cancer everywhere. So, I would say smoking cessation is extremely important as a part of any lung cancer screening program.
Scott Webb: Yeah, I see what you mean. We can't really outrun our family history and genetics. But if we are smokers, it is something that is within our control. It may not be easy to quit smoking, but at least it is something we know we can do. And you've discussed here the benefits today. So, thanks so much. You stay well.
Dr. Jonathan Waxman: You as well. Thank you for this opportunity.
Host: For more information go to BayCare.org. And that wraps up this episode of BayCare HealthChat. Always remember to subscribe, rate and review this podcast and all of the other BayCare podcasts, so we can share the wealth of information from our experts together. I'm Scott Webb. Stay well.
Scott Webb: Welcome to BayCare HealthChat. I'm Scott Webb. And I invite you to listen as we discuss lung cancer, lung cancer screening, and the benefits of low-dose CT scans. And joining me today is Dr. Jonathan Waxman. He's board-certified in general surgery and thoracic surgery.
Doctor, thanks so much for your time today. We're going to talk about lung cancer and primarily screening and screening options. But before we get there, just as a baseline, who's at the highest risk for lung cancer?
Dr. Jonathan Waxman: Thank you for having me. First and foremost, active smokers are the patient population that are at the highest risk. As we know, smoking is the number one risk factor for developing lung cancer. Patients with a family history of lung cancer also should be concerned about the possibility of them having cancer.
Scott Webb: Yeah, and I know there's probably some other risk factors too. So how common is lung cancer?
Dr. Jonathan Waxman: Well, lung cancer is the second most common cancer in men after prostate and in women after breast cancer. Having said that, it's the number one cancer-related death in both sexes.
Scott Webb: Yeah, it definitely is. So, obviously, early diagnosis would be key in trying to prevent it or stop it or cure it possibly. So, let's talk about that then. Let's talk about the screening options. What are they for lung cancer?
Dr. Jonathan Waxman: Up until recently, and that's about 10 or 15 years ago, we found out through a lot of research that low-dose CT scans are the best tool to screen for lung cancer and diagnose it early. Before, we used to rely on chest x-rays, but we found that there're really not reliable. And about 11 years ago, there was a very important trial comparing x-rays with low-dose CT scans in a high-risk patient population. And those patients that underwent low-dose CT scan had a decreased mortality by as much as 20%. So that's the tool that we use now to recommend for lung cancer screening.
Scott Webb: Yeah. So, that's what you recommend. Obviously, I know there are some other options, as you say. So when a patient is trying to decide working with someone like yourself, their health care providers, medical providers, is there really a choice to be made? Are there any times when one of the other options might be best for them or really is it the low-dose CT scan?
Dr. Jonathan Waxman: It's really the low-dose CT scan, the one test that has shown being useful in trying to identify cancer at an earlier stage and try to decrease mortality from this really bad disease. So, we really don't recommend any other test for lung screening other than the low-dose CT scan. And whenever we discuss this screening modality with our patients, obviously, we do it in what we call a shared decision-making process because we have to explain the benefits and the cons of undergoing such a screening process.
Scott Webb: So then, let's talk about who can get a low-dose CT scan.
Dr. Jonathan Waxman: Those patients who are eligible for lung screening are those who are between 50 and 80 years of age, current or former smokers who have at least a 20-pack year history, if they are former smokers that have quit within the last 15 years and they don't have any documented case of lung cancer within the past five years.
Scott Webb: All right. So, it does sound like the low-dose CT scan is becoming the gold standard, if it's not already. And you've given us a sense there who's eligible anyway to get the scan. Let's talk some more about the benefits of the low-dose CT scan.
Dr. Jonathan Waxman: Well, low-dose CT scan is a very easy technique first of all. It only takes probably less than five minutes to have a CT scan. There are no needles, there are no injections, and they're done on a regular CT scan machine, that's particularly important for those patients who may have problems with claustrophobia for example. So, it's really very easy to administer. And the benefits are that it offers us the opportunity to identify lung cancers at an earlier stage. The majority of lung cancers by the time they give symptoms are usually found at an advanced stage. And that's one of the reasons why lung cancer is so lethal. And the majority of early-stage lung cancers are found by accident or in asymptomatic patients. So by doing lung cancer screening with low-dose CTs, it offers us an opportunity to catch these cancers at an earlier stage, meaning they're much smaller, contained only to one part of the lung, therefore offering the possibility of offering meaningful curative treatments to our patients.
Scott Webb: Yeah. And so when we think about it, because it's hard to have conversations about medicine without talking at least a little bit about insurance. So, what's the process for someone to get screened? Is it something that they can request? Is it based on family history and other factors like smoking? Does it have to come from your medical provider? Maybe you can just take us through that a little bit. How does that actually happen?
Dr. Jonathan Waxman: The most important factor is to recognize those patients who are at risk of lung cancer and, particularly, that meet current accepted lung cancer screening criteria, such as people between the ages of 50 and 80, current or former smokers, and if there are former smokers that have quit within the last 15 years and no documented case of lung cancer within the past five years. Once a patient meets those criteria, the referring provider can order a low-dose CT scan usually covered by most insurances.
Scott Webb: I see what you mean. So, as long as you fit the criteria, then the order can be put in. And as you say, it's relatively quick and certainly painless, and for anybody who's claustrophobic. So, it sounds like a lot of benefits. Good stuff today, doctor. As we wrap up here, what are your final thoughts whether it's to encourage people to quit smoking or be screened if they fit the criteria? I'll leave it to you.
Dr. Jonathan Waxman: Thank you. One of the most important elements of lung cancer screening also includes patient education in regards to smoking cessation. It's important to have this conversation with patients as this is the one modifiable risk factor that we can change to try to decrease the incidence of lung cancer everywhere. So, I would say smoking cessation is extremely important as a part of any lung cancer screening program.
Scott Webb: Yeah, I see what you mean. We can't really outrun our family history and genetics. But if we are smokers, it is something that is within our control. It may not be easy to quit smoking, but at least it is something we know we can do. And you've discussed here the benefits today. So, thanks so much. You stay well.
Dr. Jonathan Waxman: You as well. Thank you for this opportunity.
Host: For more information go to BayCare.org. And that wraps up this episode of BayCare HealthChat. Always remember to subscribe, rate and review this podcast and all of the other BayCare podcasts, so we can share the wealth of information from our experts together. I'm Scott Webb. Stay well.