Selected Podcast
Should I Get a Lung Cancer Screening?
Keith D. Mortman, MD, FACS, FCCP, discusses the option for lung cancer screenings of those at high risk of developing the disease, including people who are 55 to 77 years old, have smoked at least a pack of cigarettes a day for the last 30 years, have quit smoking within the past 15 years, and have a family history of the disease. Since it often has few symptoms until the late stages, this screening can provide critical time for treatment.
Featured Speaker:
Learn more about Dr. Keith D. Mortman
Keith D. Mortman, MD
Dr. Keith D. Mortman, he is an Associate Professor of Surgery at The George Washington University School of Medicine & Health Sciences and the Chief, Division of Thoracic Surgery at the George Washington University Hospital and is affiliated with The George Washington University Hospital and GW Medical Faculty Associates.Learn more about Dr. Keith D. Mortman
Transcription:
Dr. Michael Smith (Host): Welcome to GW Healthcast. I'm Dr. Michael Smith. The topic today – should I get a lung cancer screening? My guest is Dr. Keith Mortman. Dr. Mortman is an associate professor of surgery at the George Washington University School of Medicine and Health Sciences, and the chief for the Division of Thoracic Surgery at the George Washington University Hospital and is affiliated with The George Washington University Hospital and GW Medical Faculty Associates. Dr. Mortman, welcome to the show.
Dr. Keith D. Mortman (Guest): Thank you. Thanks for having me.
Dr. Smith: Who is at risk for lung cancer and who should get the lung cancer screening?
Dr. Mortman: The lung cancer screening is designed for patients who are at high risk for develop lung cancer, but do not yet exhibit any of the signs or symptoms. There was a study that was published in 2011, which was the National Lung Screening Trial, and that is the basis of this information and subsequent screening programs. It showed that the patients who are at highest risk are those that are aged 55 to 77 as the upper limit currently, people who smoked at least a pack a day for 30 years or the equivalent, and even those who have quit smoking and have done so within the past 15 years, as well as patients who have a family history of lung cancer.
Dr. Smith: Do you think this is common knowledge? Do enough patients, people in the community, know that there actually is a lung cancer screen?
Dr. Mortman: Unfortunately, it’s not as common knowledge as we would like it to be. We spend a fair bit of time educating not only the public, but our fellow physicians as well, particularly primary care physicians who tend to see their patients on a more regular basis.
Dr. Smith: When you look at the lung cancer screening itself, what exactly is the lung screening test and what is it looking for?
Dr. Mortman: The test is a low dose CT scan. The actual test itself probably takes 30 to 60 seconds, so it’s a very quick test and it’s a lower dose of radiation than the standard chest CT scan. What we’re looking for are abnormalities in the lung. This is a means by which to detect an early stage lung cancer before any of the signs or symptoms develop. Unfortunately, lung cancer can be a silent killer of sorts, if you will, because when people develop signs or symptoms from their lung cancer, they tend to be larger, more advanced and may have already metastasized to other places in the body. A very early stage lung cancer when it’s small and before it spreads to lymph nodes or other structures is typically asymptomatic – it’s not causing any symptoms. That’s a small nodule that can be picked up by other means. For instance, if somebody has a chest x-ray before a knee operation, that can actually show a small nodule before it has any signs or symptoms.
Dr. Smith: Obviously you mentioned it’s for high risk patients, but what are some of the limitations of the screening test?
Dr. Mortman: There are not many limitations. A lot of that has to do with what we call spatial resolution. Certainly if a nodule reaches a certain size, that’s going to be picked up reliably on the CT scan. The important thing that we as physicians have to remember and have to be careful to interpret is that not every abnormality or nodule on a CT scan is necessarily lung cancer. In fact, only a very small minority of those abnormalities are actually going to wind up being a malignancy. We have to be very careful in terms of how we interpret and report the results of the study and there's a very clear and defined way that we do that. It’s called the lung-RADS criteria. For people who wind up having a normal scan – no abnormalities – then we typically tell them to come back in a year and get scanned on an annual basis. They can have what we call an indeterminate pulmonary nodule – something as small as two to three or four millimeters – and those we would typically watch. Instead of going a full year, they might need another CT scan perhaps in six months to make sure that there's been no interval change in that nodule, or sometimes they can have more concerning abnormalities. One of the benefits of this chest CT scan is that not only can we look at the lungs, but we could look at other structures in the chest as well.
Dr. Smith: If somebody listening is at high risk for lung cancer, at what age should this begin?
Dr. Mortman: The lower limit of the age range is 55. The currently accepted age range whereby the scan is actually covered by almost all insurance plans, that age range is 55 on the low end up to 77 on the high end.
Dr. Smith: Let’s go back to something you touched on when there is a positive result to this screening. Run us through what happens after that to the patient.
Dr. Mortman: After the screening, the CT scan of course is read initially by a board certified radiologist at our GW screening program. All of the scans would come across my desk as well, so there's a second pair of eyes – a thoracic surgeon that looks at the scan also – we have a very high concordance rate between the surgeon reading and the radiologist reading it, but we look at these different abnormalities so if something does appear suspicious, both the patient as well as their primary care physician will receive a letter stating the results of the scan, and if things are suspicious enough that they would need to meet with either a thoracic surgeon or perhaps a pulmonologist to go ahead and investigate that further.
Dr. Smith: Since lung cancer screening, maybe it’s not as known as, say, prostate cancer screening or breast cancer screening, is there a movement or a plan to educate the community better, that this screen is available for high risk patients?
Dr. Mortman: Many programs, when they were developed just in recent years when different hospital and the healthcare systems put together screening programs, there was marketing to the public, which we’re done here at GW as well to let them know that this test is available, and more recently – meaning about in the past two years or so – again covered by Medicare and most private insurances. Usually, there's no out-of-pocket expense for their patients. It’s usually advertised at some of the healthcare screening programs that our hospital participates in.
Dr. Smith: In summary, Dr. Mortman, what would you like people to know about lung cancer screening?
Dr. Mortman: I certainly would like them to know that if they have these high risk criteria – meaning if they are in the 55 to 77 age group – if they are a current smoker and have smoked the equivalent of a pack a day for 30 years, or they’ve quit smoking with the past 15 years, these are patients who are at risk. I would urge them to speak with their primary care physician about these risk factors and if the low dose CT scan is appropriately for them, and if so, their primary care doctor can get in touch with us here in the Division of Thoracic Surgery at GW.
Dr. Smith: Dr. Mortman, I want to thank you for the work that you are doing and also thank you for coming to the show today. You're listening to the GW Healthcast. Please visit GWDocs.com to get connected with Dr. Mortman or another provider, or call 1-888-4GW-DOCS to schedule an in-person or virtual appointment. This is Dr. Michael Smith. Thanks for listening.
Dr. Michael Smith (Host): Welcome to GW Healthcast. I'm Dr. Michael Smith. The topic today – should I get a lung cancer screening? My guest is Dr. Keith Mortman. Dr. Mortman is an associate professor of surgery at the George Washington University School of Medicine and Health Sciences, and the chief for the Division of Thoracic Surgery at the George Washington University Hospital and is affiliated with The George Washington University Hospital and GW Medical Faculty Associates. Dr. Mortman, welcome to the show.
Dr. Keith D. Mortman (Guest): Thank you. Thanks for having me.
Dr. Smith: Who is at risk for lung cancer and who should get the lung cancer screening?
Dr. Mortman: The lung cancer screening is designed for patients who are at high risk for develop lung cancer, but do not yet exhibit any of the signs or symptoms. There was a study that was published in 2011, which was the National Lung Screening Trial, and that is the basis of this information and subsequent screening programs. It showed that the patients who are at highest risk are those that are aged 55 to 77 as the upper limit currently, people who smoked at least a pack a day for 30 years or the equivalent, and even those who have quit smoking and have done so within the past 15 years, as well as patients who have a family history of lung cancer.
Dr. Smith: Do you think this is common knowledge? Do enough patients, people in the community, know that there actually is a lung cancer screen?
Dr. Mortman: Unfortunately, it’s not as common knowledge as we would like it to be. We spend a fair bit of time educating not only the public, but our fellow physicians as well, particularly primary care physicians who tend to see their patients on a more regular basis.
Dr. Smith: When you look at the lung cancer screening itself, what exactly is the lung screening test and what is it looking for?
Dr. Mortman: The test is a low dose CT scan. The actual test itself probably takes 30 to 60 seconds, so it’s a very quick test and it’s a lower dose of radiation than the standard chest CT scan. What we’re looking for are abnormalities in the lung. This is a means by which to detect an early stage lung cancer before any of the signs or symptoms develop. Unfortunately, lung cancer can be a silent killer of sorts, if you will, because when people develop signs or symptoms from their lung cancer, they tend to be larger, more advanced and may have already metastasized to other places in the body. A very early stage lung cancer when it’s small and before it spreads to lymph nodes or other structures is typically asymptomatic – it’s not causing any symptoms. That’s a small nodule that can be picked up by other means. For instance, if somebody has a chest x-ray before a knee operation, that can actually show a small nodule before it has any signs or symptoms.
Dr. Smith: Obviously you mentioned it’s for high risk patients, but what are some of the limitations of the screening test?
Dr. Mortman: There are not many limitations. A lot of that has to do with what we call spatial resolution. Certainly if a nodule reaches a certain size, that’s going to be picked up reliably on the CT scan. The important thing that we as physicians have to remember and have to be careful to interpret is that not every abnormality or nodule on a CT scan is necessarily lung cancer. In fact, only a very small minority of those abnormalities are actually going to wind up being a malignancy. We have to be very careful in terms of how we interpret and report the results of the study and there's a very clear and defined way that we do that. It’s called the lung-RADS criteria. For people who wind up having a normal scan – no abnormalities – then we typically tell them to come back in a year and get scanned on an annual basis. They can have what we call an indeterminate pulmonary nodule – something as small as two to three or four millimeters – and those we would typically watch. Instead of going a full year, they might need another CT scan perhaps in six months to make sure that there's been no interval change in that nodule, or sometimes they can have more concerning abnormalities. One of the benefits of this chest CT scan is that not only can we look at the lungs, but we could look at other structures in the chest as well.
Dr. Smith: If somebody listening is at high risk for lung cancer, at what age should this begin?
Dr. Mortman: The lower limit of the age range is 55. The currently accepted age range whereby the scan is actually covered by almost all insurance plans, that age range is 55 on the low end up to 77 on the high end.
Dr. Smith: Let’s go back to something you touched on when there is a positive result to this screening. Run us through what happens after that to the patient.
Dr. Mortman: After the screening, the CT scan of course is read initially by a board certified radiologist at our GW screening program. All of the scans would come across my desk as well, so there's a second pair of eyes – a thoracic surgeon that looks at the scan also – we have a very high concordance rate between the surgeon reading and the radiologist reading it, but we look at these different abnormalities so if something does appear suspicious, both the patient as well as their primary care physician will receive a letter stating the results of the scan, and if things are suspicious enough that they would need to meet with either a thoracic surgeon or perhaps a pulmonologist to go ahead and investigate that further.
Dr. Smith: Since lung cancer screening, maybe it’s not as known as, say, prostate cancer screening or breast cancer screening, is there a movement or a plan to educate the community better, that this screen is available for high risk patients?
Dr. Mortman: Many programs, when they were developed just in recent years when different hospital and the healthcare systems put together screening programs, there was marketing to the public, which we’re done here at GW as well to let them know that this test is available, and more recently – meaning about in the past two years or so – again covered by Medicare and most private insurances. Usually, there's no out-of-pocket expense for their patients. It’s usually advertised at some of the healthcare screening programs that our hospital participates in.
Dr. Smith: In summary, Dr. Mortman, what would you like people to know about lung cancer screening?
Dr. Mortman: I certainly would like them to know that if they have these high risk criteria – meaning if they are in the 55 to 77 age group – if they are a current smoker and have smoked the equivalent of a pack a day for 30 years, or they’ve quit smoking with the past 15 years, these are patients who are at risk. I would urge them to speak with their primary care physician about these risk factors and if the low dose CT scan is appropriately for them, and if so, their primary care doctor can get in touch with us here in the Division of Thoracic Surgery at GW.
Dr. Smith: Dr. Mortman, I want to thank you for the work that you are doing and also thank you for coming to the show today. You're listening to the GW Healthcast. Please visit GWDocs.com to get connected with Dr. Mortman or another provider, or call 1-888-4GW-DOCS to schedule an in-person or virtual appointment. This is Dr. Michael Smith. Thanks for listening.