You can quit smoking today, but it takes years to quit worrying about lung cancer. That’s why smokers and ex-smokers are increasingly getting proactively screened, to catch tumors while they are still small and easier to treat.
MarinHealth Medical Center oncologist Dr. Alex Metzger is a strong supporter of early screening for lung cancer. In this podcast, he discusses the reasons for screening, who is eligible, environmental causes of lung cancer, and lung health in general.
Selected Podcast
A Life Saving Test: Early Screening for Lung Cancer
Featured Speaker:
Learn more about Alex Metzger, MD
Alex Metzger, MD
Alex Metzger, MD joined MCC in 2006 and feels extremely lucky that his first job was his dream job. Supportive colleagues, a collaborative environment and the challenge of helping each patient are the reasons he enjoys going to work every day.Learn more about Alex Metzger, MD
Transcription:
Bill Klaproth (Host): Lung cancer is the leading cause of cancer deaths in both men and women in the United States. Now early detection is the best defense, but how to catch it early? So, here to talk with us about lung cancer and screening options is Dr. Alex Metzger and oncologist at Marin General Hospital. Dr. Metzger, thank you so much for your time we appreciate it. So, let’s with this. What cases lung cancer?
Dr. Alex Metzger, MD (Guest): The easiest answer to that is smoking, although there is much more than just smoke exposure. There are environmental exposures, but I think the most obvious cause of lung cancer in this country and worldwide is tobacco use.
Bill: So, it sounds like as you said, environmental and lifestyle choices are the culprit. So, then not necessarily hereditary makeup?
Dr. Metzger: There is a component to hereditary cancers, but it is dwarfed by the exposure to smoke that is the primary cause of lung cancers. But there is a small percentage that arise from genetic predispositions.
Bill: So, who is at risk then? Are even non-smokers at some type of a risk as well?
Dr. Metzger: Yes. What we are seeing is that about 10% of lung cancers occur in nonsmoking individuals and they tend to fit a certain profile, sometimes younger female of East Asian ancestry. We tend to see the nonsmoking lung cancers in that population.
Bill: And lung cancer is difficult because there aren’t really that many early symptoms, is that right?
Dr. Metzger: That’s correct. Unfortunately, when lung cancers get diagnosed in many situations; it’s beyond a place where it can be cured and so, we are left with trying to manage the disease rather than trying to cure the disease. When lung cancers are diagnosed at an earlier stage, it is often an incidental diagnosis when someone has come in for a scan for another reason and it just picks up an incidental lung cancer. That’s not that uncommon and that’s why there’s a real need to help screen for lung cancer in those at highest risk.
Bill: So, you almost find it by accident then, that’s what it sounds like.
Dr. Metzger: That is a very – yeah and until there is better screening, that has been our experience is that the earliest stages of lung cancers are often found having other scans done for other reasons.
Bill: So, let’s talk about those screening options. In the past, how has lung cancer been diagnosed and what are the screening options today?
Dr. Metzger: So, they were looking at chest x-rays for those at highest risk, but that never translated to a meaningful screening tool and it wasn’t until some big trials emerged looking at the use of low dose non-contrast or minimal contrast CT scans did they find that it was clearly superior to chest x-rays in diagnosing lung cancers and so it became clear that low dose CAT scans is the tool to pick up early lung cancer.
Bill: So, is that the norm today in lung cancer screening?
Dr. Metzger: That’s correct.
Bill: Are there any other new techniques that are being developed or tried?
Dr. Metzger: The good thing about these non-contrast CT scans is that they are very effective at picking up lung cancers with minimal exposures to the radiation that sometimes get used with CAT scans. So, there really hasn’t been a need to push for a different type of screening test when we can get such good information from this low dose CT scan.
Bill: And Marin General is offering these low dose CT scans, right?
Dr. Metzger: That’s right. The radiologists at Marin General have been able to develop a protocol for giving the least amount of radiation necessary to get the information needed through the CT scans, so it’s a very specific protocol being used as part of this lung cancer screening program.
Bill: So, who qualifies for the new screening protocol, Dr. Metzger?
Dr. Metzger: So, there have been guideline published about who is at risk for developing lung cancer and the main guidelines that we follow are the following. Patients who are between the ages of 55 and 80, those who have a 30-pack-year smoking history, meaning they have either smoked a pack a day for 30 years or two packs a day for 15 years and those who have quit – if they have quit smoking, they have quit within 15 years at screening. So, that picks up patients who are at risk who aren’t currently smoking but are still at risk for developing lung cancer.
Bill: Got ya. And is this covered by insurance as well?
Dr. Metzger: It is. That was a big leap to get to this point. The data was put out there, but it took some time for Medicare to recognize it as an acceptable screening tool and once they were able to provide insurance coverage for these scans; it allowed the use of this screening for many people to – who would have to pay out-of-pocket otherwise.
Bill: Well, that’s really good news. And this new screening certainly isn’t a substitute for quitting smoking, right? Smokers shouldn’t be like heh they’ve got a new screening options, I can keep smoking because they’ll catch it, right?
Dr. Metzger: Actually, that’s absolutely right and as part of the Medicare coverage guidelines; in order to get coverage for a low dose CT scan, one has to provide counseling to stop smoking for those patients who are actively smoking. So, you are absolutely right. Any effective program for lung cancer screening has to incorporate counseling about how to stop smoking.
Bill: Well that’s very good to know. And speaking of stopping smoking, Dr. Metzger, can you talk to us a little bit about prevention at all and lung health? Are there things we can do to insure our lungs stay healthy?
Dr. Metzger: Yes. There are medications on the market that are being used to help decrease your drive for nicotine that is found in cigarettes and so those are pharmaceuticals that can be helpful besides that, people have often used other modalities such as biofeedback, even hypnosis. Those are less well-studied but have anecdotally shown help for stopping smoking. And of course, lung health is going to always be about exercising and increasing your lung capacity, though that doesn’t necessarily prevent lung cancer, it just a part of one’s good health.
Bill: And Dr. Metzger, what about environmentally when you are working with substances that are creating a certain kind of dust? You should always be wearing a mask as well, right?
Dr. Metzger: That’s correct. There are certain types of cancers that are asbestos related, those are clearly important for masks. So, that’s another important component.
Bill: Well Dr. Metzger, thank you so much for your time today. It’s been a pleasure talking with you. For more information you can visit www.maringeneral.org/lung that’s www.maringeneral.org/lung . Or you can call 415-925-7472, that’s 415-925-7472. This is the Healing Podcast brought to you by Marin General Hospital. I’m Bill Klaproth. Thanks for listening.
Bill Klaproth (Host): Lung cancer is the leading cause of cancer deaths in both men and women in the United States. Now early detection is the best defense, but how to catch it early? So, here to talk with us about lung cancer and screening options is Dr. Alex Metzger and oncologist at Marin General Hospital. Dr. Metzger, thank you so much for your time we appreciate it. So, let’s with this. What cases lung cancer?
Dr. Alex Metzger, MD (Guest): The easiest answer to that is smoking, although there is much more than just smoke exposure. There are environmental exposures, but I think the most obvious cause of lung cancer in this country and worldwide is tobacco use.
Bill: So, it sounds like as you said, environmental and lifestyle choices are the culprit. So, then not necessarily hereditary makeup?
Dr. Metzger: There is a component to hereditary cancers, but it is dwarfed by the exposure to smoke that is the primary cause of lung cancers. But there is a small percentage that arise from genetic predispositions.
Bill: So, who is at risk then? Are even non-smokers at some type of a risk as well?
Dr. Metzger: Yes. What we are seeing is that about 10% of lung cancers occur in nonsmoking individuals and they tend to fit a certain profile, sometimes younger female of East Asian ancestry. We tend to see the nonsmoking lung cancers in that population.
Bill: And lung cancer is difficult because there aren’t really that many early symptoms, is that right?
Dr. Metzger: That’s correct. Unfortunately, when lung cancers get diagnosed in many situations; it’s beyond a place where it can be cured and so, we are left with trying to manage the disease rather than trying to cure the disease. When lung cancers are diagnosed at an earlier stage, it is often an incidental diagnosis when someone has come in for a scan for another reason and it just picks up an incidental lung cancer. That’s not that uncommon and that’s why there’s a real need to help screen for lung cancer in those at highest risk.
Bill: So, you almost find it by accident then, that’s what it sounds like.
Dr. Metzger: That is a very – yeah and until there is better screening, that has been our experience is that the earliest stages of lung cancers are often found having other scans done for other reasons.
Bill: So, let’s talk about those screening options. In the past, how has lung cancer been diagnosed and what are the screening options today?
Dr. Metzger: So, they were looking at chest x-rays for those at highest risk, but that never translated to a meaningful screening tool and it wasn’t until some big trials emerged looking at the use of low dose non-contrast or minimal contrast CT scans did they find that it was clearly superior to chest x-rays in diagnosing lung cancers and so it became clear that low dose CAT scans is the tool to pick up early lung cancer.
Bill: So, is that the norm today in lung cancer screening?
Dr. Metzger: That’s correct.
Bill: Are there any other new techniques that are being developed or tried?
Dr. Metzger: The good thing about these non-contrast CT scans is that they are very effective at picking up lung cancers with minimal exposures to the radiation that sometimes get used with CAT scans. So, there really hasn’t been a need to push for a different type of screening test when we can get such good information from this low dose CT scan.
Bill: And Marin General is offering these low dose CT scans, right?
Dr. Metzger: That’s right. The radiologists at Marin General have been able to develop a protocol for giving the least amount of radiation necessary to get the information needed through the CT scans, so it’s a very specific protocol being used as part of this lung cancer screening program.
Bill: So, who qualifies for the new screening protocol, Dr. Metzger?
Dr. Metzger: So, there have been guideline published about who is at risk for developing lung cancer and the main guidelines that we follow are the following. Patients who are between the ages of 55 and 80, those who have a 30-pack-year smoking history, meaning they have either smoked a pack a day for 30 years or two packs a day for 15 years and those who have quit – if they have quit smoking, they have quit within 15 years at screening. So, that picks up patients who are at risk who aren’t currently smoking but are still at risk for developing lung cancer.
Bill: Got ya. And is this covered by insurance as well?
Dr. Metzger: It is. That was a big leap to get to this point. The data was put out there, but it took some time for Medicare to recognize it as an acceptable screening tool and once they were able to provide insurance coverage for these scans; it allowed the use of this screening for many people to – who would have to pay out-of-pocket otherwise.
Bill: Well, that’s really good news. And this new screening certainly isn’t a substitute for quitting smoking, right? Smokers shouldn’t be like heh they’ve got a new screening options, I can keep smoking because they’ll catch it, right?
Dr. Metzger: Actually, that’s absolutely right and as part of the Medicare coverage guidelines; in order to get coverage for a low dose CT scan, one has to provide counseling to stop smoking for those patients who are actively smoking. So, you are absolutely right. Any effective program for lung cancer screening has to incorporate counseling about how to stop smoking.
Bill: Well that’s very good to know. And speaking of stopping smoking, Dr. Metzger, can you talk to us a little bit about prevention at all and lung health? Are there things we can do to insure our lungs stay healthy?
Dr. Metzger: Yes. There are medications on the market that are being used to help decrease your drive for nicotine that is found in cigarettes and so those are pharmaceuticals that can be helpful besides that, people have often used other modalities such as biofeedback, even hypnosis. Those are less well-studied but have anecdotally shown help for stopping smoking. And of course, lung health is going to always be about exercising and increasing your lung capacity, though that doesn’t necessarily prevent lung cancer, it just a part of one’s good health.
Bill: And Dr. Metzger, what about environmentally when you are working with substances that are creating a certain kind of dust? You should always be wearing a mask as well, right?
Dr. Metzger: That’s correct. There are certain types of cancers that are asbestos related, those are clearly important for masks. So, that’s another important component.
Bill: Well Dr. Metzger, thank you so much for your time today. It’s been a pleasure talking with you. For more information you can visit www.maringeneral.org/lung that’s www.maringeneral.org/lung . Or you can call 415-925-7472, that’s 415-925-7472. This is the Healing Podcast brought to you by Marin General Hospital. I’m Bill Klaproth. Thanks for listening.