Transcription:

Bill Klaproth (Host):  So, if you’re not a smoker, you probably feel that you have nothing to worry about when it comes to lung cancer. Well, maybe think again. What do nonsmokers need to know about lung cancer? So, let’s find out with Dr. Alex Metzger, a Hematologist and Oncologist at Marin Cancer Care.

This is The Healing Podcast brought to you by MarinHealth. I’m Bill Klaproth. Dr. Metzger, it is great to talk with you. Thank you so much for your time. First off, could you give us some brief background on yourself?

Alex Metzger, MD (Guest):  Yeah sure. So, I’m a Medical Oncologist working in Marin, but I started out on the East Coast at Columbia University for undergraduate. Did my medical School at Jefferson Medical College in Philadelphia but did my Internal Medicine and Fellowship training at UC Davis before settling here in Marin in 2006.

Host:  Love it. and we’re happy to have you with us. Dr. Metzger, in light of the COVID-19 pandemic, lung health has become an important focus for all of us. And we know that smoking can increase risks for cancers of the lungs and other areas. But is it possible to get lung cancer if you’re not a smoker?

Dr. Metzger:  Yeah, unfortunately, we do see patients with a diagnosis of lung cancer even in what we call never smokers.

Host:  Okay. That leads me to my next question. Is lung cancer one of the biggest cancer killers? Is it something we really need to pay attention to even for nonsmokers?

Dr. Metzger:  Yeah, absolutely. Lung cancer unfortunately is the leading cause of cancer death worldwide even though it’s not the most common cancer diagnosis, one of the most if not the most lethal cancer. So, we all need to be aware of this diagnosis.

Host:  Okay. And then what causes lung cancer?

Dr. Metzger:  All cancers are genetic mutations and we do know that smoking is the biggest driver for most forms of lung cancer, although, as we’ll talk about, we also see lung cancer happen in nonsmoking patients.

Host:  So, obviously smoking is the leading cause of lung cancer. How about in never smokers as you put it; what causes cancer in never smokers generally?

Dr. Metzger:  There’s a lot of interest in trying to understand that. There have been a lot of research and epidemiology studies to understand why never smokers get lung cancer. And it’s a combination of multiple factors including genetics, where you may come from in the world, exposure to nonsmoking related hazards and other environmental exposures. There’s a lot of interest in trying to understand why never smokers get lung cancer but they do.

Host:  So, when we talk about those other factors, genetics, geography as you put it, nonsmoking related hazards; can you give us an example of some of those nonsmoking related hazards? I’m thinking of radon and things like that. What are some of the other things we should potentially be aware of?

Dr. Metzger:  Well radon is interesting as it is definitely something that’s present in or can be present in and around our homes. The interesting thing about radon though is that we still don’t know clearly the relationship between radon in our environment and lung cancer. But it is still a bit of an unknown. Other things that are important that are nonsmoking related exposures would be asbestos as well as some viruses can be associated with lung cancer that we don’t typically think about that and of course, there’s the interest in secondhand smoke which is potentially a cause of lung cancer in never smokers.

Host:  Wow, that’s really interesting. So, let me ask you about this. are there other indicators of risk? Does nonsmoking lung cancer hit women or men more?

Dr. Metzger:  That is actually really interesting in that we definitely see an increased risk of nonsmoking related lung cancer in women over men. And not only that, it also seems to be affecting younger patients as opposed to older patients. So, we’re seeing in our never smoker lung cancer population, we see a predominance of women over men statistically, as well as younger patients as compared to older patients and that could be related to genetics obviously, but also there’s interest in where we come from and in particular, I’m talking about women from Asian countries. That seems to be the highest risk population for nonsmoking related lung cancer.

Host:  That’s really interesting. So, increased risk possibly because of ethnicity and then you said even younger people are getting it and women. So, that’s something we wouldn’t have ordinarily thought. And then when you’re also talking about other things, risk factors; what about pollution and then kind of a weird one, HPV, how does that fit into this?

Dr. Metzger:  Yeah, I think there’s a lot of concern about pollution and occupational exposures. It’s a bit of a trickier one to actually tie in directly to lung cancer diagnoses. We don’t have the best data to truly link pollution to lung cancer, though my suspicion is that there is a likelihood cause and effect there. And in terms of HPV, or the human papilloma virus, that is a virus that has been clearly implicated in other types of cancers, most notably cervical and some other types of cancers but there is a small but potentially real relationship to HPV and nonsmoking related lung cancers though it is not something we know too much about at this time.

Host:  So, then what are the symptoms of lung cancer in nonsmokers or never smokers as we’re calling them?

Dr. Metzger:  One of the challenges that we have in lung cancer is that often by the time lung cancer has shown itself to cause symptoms, it’s already fairly advanced. That’s one of our biggest challenges. Some of the symptoms that are of concern for lung cancer would be a chronic and worsening cough, possibility of a weight loss and loss of appetite over time. Sometimes it could also reveal itself by blood in your sputum when you are coughing. It is one of our biggest challenges to diagnose lung cancer at an early stage. I would like to also just add that in smokers, we now have a tool to identify those at higher risk for lung cancer based upon the number of pack years smoked and how long you’ve been – how many packs you’ve been smoking and, but we don’t have a tool for never smokers. There really is no way to identify somebody who is clearly at risk, which is a challenge.

Host:  So, are these symptoms different from what smokers experience as symptoms?

Dr. Metzger:  I would say no. I think that when lung cancer shows itself, regardless of smokers versus nonsmokers, the symptoms are quite similar.

Host:  And then if you experience any of these symptoms, what should you do? Who should you go see for an assessment?

Dr. Metzger:  When you have symptoms of concern that are new for you or different; it’s difficult to know what’s serious and what’s not. And I would just tell you to listen to your body, go to your doctor, explain your symptoms. Sometimes it may be treated as an infection because that’s much more common than cancer. And if it does not improve, or symptoms worsen, then you also have to continue to let your doctor know that your symptoms are not getting better which would then drive further investigation.

Host:  Okay and then, speaking of that further investigation. How do you diagnose this? Are there diagnostics that would be done to determine if you have lung cancer and what type it is?

Dr. Metzger:  Yes. Chest x-rays, are still important but to truly make a diagnosis of lung cancer; typically a CT scan or a CAT scan of your chest would be the most definitive imaging that would be needed to identify possible lung cancer.

Host:  And then just curious, what is the likely type of cancer that would be found?

Dr. Metzger:  So, nonsmoker ing lung cancers are typically adenocarcinomas which is the most common type of lung cancer. But definitely the most common lung cancer in nonsmokers. And what is interesting, as well about adenocarcinomas in nonsmoking patients is that they often can have specific mutations that could enable more specific and better and targeted treatments.

Host:  So, when you say better and targeted treatments, does that mean nonsmokers may have a better chance at beating this?

Dr. Metzger:  What I would say, is that nonsmokers have a higher likelihood of benefitting from what we call targeting the mutations specifically in a gene called EGFR and so, whenever we find a patient who was a nonsmoker, we look for these mutations.

Host:  So, then with those mutations, and better targeted treatment; is the risk of death in never smokers less than lung cancer for smokers?

Dr. Metzger:  That’s an interesting question. And I would say there have been some data to suggest that the survival is better for nonsmoking based upon the identification of these mutations and possibly a younger age and otherwise healthier person. But that’s not entirely well-described as I know it.

Host:  Okay and then if you end up having lung cancer, what are the various treatment options?

Dr. Metzger:  Just like in any cancer, you really want to understand the stage of a cancer which drives the appropriate treatment which could include surgery versus possibly a radiation and of course in our world of medical oncology; the use of targeted therapies, immunotherapies and even chemotherapy still.

Host:  So, then let’s talk about prevention. What can people do to avoid this or catch it early in order to deal with it fast?

Dr. Metzger:  That’s one of the challenges because there really isn’t any clear identifiers as to risk. Some of the more obvious ones would possibly be identifying who has had a lot of exposure to secondhand smoke, possibly family history of lung cancer. These are quite rare. But most importantly, is to pay attention to your symptoms. Do not ignore your symptoms. And go to your doctor to describe your symptoms so that it can be identified as early as possible.

Host:  Yeah, that makes sense and then what about things like lifestyle, diet and exercise? Should we be checking for asbestos exposure if we live in an older house or should we be having our basements checked for radon?

Dr. Metzger:  I don’t think we are at the point where we need to get everyone to get radon testing. I think again, that’s not a clear cut connection. I think if there’s any concern for exposure to asbestos or radon then that of course makes sense to look into that for your own home. But in terms of diet and lifestyle; they are unfortunately very nonspecific. You want a good healthy diet. You want to exercise. These are definitely going to help you be a healthier person but it’s not specific towards prevention of lung cancer as we know it.

Host:  This has really been interesting Dr. Metzger. Thank you so much for talking with us about this. And again, thank you so much for your time. We appreciate it.

Dr. Metzger:  Yeah. Thank you for your time and interest.

Host:  That’s Dr. Alex Metzger and to learn more, please visit www.mymarinhealth.org. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is The Healing Podcast brought to you by MarinHealth. I’m Bill Klaproth. Thanks for listening.