Victor Gordon, MD, discusses why lung screenings are important, who represents a good candidate for screening, and what treatment options are considered should the screening detect something concerning.
In the interview, Dr. Gordon answers the following:
1) As a pulmonologist, you see a wide range of lung diseases and conditions. What are some of the conditions you see most often in your practice?
2) One of the most frightening diagnoses for patients is cancer. Obviously, smoking is a key risk factor. Is a lung cancer diagnosis always a result of cigarette smoking, or could there be other causes for the disease?
3) Thirty years ago, a diagnosis of lung cancer was often considered a death sentence. However, that’s not always the case any longer. Can you tell our listeners how evolving technology in detection and treatment of the disease has improved outcomes for those diagnosed with lung cancer?
4) Lung screening in its current form may be new to some of our listeners. Can you describe the process?
5) Who’s the best candidate for lung screening? Are there specific criteria or risk factors that make some individuals a more likely screening candidate?
6) What about individuals who have already quit smoking, maybe for several years? Should they consider lung screening?
7) If the screening is positive, what are the treatment options?
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Importance of Lung Screening
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Learn more about Victor Gordon, MD
Victor Gordon, MD
Victor Gordon, MD, is the Medical Director of Pulmonary Rehabilitation.Learn more about Victor Gordon, MD
Transcription:
Alyne Ellis (Host): We’re all used to some of those routine tests that come up regularly—physicals, shots, colonoscopies. But maybe there’s another test we should add to the list—a lung screening. Over 200,000 people in the United States will be diagnosed with lung cancer this year. Long before the outward symptoms occur, trouble could be brewing, and you might not even know. I'm Alyne Ellis. Welcome to McLaren’s In Good Health. Dr. Victor Gordon is the medical director of pulmonary rehabilitation at McLaren Healthcare. As a pulmonologist, you see a wide range of lung diseases. What are some of the conditions that you see, Dr. Gordon, most often in your practice?
Victor Gordon M.D. (Guest): We do see a wide variety of pulmonary disease in the office. Primarily, I think, COPD as well as asthma. Occupational lung diseases are very common, and lung cancer is definitely one that I personally focus on. Overwhelmingly, I think, probably the one that we talk least about is sleep disordered breathing too, but that’s certainly a very common presentation in the office.
Host: I'm assuming, of course, that the most frightening diagnosis is lung cancer. Smoking, of course, is a key risk, but there are other things I think that can cause this problem besides cigarette smoking. I'm wondering if you can talk about other causes of lung cancer.
Dr. Gordon: Well, that’s right. Probably more than 90% of lung cancers are caused by smoking. Only about 2% to 3% of patients will have a diagnosis that have never smoked of lung cancer. Some of the most common things that occur even naturally are things like even radon gas. That occurs naturally in the environment. Something that comes up from the Earth’s crust and the soil and part of decomposition of radium. That is something that we do sometime recommend screening for patients who have never had a smoking history and do get diagnosed with lung cancer. We do recommend getting radon levels checked in the home frequently. In addition there are other less common risk factors, but certainly asbestos exposures throughout medical history and carcinogens. Sometimes there's even genetic predisposition and does run in families on occasion.
Host: I know that 30 years ago it just used to be a death sentence when you get lung cancer compared to now specifically. So I guess that’s just really not always the case any longer. Maybe you can tell our listeners about the technology that’s evolved that’s aided in the detection and the treatment of lung cancer.
Dr. Gordon: Unfortunately, still symptomatic lung cancer still portends a very poor prognosis. Today we do have a low dose CT screening. That is something that we have been able to recognize earlier lung cancers. About half the patients that do undergo a low dose CT screening will be diagnosed in an early stage or stage one condition. This allows them to be treated and many of them even cured of lung cancer.
Host: So maybe you could describe a little bit of what this screening evolves if you were to go and have it done.
Dr. Gordon: We don’t screen everybody. Low dose CT screening is offered to a very specific patient population. If you were a smoker, you have a 30 plus pack year history of smoking—meaning that you’ve smoked one pack of cigarettes per day for approximately 30 years, that’s in total—if you’re between the age of 55 and 80, and I've you’ve not quit smoking within the last 15 years then we do recommend undergoing what's called a low dose CT screening.
Host: That involves lying in a tube? What does that involve, the actual test itself.
Dr. Gordon: The actual test is a CAT scan. It’s basically, it’s just like an x-ray machine but it takes a 360 degree image of the patient while they're lying flat on a board. We use a lot less radiation in performing the test, thus the name. It gives us about a 25% more visualization of the lung fields than a standardized chest x-ray could.
Host: You recommend this even if a person doesn’t have symptoms at that point because the symptoms, once you’ve got that, it’s so much more serious like the coughing and the wheezing and stuff.
Dr. Gordon: Unfortunately today one of the things that we don’t talk about too often but is that lung cancer is being diagnosed in more non-smokers these days than smokers themselves. So we do recommend if you do fall under the category to get screened early and get screened every single year.
Host: You’ve covered the risk factors in terms of smoking and when you need to get it in relation to that. But are there other risk factors that would sort of pinpoint your right off the bat that a person should get screened?
Dr. Gordon: Yeah. If a patient does have a strong family history of lung cancer in their family—Like we said before, there does seem to be a genetic predisposition. There are environmental factors, which can be within households. So another strong predictor of the potential for lung cancer would be having a family history or even a personal history of another cancer.
Host: Tell me a little in terms of the screening. It doesn’t take you very long, but you get almost instant results I assume.
Dr. Gordon: The actual time at the facility—usually it’s done at most hospital based facilities. Can be done in the outpatient diagnostic setting as well. Usually the test only takes a few minutes to complete. It’s very easy to schedule these patients. It really doesn’t take a lot of time.
Host: So once the screening is done and you get the results, let’s say that it’s positive. I know there are many treatment options you can pursue and maybe you could correlate that with some of the results you might get from a lung screening.
Dr. Gordon: About half the patients, as mentioned before, will get diagnosed with a stage one diagnosis if they do find a lung nodule. Usually the lung nodule will lead to more testing. That can be done by biopsy either done bronchoscopically by a pulmonologist or it can be done by percutaneous fine needle aspiration by interventional radiologist. Once we do confirm a diagnosis of lung cancer if it early stage, there are several options available to patients. Surgery would be one. That or SBRT, which is stereotactic radio therapy which is performed by a radiation oncologist. Those are some of the treatment options available if it’s early stage. If a patient is found to have a later stage diagnosis, chemotherapy in concert with radio therapy is generally preferred without surgical intervention.
Host: In your practice—just your experience yourself—how many people have you had that have come in, probably felt pretty well, but had a history in their family of lung cancer or they'd been an ex-smoker. They have this screening, and something shows up. Is it a lot of people?
Dr. Gordon: Well, if we screened the general population—which we don’t—about 20% of the population would actually have a lung finding or a lung nodule. So it’s important that we relay this information to people to help alleviate anxiety about abnormal findings on low-dose CT screenings. Fortunately, it’s still a very low percentage that will have a positive screening. Only about 3% of the patients that were identified in a national lung screening trial actually go on to get diagnosed with lung cancer. So it’s still a very low number, but if that number is zero it’s still very concerning to the patient. I hope we can raise awareness. I hope patients can get in and loved ones can get encouraged to get screened if they do qualify.
Host: Dr. Victor Gordon is the medical director of pulmonary rehabilitation at McLaren Healthcare. I'm Alyne Ellis. To learn more about Dr. Gordon or submit a question, visit mclaren.org/wagner.
Alyne Ellis (Host): We’re all used to some of those routine tests that come up regularly—physicals, shots, colonoscopies. But maybe there’s another test we should add to the list—a lung screening. Over 200,000 people in the United States will be diagnosed with lung cancer this year. Long before the outward symptoms occur, trouble could be brewing, and you might not even know. I'm Alyne Ellis. Welcome to McLaren’s In Good Health. Dr. Victor Gordon is the medical director of pulmonary rehabilitation at McLaren Healthcare. As a pulmonologist, you see a wide range of lung diseases. What are some of the conditions that you see, Dr. Gordon, most often in your practice?
Victor Gordon M.D. (Guest): We do see a wide variety of pulmonary disease in the office. Primarily, I think, COPD as well as asthma. Occupational lung diseases are very common, and lung cancer is definitely one that I personally focus on. Overwhelmingly, I think, probably the one that we talk least about is sleep disordered breathing too, but that’s certainly a very common presentation in the office.
Host: I'm assuming, of course, that the most frightening diagnosis is lung cancer. Smoking, of course, is a key risk, but there are other things I think that can cause this problem besides cigarette smoking. I'm wondering if you can talk about other causes of lung cancer.
Dr. Gordon: Well, that’s right. Probably more than 90% of lung cancers are caused by smoking. Only about 2% to 3% of patients will have a diagnosis that have never smoked of lung cancer. Some of the most common things that occur even naturally are things like even radon gas. That occurs naturally in the environment. Something that comes up from the Earth’s crust and the soil and part of decomposition of radium. That is something that we do sometime recommend screening for patients who have never had a smoking history and do get diagnosed with lung cancer. We do recommend getting radon levels checked in the home frequently. In addition there are other less common risk factors, but certainly asbestos exposures throughout medical history and carcinogens. Sometimes there's even genetic predisposition and does run in families on occasion.
Host: I know that 30 years ago it just used to be a death sentence when you get lung cancer compared to now specifically. So I guess that’s just really not always the case any longer. Maybe you can tell our listeners about the technology that’s evolved that’s aided in the detection and the treatment of lung cancer.
Dr. Gordon: Unfortunately, still symptomatic lung cancer still portends a very poor prognosis. Today we do have a low dose CT screening. That is something that we have been able to recognize earlier lung cancers. About half the patients that do undergo a low dose CT screening will be diagnosed in an early stage or stage one condition. This allows them to be treated and many of them even cured of lung cancer.
Host: So maybe you could describe a little bit of what this screening evolves if you were to go and have it done.
Dr. Gordon: We don’t screen everybody. Low dose CT screening is offered to a very specific patient population. If you were a smoker, you have a 30 plus pack year history of smoking—meaning that you’ve smoked one pack of cigarettes per day for approximately 30 years, that’s in total—if you’re between the age of 55 and 80, and I've you’ve not quit smoking within the last 15 years then we do recommend undergoing what's called a low dose CT screening.
Host: That involves lying in a tube? What does that involve, the actual test itself.
Dr. Gordon: The actual test is a CAT scan. It’s basically, it’s just like an x-ray machine but it takes a 360 degree image of the patient while they're lying flat on a board. We use a lot less radiation in performing the test, thus the name. It gives us about a 25% more visualization of the lung fields than a standardized chest x-ray could.
Host: You recommend this even if a person doesn’t have symptoms at that point because the symptoms, once you’ve got that, it’s so much more serious like the coughing and the wheezing and stuff.
Dr. Gordon: Unfortunately today one of the things that we don’t talk about too often but is that lung cancer is being diagnosed in more non-smokers these days than smokers themselves. So we do recommend if you do fall under the category to get screened early and get screened every single year.
Host: You’ve covered the risk factors in terms of smoking and when you need to get it in relation to that. But are there other risk factors that would sort of pinpoint your right off the bat that a person should get screened?
Dr. Gordon: Yeah. If a patient does have a strong family history of lung cancer in their family—Like we said before, there does seem to be a genetic predisposition. There are environmental factors, which can be within households. So another strong predictor of the potential for lung cancer would be having a family history or even a personal history of another cancer.
Host: Tell me a little in terms of the screening. It doesn’t take you very long, but you get almost instant results I assume.
Dr. Gordon: The actual time at the facility—usually it’s done at most hospital based facilities. Can be done in the outpatient diagnostic setting as well. Usually the test only takes a few minutes to complete. It’s very easy to schedule these patients. It really doesn’t take a lot of time.
Host: So once the screening is done and you get the results, let’s say that it’s positive. I know there are many treatment options you can pursue and maybe you could correlate that with some of the results you might get from a lung screening.
Dr. Gordon: About half the patients, as mentioned before, will get diagnosed with a stage one diagnosis if they do find a lung nodule. Usually the lung nodule will lead to more testing. That can be done by biopsy either done bronchoscopically by a pulmonologist or it can be done by percutaneous fine needle aspiration by interventional radiologist. Once we do confirm a diagnosis of lung cancer if it early stage, there are several options available to patients. Surgery would be one. That or SBRT, which is stereotactic radio therapy which is performed by a radiation oncologist. Those are some of the treatment options available if it’s early stage. If a patient is found to have a later stage diagnosis, chemotherapy in concert with radio therapy is generally preferred without surgical intervention.
Host: In your practice—just your experience yourself—how many people have you had that have come in, probably felt pretty well, but had a history in their family of lung cancer or they'd been an ex-smoker. They have this screening, and something shows up. Is it a lot of people?
Dr. Gordon: Well, if we screened the general population—which we don’t—about 20% of the population would actually have a lung finding or a lung nodule. So it’s important that we relay this information to people to help alleviate anxiety about abnormal findings on low-dose CT screenings. Fortunately, it’s still a very low percentage that will have a positive screening. Only about 3% of the patients that were identified in a national lung screening trial actually go on to get diagnosed with lung cancer. So it’s still a very low number, but if that number is zero it’s still very concerning to the patient. I hope we can raise awareness. I hope patients can get in and loved ones can get encouraged to get screened if they do qualify.
Host: Dr. Victor Gordon is the medical director of pulmonary rehabilitation at McLaren Healthcare. I'm Alyne Ellis. To learn more about Dr. Gordon or submit a question, visit mclaren.org/wagner.