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Melanie Cole (Host):  Should you consider lung cancer screening? And, what’s involved? My guest today is Dr. Charles Malpass. He is a board certified physician in pulmonary medicine and critical care medicine whose specialties include lung screenings. Welcome to the show, Dr. Malpass. Have there been any recent changes to the screening criteria and what exactly is cancer screening?

Dr. Charles Malpass (Guest):  Absolutely. A large part of this is based upon a publication from 2011 in the New England Journal of Medicine. It actually showed that we can save lives by doing a low dose lung cancer screening CT scan of the chest. There are three societies that have weighed in on what is the target population for lung cancer screening. But, the big piece to know is that at age 55-75, someone who has smoked for greater than 30-pack years. To do the calculation, if you smoked one pack of cigarettes for one year, that’s a one-pack year, so 30-pack years in total. Or, if you were, let’s say two packs a day. That’s only 15 years of smoking. And, the person who is a current smoker or has stopped smoking in the past 15 years has really been our target population for lung cancer screening.

Melanie:  What’s involved in the screening? Is this a complicated thing?

Dr. Malpass:  No. It’s very simple. It’s a low dose CT scan of the chest. This is a radiation exposure comparable to a mammogram or, basically, a few chest x-rays. There are no IVs. There are no medicines given to you for that and it only takes a few minutes in the CT scanner to obtain the study.  

Melanie:  If people have been 30-year pack smokers, or 15, or even a half a pack a day, are they somebody who should get screened? Who do they talk to, first of all? And is this something that insurance will recognize?

Dr. Malpass:  Absolutely great questions. Really, what was done with the study and what we are doing now to try to mirror the findings and the work process of the study is trying to capture that highest risk population which would include people that had recently quit smoking within the past 15 years and who have had a large exposure with that 30-pack year history. We do not know the answer to the question of if you’ve smoked for a 15-pack year history, is this a beneficial screening study for you? That answer is just not known and has not been studied yet. We chose the highest risk population to say, “Could we exert a benefit for these patients with that?” We just don’t know that second question yet.

Melanie:  If somebody does get screened, what are you looking for in that screening?

Dr. Malpass:  What we’ve done here at UVA is had the radiologists pattern their practice of reviewing the CT scan in identifying small nodules. What we want to do is be able to find lung cancer early so that we can enact change upon it, mostly through surgical methods of curative intent.  The problem with lung cancer is the lung does not sense pain itself. So, by the time someone develops symptoms associated with their lung cancer often it’s too late. We can’t make huge differences in their care as far as complete removal of that lung cancer. If we find it early, we really can embark on improving their mortality and also markedly improve it there. What we want to do is be able to find small nodules in the earliest stage of lung cancer in the lung itself.  

Melanie:  Dr. Malpass, we use the word “screening”, so it’s not a diagnostic test. Is this something that goes on a permanent record because people hesitate to go in to have something that they think is going to follow them.

Dr. Malpass:  It is a study that the results of will be in your medical record. Though and I completely agree that it is not a definitive test in that you can identify a nodule of the lung, but it really takes following that nodule over time and/or a diagnostic procedure of sampling that nodule to be able to say what it is from. If we look at our population as a whole here in central Virginia and across the eastern seaboard, there are a very large number of people who have never smoked and that are going to have lung nodules on their CT scan which should not affect their healthcare or their access to their healthcare and can be a very benign finding. With the screening CT scan, we often do find something and that’s why we want to target the highest risk population of those former smokers to be able to increase the probability of that being a possible cancer in our diagnostic procedures.

Melanie:  What about the non-smokers? Can they get screened as well?

Dr. Malpass:  At this time, I do not think it’s beneficial for those people to get a screening CT scan. Lung cancer does occur in the non-smoker, though to a much smaller extent in comparison to the smoker. It’s a balance of exposing those people to radiation that they don’t need to be exposed to. If we do find something, exposing those people to potentially the risk of a diagnostic procedure whether it be a biopsy or further radiation screening. We do not think that is immediately beneficial for those people in that screening process.

Melanie:  Does insurance cover this particular screening?

Dr. Malpass:  Good question. If done correctly and mirroring the trial that it was done where you have the discussion of the benefits of screening, the risks of screening, the radiation exposure, and also targeting the right population, if that’s done correctly in concert with a smoking cessation intervention, it should be covered most often by insurance providers in this process with the appropriate documentation.

Melanie:  Are there any recent advances and exciting things that you want to quickly discuss in the field of lung cancer treatment? Things you want the listeners to know about what’s going on out there in the field of research?

Dr. Malpass: Absolutely. What we’re trying to do on the pulmonary side, which often is on the front end and diagnostic end, identifying patients that do have lung cancer and appropriately getting them into oncological care and surgical care as appropriate, is that we have methods of minimally invasive methods of sampling the lung and identify what that process is. Here at University of Virginia, we offer bronchoscopic procedures that would facilitate a sampling of lymph nodes central into the chest which is a same day procedure and can be done under minimal sedation--the same sedation that would be done for a colonoscopy. We offer procedures where we can target legions from the inside bronchoscopically navigating through a CT scan. Also, on the radiology side, they offer comprehensive services as far as diagnosing from the outside and in biopsy via a CT scan, as well, too, abnormal legions. Additionally, and importantly, if it is a malignancy, targeting that person’s malignancy through genetic testing. We offer TruSight genetic screening panel which is done on all non-small cell lung cancers that are of adenocarcinoma and can really allow us to do some targeted new therapies which are exciting in practice.

Melanie:  That’s absolutely fascinating. In just the last minute, Dr. Malpass, why should someone come to UVA Pulmonary and Respiratory for their treatment?

Dr. Malpass:  Absolutely. I think we do an excellent job of coordinating our services. On a weekly basis, we meet as a group and allow close face-to-face communication of providers that are all helping take care of patients. So, if, unfortunately, someone does develop lung cancer, face-to-face I’m talking to surgeons that can potentially provide curative care. I’m talking to the oncologist. I’m talking to radiologists that are specialized in thoracic imaging. Additionally, I’m talking to radiation oncologists. Under one roof, you have specialists in all fields of medicine to compliment that care to try to get them early, aggressive care in treating their process.

Melanie:  Thank you so much. You’re listening to UVA Health Systems Radio. For more information, you can go to UVAHealth.com. That’s UVAHealth.Com. This is Melanie Cole. Thanks so much for listening.