The CDC says more people in the U.S. die from lung cancer than any other type of cancer for both men and women. Dr. Justin Thomas and Physician's Assistant Regina Schroeder discuss what a lung cancer screening is, who benefits from them, and more.
Regina Schroeder is a Physician's Assistant with decades of experience and is the provider for Eisenhower Health's Lung Cancer Screening program.
Justin Thomas, MD, is a formally trained and Board Certified Interventional Pulmonologist who specializes in minimally invasive procedures for diagnosis and treatment or palliation of lung cancer, benign and malignant airway disease, and diffuse lung diseases. Dr. Thomas is also Board Certified in Internal Medicine, Pulmonary Medicine, and Critical Care Medicine.
Dr. Thomas received his medical degree from the University of Colorado Health Sciences Center. He then trained in Internal Medicine at the Mayo Clinic in Rochester, Minnesota and went on to train in Pulmonary and Critical Care Medicine at the University of Pittsburgh Medical Center, where he concentrated on interventional pulmonary procedures and performed research in interstitial lung diseases.
After finishing his fellowship in Pulmonary and Critical Care Medicine, Dr. Thomas pursued an additional year of formal fellowship training in Interventional Pulmonology at National Jewish Health in Denver, Colorado. There he trained with Dr. Ali Musani, a world renowned interventional pulmonologist and leader in this new field of pulmonary medicine.
Dr. Thomas is one of the first in the country to be formally Board Certified in Interventional Pulmonology. Having completed this fellowship training, he has become an expert in bronchoscopic procedures, some of which include electromagnetic navigational bronchoscopy, radial and central endobronchial ultrasound, laser and electrocautery therapy, airway stent placement, balloon and rigid bronchoscopy dilation for benign and malignant airway disease (e.g., tracheal stenosis, tumor debulking). In addition, Dr. Thomas performs pleuroscopy to diagnose pleural lung disease and pleural effusions, tunneled pleural catheter insertion for palliation in patients with pleural effusions, bronchial thermoplasty for severe asthmatics, and percutaneous tracheostomy.
Before attending medical school, Dr. Thomas had a serious knee injury requiring a prolonged stay in the hospital. "This experience was invaluable as it gave me compassion and empathy for my patients and gave me a better understanding of what they might need," states Dr. Thomas. "With critical care medicine, I am often working with families to calm their fears, and provide information and education regarding their loved one's care. It is this interaction that I find very valuable and rewarding and have found that keeping a calm presence puts patients and their families at ease."
In addition to a Bachelor of Science degree in Molecular, Cellular, and Developmental Biology, Dr. Thomas also holds a Bachelor of Arts degree in Music and enjoys playing the soprano, alto and tenor saxophones.
Maggie McKay (Host): The CDC says more people in the U. S. die from lung cancer than any other type of cancer for both men and women. So today we'll find out about what a lung cancer screening is and who benefits from it.
We'll find out more with Dr. Justin Thomas, Interventional Pulmonologist Manager at Eisenhower Health, and Physician's Assistant, Regina Schroeder, with the Eisenhower Lung Cancer Screening Program. Welcome to Living Well with Eisenhower Health. I'm Maggie McKay. Thank you both for joining us today, Dr. Thomas and Regina. We appreciate you making the time.
Justin Thomas, MD: Thank you. Thanks for having us.
Host: I understand that Eisenhower Health has a lung cancer screening program. Tell me about it.
Justin Thomas, MD: Yes. So we started the lung cancer screening clinic back in July of 2022. And this had been years in the making. We actually were originally part of the, ILCAP. That's the International Early Lung Cancer Action project. It was a study looking at lung cancer screening in high risk patients, meaning patients who've been prior smokers. And from that developed the need to, after the study was finished, to continue providing services for the Valley here for patients who are at high risk to develop lung cancer and provide a means to streamline that in the lung cancer screening clinic.
Host: And how prevalent is lung cancer in our country? What are the symptoms?
Justin Thomas, MD: Yeah, so as you mentioned, actually, lung cancer is first of all, the leading cause of cancer deaths for both men and women. It will develop in about 1 in 16 men, and about 1 in 17 women will develop lung cancer.
Host: It's usually smokers that get lung cancer, right?
Justin Thomas, MD: Yeah, most commonly about 80 to maybe 90 percent of lung cancers here in the States are due to smoking. However, you know, although cigarettes are the most common risk factor, about 25 percent of cases worldwide are actually found in people who've never smoked.
Host: Wow. Can anyone get a screening for lung cancer? And if not, who should get screened?
Regina Schroeder, PA: The United States Preventative Task Force has set forth guidelines for those that we feel are at the highest risk for lung cancer, and some of those limitations and guidelines include that they're ages between 50 and 80 years old, that they've smoked in the last 15 years, and that they've smoked about 20 medical pack years.
And the way we define medical pack years is an example would be one pack per day for 20 years or a half a pack per day for 40 years would meet those guidelines.
Host: And what are the benefits of screening for lung cancer?
Regina Schroeder, PA: Well, mostly we want to do early detection. The lung cancer diagnosis is often very late in its stages. We're looking to detect lung cancer much earlier. With early detection, we know that we can improve survivability, and that is the main goal, to increase survivability in this population.
Justin Thomas, MD: I would add on to that as well and just as Regina stated, actually up to about 80 percent of lung cancer, unfortunately, is caught in the late stage. And so, as Regina said, the idea is to try and catch it before it's already spread to lymph nodes and elsewhere in the body. And the National Lung Screening Trial and several other trials since then have shown a 20 to 40 percent reduction in dying from lung cancer by screening.
Host: So screening is pretty crucial. Can we just go over the symptoms one more time, just so people know?
Justin Thomas, MD: Yeah, so, you know, unfortunately, lung cancer does not cause a lot of symptoms until typically the late stage, which again is why lung cancer is often caught in the late stage. The patient may present to their doctor with a cough that is just persistent, maybe they'll get antibiotics, it just won't go away.
And that cough lingers for weeks to months, and that may be a symptom of lung cancer. Or they may cough up blood, maybe they lose weight, unexpectedly. If they're developing shortness of breath, oftentimes that is more of a later symptom. But by and large most lung cancer does not cause symptoms.
Host: What is a lung nodule, and are they cancerous?
Justin Thomas, MD: Yeah, so a lung nodule is basically a spot in the lung that shouldn't be there. And usually that's some type of tissue in the lung that has sort of organized. Um, lung cancer starts off as a small nodule, but fortunately the vast majority of lung nodules are not cancerous. In fact, only about three or four in a hundred of these small spots are going to be cancerous, if you look at the entire population. So, while they can potentially be cancerous, they, for the most part, are not.
Host: Is a low dose CT screening dangerous? Are there any side effects we need to know?
Justin Thomas, MD: First of all, the medical radiation we get, can be somewhat significant. From a standpoint of you and I sitting here in this room; the amount of exposure to background radiation, or what we call cosmic radiation, it's equivalent to about three millisieverts of radiation.
And a typical CT scan of the chest will be about seven millisieverts. However, a low dose CT is about 1. 5 to 3 millisieverts. So it's essentially equivalent to living on this earth, the amount of radiation we're getting from the sun, from the earth. Just sitting in this room, it's equivalent to about 6 to 12 months of living on this earth.
So, it has been deemed very safe. The risk, of the radiation is really outweighed by the benefit in appropriate patients. The biggest risk comes from really detecting nodules or other abnormalities that may be asymptomatic. And maybe they're nothing to really be worried about at all, so there can be potentially, you know, anxiety, upon discovering that you have a nodule and the fact that you gotta have it followed, et cetera, and we'll talk about that later, but also, there may be something we discover that then we say we go in and we biopsy, we may harm the patient in doing so, such as collapse of lung or whatever, and that thing that we found may not have been anything in the first place.
So that's really where kind of the risk lies and those discussions will be had by your physician when you inquire about whether or not you are a lung cancer screening candidate, and those risks have to be weighed against the potential benefit.
Host: Mmhmm. And if someone is screened and they find a nodule or cancer, what happens next?
Justin Thomas, MD: Well, you find a nodule, there's certain steps your physician will take which may just include another CT scan in 3, 6, or 12 months. Perhaps something called a PET CT, and these scans are what pick up metabolic activity and nodules in other tissues. So, metabolic activity can be associated with cancer, although it does not diagnose cancers, there's other conditions that can increase metabolic activity.
In particular, tissues such as inflammation, infection, autoimmune conditions. We can also risk stratify patients based on the size of the nodule, the location, the patient's age, their smoking history, family history. That helps us determine really the next step and how aggressive we're going to be in working up this nodule.
There's even a lab test that we use that's a proteomic testing which looks for particular proteins that are associated with a higher risk of cancer. And that helps us risk stratify patients. So, if you do see a positivity on this proteomic testing or say the PET scan, then the next steps really are determining what is the best way to biopsy a nodule.
And that can be done either by a bronchoscopy. And here at Eisenhower, we have a robotic bronchoscopy, which I perform. And I've done over 400 of these robots cases, over the last three years. And there's also CT guided needle biopsies. So patients go on a CAT scanner and they can get a needle biopsy of the nodule that does carry some risk of collapsing lung.
There may be lymph nodes that we discover on the PET scan, so we may have to go after lymph nodes and that sort of thing. So really the imaging kind of helps guide us as to what the next step is going to be.
Host: So when it comes to getting a screening, is it covered by insurance?
Regina Schroeder, PA: So, generally, it is covered by insurance. Using the word screening provides, the patient with the allowance as long they meet the guidelines that were set forth by Medicare and the United States Preventative Task Force, but each person who qualifies should always make sure that they don't have some unusual situation with their insurance that they might have a deductible, but most often it is covered by insurance at no cost to the patient.
Host: And is a physician referral required?
Regina Schroeder, PA: At Eisenhower, we can take referrals either directly from a physician or a patient can self refer themselves to our clinic by just calling and asking to be screened.
Host: Is there anything else in closing that either of you would like to add that you would like people to know about lung cancer and getting a screening?
Justin Thomas, MD: Well, something I'd like to add is, although there's been several studies now that have shown dramatic benefit for patients and catching lung cancer early and, actually reducing their mortality or their chances of dying from lung cancer by 20 to 40%, unfortunately, across the country, there's been very low uptake of the screening process by physicians or patients, maybe just due to knowledge that it's out there.
And so I think that if you suspect that you may have a higher risk as Regina had mentioned, 20 pack year history, 50 to 80, maybe you've got a family history of lung cancer; just ask your physician if you may qualify for lung cancer screening. Even if you've got just a strong family history of lung cancer, it might be worth talking about that with your primary doctor.
Regina Schroeder, PA: Just to provide our referral line, our office line would be great. You can reach us at 760-837- 8880 and we can answer any questions that any patient may have, whether they would be eligible to be screened or not.
Host: That's great. Well, although this is such a serious topic and you know, it sounds grim when the CDC says more people in the U. S. die from lung cancer than any other type of cancer, at least it's helpful to know about screening and prevention and, who should be looking into getting one. So thank you both so much for your time. It was very informative and helpful.
Justin Thomas, MD: Thank you, Maggie.
Regina Schroeder, PA: Thank you.
Maggie McKay (Host): That's Dr. Justin Thomas and Regina Schroeder. And if you'd like to find out more, as Regina said, you can please call 760-837-8880 or go to eisenhowerhealth.org/services/lungcancerscreening. 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.
I'm Maggie McKay. This is Living Well with Eisenhower Health. Healthcare as it should be. Thank you for listening.