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Task Force Recommends New Lung Cancer Screening Guidelines

Task Force Recommends New Lung Cancer Screening Guidelines
Task Force Recommends New Lung Cancer Screening Guidelines
GUESTS:Dr. Phillipe Montgrain, Pulmonologist, UC San Diego Medical Center Debra Kelley, Regional Director, American Lung Association

TOM FUDGE: Our top story on Midday Edition today, there are common cancers and there are deadly cancers. Lung cancer is both. The American Cancer Society put new cases of lung cancer in the third behind prostate and breast cancer. More people die of lung cancer than breast, prostate, and colon cancer combined. There is a new weapon in the fight against lung cancer. This will have the support of insurance policies under ObamaCare. I'm talking about regular lung scans for heavy smokers. Joining me to talk about this today are Dr. Phillipe Montgrain and Debra Kelley. I gave a few facts about lung cancer, that expand on that. It will come as no surprise that smoking is still the big gorilla when it comes to causing lung cancer. DEBRA KELLEY: Smoking accounts for about 80% of all lung cancers. Other lung cancers are really due to exposures to things like radon or asbestos. TOM FUDGE: Against this is due to only biological, or genetic factors as well? DEBRA KELLEY: Definitely genetic factors as well. TOM FUDGE: You mentioned radon and I used to live in the Midwest where they talked about it a bit. We do not talk about it as much in California as a cause of lung cancer. DEBRA KELLEY: We do not have the kind of rock formations that lead to those kinds of gas emissions but we do have serious air pollution. Diesel exhaust is actually a very significant cause of lung cancer in California. TOM FUDGE: And the fact that we don't have basements also deals with the fact that radon is not very risky. Doctor Montgrain, what would you like to add in terms of what we heard from Debra in the nature of lung cancer? PHIL MONTGRAIN: I agree that cigarettes are the number one cause. We're talking about lung cancer screening today, but we are saving many more lives with tobacco cessation than that with lung cancer screening. We can't forget the importance of tobacco cessation. MAUREEN CAVANAUGH: People who do not smoke are still at risk? DEBRA KELLEY: Yes about 13% of non-smokers have been diagnosed with lung cancer. I just spoke with a man who was just diagnosed with stage IV lung cancer. He had never smoked and had no risk factors and he's really looking at a dire medical experience. PHIL MONTGRAIN: We are indeed seeing increased rates of lung cancer in non-smokers, particularly young women. This is an alarming trend. A very specific type of cancer called adenocarcinoma. We do not know if it's related to other genetic drivers but we're actively with researching and the lung cancer field. TOM FUDGE: But it does affect women more than men? PHIL MONTGRAIN: In lung cancer, yes. TOM FUDGE: Why is this a difficult cancer to detect? PHIL MONTGRAIN: By the time it causes symptoms, the cancer is usually at an advanced stage. The challenge, and where we hope that lung cancer screening will help, is to detect cancer earlier at a stage where it is limited to the lung and can be cured through surgical procedures. TOM FUDGE: We will get that screening in a moment, but I want to mention to you that I've read that there are few nerve endings in the lungs and therefore people do not feel a tumor. PHIL MONTGRAIN: That is correct, the lungs are not well innervated and you will not feel it. You may have a dry cough. TOM FUDGE: Now we have regular lung scans, or maybe we'll see it soon. From a regulatory standpoint what is going on here? Is this a new requirement? DEBRA KELLEY: It's really a recommendation that is coming out of the public health screening task force. We know there will be a lot of confusion among patients and providers about this, I would like to turn it over to Phil. PHIL MONTGRAIN: The task force is coming with the recommendation and that is a great first step. That is a huge push for insurance coverage of those things. That is very important. The challenge will be establishing a good screening program because it is not just about a CAT scan, it's easy to do. We need screening programs where we have the appropriate infrastructure to follow up on tests and do the right thing to make sure that patients that do not have lung cancers are not harmed and those who do have the appropriate follow-up. TOM FUDGE: So this is a CAT scan? PHIL MONTGRAIN: It is called a low-dose CT scan, it's about a fifth of the normal dose. TOM FUDGE: How sensitive are these CAT scans? What can ther detect? PHIL MONTGRAIN: They are very sensitive, they are superior to chest x-rays and they can detect very small lumps. DEBRA KELLEY: People who are recommended to get these, if you're a current or former smoker, between the ages of 55 to 79, and you have a thirty pack history of smoking, which means you take the number of packs that you smoked per day and you multiply that by the number of years you smoked, one pack a day for thirty years, that is a thirty pack year. The other thing is whether or not you have quit within the last fifteen years, all of those factors need to be taken into consideration and you should talk to your doctor about getting screened. TOM FUDGE: By guests are Debra Kelly and Phil Montgrain. You're talking about creating a program in order to make the scans more effective, are you confident that physicians and doctors know about these recommendations? PHIL MONTGRAIN: I think many people have been attuned to this new trial. Those have been out for a year or two now. I think we do need to do a lot of education and get the word out there. We need to make sure that both patients knows about these and physicians and primary care providers know about this test and how to counsel their patients. TOM FUDGE: I assume that you're both on board with this? DEBRA KELLEY: Absolutely. PHIL MONTGRAIN: Absolutely. TOM FUDGE: Is it possible for this to test positive for tumors when they don't exist? PHIL MONTGRAIN: Yes, that is the biggest risk that needs to be discussed. We know that our recorder of the scans will be positive, the other for the trial and we the overwhelming majority of those will be false alarms. That is true. Most of those can be used assault by having another CAT scan at pumas later to make sure that nothing is changed and the spots are not growing, but some of those may end up having a biopsies or invasive procedures and those have inherent risk. The downside to these screenings is the false alarms. And the anxiety that can come with it. But positive is that you are saving three to three lung cancer deaths per 1000 screens. TOM FUDGE: I know that this is a low-dose scan, but what is the possibility that radiation from the scan could make the cancer worse? PHIL MONTGRAIN: The good thing about low dosage, it's not zero but is a very low dose that is lower than the amount of radiation that you're exposed to buy that at one year on earth, and this is about equivalent to about twenty-five chest x-rays, it's a fifth of the dose of the normal CAT scan you make it. The risk is not zero, but is quite low, but you have to keep in mind that would start screening at age 55 if we screen someone for twenty-five years, that is twenty-five of these low-dose CAT scans, it may add up and it's something that we will pay attention to. DEBRA KELLEY: I think that people who have a history of smoking, and you qualify for these for this type of young lung scan, it is important to contact your physician or healthcare provider and have a conversation about whether this is recommended for you. We believe that the affordable care act, these scans will be covered under the affordable care act provisions as a screening tool for those who meet the criteria. It can be a complicated thing to talk about, talk to your physician. TOM FUDGE: You anticipated a question about the Affordable Care Act, will ObamaCare pay for these scans? PHIL MONTGRAIN: The affordable care act should pay for any task force recommendations. It should be covered and it remains to be skiing scene and we do not know of Medicare will cover it. They have their own decision-making whether they cover these recommendations. They may cover part or all of it. TOM FUDGE: Since the task force has thrown the holy water on these CAT scans, I guess Obama care will pay for this? How costly are the scans? PHIL MONTGRAIN: There are couple hundred dollars for a CAT scan. TOM FUDGE: We have been talking about them cancer, but I've heard that lung cancer is actually not the most common cause of death the latest smoking, please comment on that. DEBRA KELLEY: That is true, smoking kills about a 440,000 Americans each year. Many of those deaths are due to heart disease and stroke them away you look at the lung cancer deaths caused by smoking it's about 125,000, heart disease and stroke is the leading cause of death, but I will say that smoking causes not only lung cancer but it also contributes to many other cancers, another 35,000 people will die and shed due to bladder cancer that is smoking-related. PHIL MONTGRAIN: There are eleven cancers caused by smoking and lung cancer is the biggest. TOM FUDGE: I am almost afraid to bring up the last question, but I will. Let me ask you about another type of smoking. Colorado and Washington have both approved recreational use of marijuana, does it concern you, considering that this may come to California soon? PHIL MONTGRAIN: We don't know yet. We do not know whether smoking marijuana has any links to lung cancers. I think it's something that needs to be answered with research and following patients and smokers. DEBRA KELLEY: We do know that marijuana actually contains higher levels of carcinogens compared to tobacco smoke, but the sciences will say whether it will lead to lung cancer. A general principle of all this, the only thing you should put in your lungs is clean fresh air. TOM FUDGE: That is a good point to end with. Thank you.

There are common cancers and there are very deadly cancers: Lung cancer is both.

Estimates by the American Cancer Society ranks new cases of lung cancer in 2013 third behind only prostate cancer and breast cancer.

The difficulty in detecting it means more people die from lung cancer than breast, prostate and colon cancer combined.


Now, the U.S. Preventative Services Task Force said lung cancer screening for many chain-smokers and former smokers should be done with a CT scan instead of an X-ray.

Under the Affordable Care Act — also known as Obamacare — CT scans are to be covered by a patient's insurance. According to the Associated Press, task force-recommended cancer screenings are to be covered under the law without the requirement of a copay. However, as the AP reports, there is a one-year time period to adopt new recommendations.