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Understanding Lung Cancer Screening - And Lung Nodules · Meaningful Medicine with Novant Health

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  Carl (Host): Meaningful Medicine is a Novant Health Podcast bringing you
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  access to leading doctors who answer questions they wish you would ask.
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  From routine care to rare conditions, our physicians offer tips to navigate medical
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  decisions and build a healthier future.
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  I'm Carl Marone, and with me today is Dr.
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  Nathaniel Meyer, a critical care pulmonologist with Novant Health.
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  And we'll be talking about lung cancer screenings and biopsy technology.
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  Dr.
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  Meyer, welcome to the podcast,
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  Nathaniel Meier, MD: Hey, thanks for having me.
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  Carl (Host): uh, glad you Are Able to be here.
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  And lung cancer is the leading cause of cancer death in the us, representing
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  about one in five of all cancer deaths.
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  Maybe you can talk a bit about the importance of early detection
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  when it comes to lung cancer.
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  Nathaniel Meier, MD: Yeah.
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  Unfortunately for lung cancer, the drop in survival is especially steep
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  compared to other more common cancers.
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  And for stage one lung cancer where the disease is very localized, the survival at
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  five years can be between 77 and 92% So, It does respond very well to treatment.
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  Generally that's, radiation or surgery where it's better tolerated than, you
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  know, more complicated systemic treatments for cancer diagnosed at later stages.
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  Carl (Host): So obviously early detection does save lives.
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  so let's talk about screening.
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  I understand there are some high-risk patient's that are eligible
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  for low-dose CT scans annually.
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  Can you talk about who's eligible for those scans and,
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  and why it's so important?
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  Nathaniel Meier, MD: So as far as who qualifies for lung cancer screening,
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  I would say the inclusion criteria are pretty clunky, And so I would just
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  encourage any patient who's over the age of 50 who has smoked on any consistent
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  basis in their lifetime to talk about whether or not they would qualify for
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  lung cancer screening with their primary care doctor or their pulmonologist.
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  and it's really important because.
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  Most lung cancer cases when they become symptomatic, it's too late.
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  the disease is too advanced, to be treatable, easily.
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  And so there's a real opportunity, a real need to try to catch patient's,
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  early when the disease is treatable.
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  Carl (Host): certainly a history of smoking raises the risk of lung cancer.
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  We know that.
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  But lung cancer also develops in in folks that don't smoke.
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  Can you, you talk a little bit about that?
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  Nathaniel Meier, MD: Yeah, I mean certainly a super strong relationship
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  between smoking and lung cancer, but we think that smoking is really only
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  causal in about 85% of lung cancer cases.
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  And, among patient's with, lung cancer who have never smoked,
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  they're still the fifth leading cause of cancer deaths worldwide.
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  There are other factors to consider, you know, radon exposure, certain
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  occupational exposures, and You know, air pollution to a lesser extent.
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  Carl (Host): I understand there, there are people may be going in for some other
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  other issue getting an x-ray, a ct, an unrelated health concern, and, and they
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  find a spot or a nodule on the lung.
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  if that should happen, can you speak to what, what would happen next?
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  Nathaniel Meier, MD: Absolutely.
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  if there's some concern for a nodule or a spot on an x-ray, it should prompt,
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  whoever ordered it to get a CT scan of the chest, to help us get some better
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  characterization of that spot or nodule.
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  And I think the radiologists here do a really good job of prompting
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  the ordering provider to make sure that happens for those cases.
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  when we confirm that there's a nodule or a spot on a CT scan of the chest, then
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  our first task is to look back and see if there's any prior imaging that we can
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  find from any other healthcare system, to see if it's been there for, more than,
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  say a couple of years, or if it's even decreased in size over that timeframe,
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  in which case we could assume that it was probably benign or, you know, way less
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  risky for something like lung cancer.
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  if that's not the case And the nodule's new And we, we can't identify
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  it on a CT scan from another system before, and there's really any risk
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  factor for lung cancer or, or cancer that could be metastatic, inside the
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  chest, whether that's smoking or a family history of cancer or personal
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  history of cancer, there needs to be some kind of follow-up for it.
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  And, we've built a lung nodule program here, in the Novant coastal market,
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  working with our lung cancer nurse navigators, our clinic radiology
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  to help identify higher risk patient's and need some assurance.
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  They're getting appropriate imaging follow-up.
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  And then for the highest risk patient's, making sure that we have
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  an opportunity to see them in clinic.
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  to talk about options for, for follow-up, which may include a biopsy.
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  Carl (Host): I understand recently, uh, your hospital added new technology
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  that makes available minimally invasive biopsies for small nodules.
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  Can you talk a little bit about that technology?
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  Nathaniel Meier, MD: yeah.
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  So we're very excited to have the ion robotic bronchoscopy platform and
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  an integrated portable CT scanner.
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  there's AI that's built into the software for ION where we're able
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  to take a CT scan of your chest.
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  Generate a three dimensional virtual display of your lungs and airways.
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  Navigate out to our target or our pulmonary nodule, using, actual
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  sensed shape of the catheter, that we use for bronchoscopy relative
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  to that 3D virtual display.
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  Once we're out at the lesion that we're trying to biopsy, we can use
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  the portable CT scanner that we have.
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  To locate the catheter position, the tools, the position of the tools
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  we're using, the position of the nodule, both before we biopsy as we do
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  biopsies to make sure we do it safely.
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  Carl (Host): that's amazing.
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  Technology and, and biopsy itself can be a scary word.
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  Is it fair to ask kind of roughly what percentage of small nodules
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  are malignant or cancerous?
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  Nathaniel Meier, MD: Yeah, and, and it really varices by size and there's, a
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  lot of imprecision with estimate of cancer risk with each size, unfortunately.
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  So for nodules less than five millimeters, that risk is probably
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  less than a percent for anything from five to 10 millimeters in size.
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  that risk is, more like 10 to 25% for nodules.
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  10 to 20 millimeters.
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  It, it rises to maybe 10 to 50% and nodules over two 20 millimeters.
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  that's more like 20 to 68%.
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  And so, like I mentioned, it's, it's, there are wide ranges of the estimate
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  of risk for, nodules of each size.
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  And that's why we feel it's important to have an opportunity
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  to meet with us in clinic to talk about, you know, how much you as a
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  patient, value diagnostic certainty.
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  And then the risks of different follow-up strategies, which
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  may include biopsy or imaging.
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  Carl (Host): if the biopsy is negative for cancer, is there still a need
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  to monitor that nodule over time?
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  Nathaniel Meier, MD: there are a few, things that we can pick up
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  with biopsies, that are, reassuring for the absence of cancer.
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  If we can do a biopsy and pick up the diagnosis of certain benign
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  tumors, such as like a hammer, tooma.
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  Or, certain infections, then we can really be reassured that This is not cancer.
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  barring that, most of the time, best practice would be to follow the nodule
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  with some imaging, periodically over a couple of years, or, not quite
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  as long if the nodule decreases in size or resolves on its own.
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  Carl (Host): we talked earlier about early detection I should also ask though,
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  if someone's having other lung issues, what, what signs should they look for that
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  would prompt them to visit their primary?
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  Nathaniel Meier, MD: Yeah, I mean there are certain alarming things
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  of course that should, should bring in, I mean, a bloody cough, but
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  also just a cough that's persisted for more than a couple of months.
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  chest tightness, wheezing, trouble breathing that really
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  limits your activities at all.
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  We're happy to see you and talk about it in our clinic.
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  Carl (Host): and back to the smoking issue, if you're a smoker, definitely if
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  there's any signs, I would guess you want to do something, but as we said earlier,
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  non-smokers can get lung cancer too.
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  So I would say if you have, I would ask, I guess if, if someone's
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  having an issue and they say, but I, I've never smoked, so I'm okay.
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  They probably should get checked out.
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  Nathaniel Meier, MD: Yeah, yeah.
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  Again, um, for any of those reasons, we'd be happy to see, a patient, you
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  like, trouble with bloody cough or unintentional weight loss, trouble
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  breathing, that limits their activities.
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  chest pain with, deep breaths, any of that.
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  we're happy to see.
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  Carl (Host): Yeah.
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  Doctor, before we let you go, I, I want to ask what drew you to
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  pulmonology as a specialty as you were going through medical school?
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  Nathaniel Meier, MD: Yeah, I mean, uh, I spent a lot of time with my grandmother
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  growing up and she was an English teacher.
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  She, read.
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  To learn.
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  She made it fun and, she was a heavy smoker.
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  And like, to the extent, sometimes I remember, almost using her, the, the smoke
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  in our house as a prop for like pretending to be a firefighter with cousins or,
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  NASCAR races in the house or something.
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  But I mean, if you name a smoking complication, she had it.
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  And for such a vibrant woman, it really limited her at the end of her life.
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  And, yeah, I mean, how could you not want to dedicate a part of your practice
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  to, helping other families avoid that,
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  Carl (Host): Yeah, absolutely.
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  Well, we're, we're grateful you chose that path, Dr.
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  Nathaniel Meyer, critical Care Pulmonologist with Novant Health.
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  Thanks for being with us today.
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  For more information, go to novant health.org.
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  If you enjoyed this podcast, please share it on your social channels and
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  explore our entire podcast library.
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  For topics of interest to you, I'm your host, Carl Maronich,
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  and This is Meaningful Medicine.
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  Thanks for listening.