All right, good afternoon.
Hello from Chicago. Welcome everyone. My name is Ryan Nagdeman
here doing a live broadcast
from Rush University Medical Center.
And today I'm chatting with Dr. Jennifer Earvolino
an internal medicine specialist at Rush,
assistant professor in our Rush University Medical College.
And thank you so much for joining us.
Thank you for having me.
This is great, so to get things started,
tell us a little bit about yourself, Dr. Earvolino.
So I am a primary care physician here at Rush
I'm a general internist,
so that means I take care of all adult patients.
So I spend the vast majority of my time
helping them manage their chronic conditions
like hypertension, diabetes, heart disease,
but we also spend a lot of time
making sure that they're up to date
on their preventive health care.
Preventive health care.
And here we are in November, Lung Cancer Awareness Month.
And so we wanted to take a moment
to share information about screenings
such a lifesaving tool and opportunity
like colonoscopies, mammograms.
You have to come across this Dr. Earvolino
you know, please describe
a lung cancer screening in your clinic.
So there's a couple things
to note about lung cancer screening. It's relatively new.
So we've really only started doing it since 2015.
Whereas as you talked about, colonoscopies,
we've been doing for far longer, mammograms.
So primary care physicians
are really used to thinking about that
and advising their patients.
But with lung cancer screening it took us a while
to get the data, to help us to know who to screen,
how often to screen, how to screen.
So that data really came into into effect,
it was published and back in 2015
is when Medicare started covering the screening.
So that's why we're trying to raise awareness
because it is a relatively new screening tool.
OK, so we do the screening.
And what does a screening show you?
So basically, what the data showed us is that
the best screening tool is a low-dose CT scan.
Not just X-rays, not sputum for looking at the cells,
but rather a low-dose CT scan.
So very low radiation to start with.
And basically what we're looking for in particular
are nodules that look like cancer.
We tend to get back - I've ordered a lot of these screens.
now in the last several years -
we get back a lot of different findings,
most of which are benign, but you know,
what we're particularly looking for
is anything that looks like a cancer.
And what we're hoping for is if it is a cancer,
an early-stage cancer.
OK, and lung cancer screening
is often associated with people who are smokers
and you know,
how do you determine who should get one?
So again, the data helped us on that.
So to start with, smoking is the number one risk factor
for developing lung cancer, I cannot stress that enough.
So there are estimates anywhere
from 80 to 90% of lung cancers
are caused by tobacco, primarily cigarettes.
And so when we were looking at
who should we screen, you know,
that was a big question about how much smoking and such.
So in the end, there are several trials
that looked at all of this,
but currently what the recommendations are
is that we only screen patients who are between
the ages of 50 and 80,
who have a 20-pack year history of smoking.
And by that, it's a very strict definition.
So we get to the pack years by taking the amount
that a person smokes in a given day
multiplied by the number of years they smoke.
So as an example, to get to 20 pack years,
someone, if they smoke one pack a day for 20 years,
that gives you 20 pack years.
Likewise, if they only smoke a half a pack a day,
but they've been smoking for 40 years,
that's going to give you
a 20 year pack year history as well.
Again, what the data showed us
is it's both the quantity,
how much you smoke on a given day and how long you've smoked
that really factor into your risk.
The last thing in terms of people
who are eligible for screening,
they have to be either current smokers or having quit
within the last 15 years, which sounds a little strange.
But the reason for that is that when people quit smoking,
they immediately start reaping the benefits of quitting.
So within five years we can demonstrate their reduced risk.
And if someone has quit smoking cigarettes after 15 years,
they've reduced their risk of developing cancer
by 80 to 90%, which is huge.
Wow. Talking about evidence and data,
any evidence that men or women are more likely
to develop lung cancer?
I mean, historically more men die from lung cancer,
but of course that's because more men historically smoked,
Unfortunately over the years,
more and more women started smoking.
And so now the numbers are becoming even. It's not really
whether you're a man or a woman, again,
I'm kind of starting to feel like a broken record,
but it's really the amount that the people have smoked.
So if you look back at data,
I think I saw somewhere back in 1965,
about 42% of U.S. citizens smoked.
Thankfully now that's down to about 19%, but again,
unfortunately we see more men with lung cancer,
but that's because historically, more men smoked,
but the women have gotten up there in the numbers as well.
I will say lung cancer
is the leading cause of cancer deaths in the United States.
It far and away surpasses breast, colon, pancreas.
It's a huge killer of people, so.
So with that, how big of a difference
can it make if it's caught early?
- So that's the beauty of these screenings.
So whenever we're recommending a screening test,
obviously we want to do something that we can intervene on
and really make a difference.
So what we found with the trials that were looking at this,
when we can catch a lung cancer at the earliest stage,
that very early stage one, it's great.
Not great, but if I get back a scan that looks suspicious,
I immediately am on the phone
with my colleagues in thoracic.
We get them into the operating room as soon as possible.
And if it's an early-stage cancer,
their five-year survival is 92% and that's without
any radiation, without any chemotherapy.
Whereas, you know, conversely, if it's a later stage,
if it's the very latest stage,
their five-year survival is zero.
And it's basically a linear curve.
At every stage that you advance your survival,
your five-year survival goes down, but if we catch it early,
which is the whole point of this,
there's a 92% chance of cure, which is great.
That's fantastic.
And your profession, primary care,
the importance of the relationship
with your patients and as a patient relationship
with my physician,
if someone believes they qualify for screening,
where does that conversation start?
I mean, as a primary care physician,
definitely everyone should have someone.
They should have someone
that they're going to the help them.
They should be seeing them once a year.
And certainly what's super important.
I mean, we get triggered
with our electronic records these days
for some of those other cancer screenings
that we already talked about.
In order for the physician to be triggered,
to talk about it electronically that is,
it's very important to have that tobacco history in there.
But I mean, patients should know if they're a smoker,
in particular, if they have the kind of pack year history
that I mentioned earlier, that 20 year pack year history,
I mean, they should be having that conversation
with their physician anyway,
because it's not just lung cancer
that tobacco is increasing their risk of.
I mean, there are so many other cancers that tobacco causes
an increased risk: heart disease, just to name a few.
So at any rate point is they should have a good relationship
with their primary care doc.
They should be honest with them.
They should talk about their smoking.
And then if they fall into this criteria,
which is very straightforward, it's a super easy, again,
it's easy to order, it's a low dose test.
It's very easy to do.
A different procedure for someone
who's already exhibiting symptoms?
So in the world of medicine, so we look at tests,
are they a screening test?
And that's for someone who's totally asymptomatic.
And in fact for a screening CT,
patients cannot have any symptoms.
However, if I have someone coming to me that say,
for example, has unexplained weight loss,
and has been coughing more
and maybe coughing up a little bit of blood,
something along those lines that has me much more concerned,
they are still going to be getting a CT scan.
It's just ordered a little bit differently.
So it's a different pathway.
They're still getting the CT scan though.
Yeah, some candidates may be slow
to seek help or seek treatment.
The stigma of, you know,
I may have brought this upon myself, which happens,
what do we tell them though, with a hope for treatment?
I always tell my patients, I mean,
we're in a partnership together.
And we probably have all done things we ought not to have
whatever in terms of our health.
We do not think that way as physicians.
And the whole point is if we can catch this early,
we can cure you, so no one should feel that way.
And I mean, even the surgery itself,
they've made advances on
when I talk with my thoracic colleagues,
they now do something called a VATS procedure.
It's a video assisted thoracic surgery,
two or three tiny little incisions usually is what it takes.
Like 1.5- to 3-centimeter incisions.
Patients usually are out the next day.
I literally just had a patient
that I screened two weeks ago.
Suspicious nodule, she was in the hospital last week,
went home the next day.
You know, the recovery is just a couple of weeks.
It looks like we got it all and, you know,
fingers crossed, she doesn't need any other treatment.
Well that's fantastic.
And as often as one should see a primary care physician,
that's one, how often should I see my PCP?
And then how often should I be thinking about screenings?
So the screenings are recommended.
So we get back, there's actually the American College
of Radiology has very discreet ways
in which we interpret the scans,
but the scans are done once a year.
Now, obviously if we find something
that maybe looks a little suspicious,
but not worrisome enough to go to surgery,
then we might do it a little bit sooner.
But the screenings are once a year,
in terms of how often to see your primary care physician,
that would depend on kind of other health conditions
that someone might have.
But I would say at least once a year.
OK, you touched on this earlier,
the amount of patients that die with lung cancer,
according to American Cancer Society,
as many as 20% of patients died were never even smokers.
And so can we talk a little bit about the incidental,
you know, that can happen.
Right, so yeah, so I've seen, you know,
differing numbers in terms of that, 10,
20% never have had a tobacco history.
So unfortunately they are going to fall outside
the screening criteria,
but you and I were talking a little bit before this.
I mean, there are other risk factors for lung cancer
that aren't quite as clearly documented.
And certainly having that conversation
with your primary care physician,
they may determine that because of say
your extensive second-hand smoke, for example,
or maybe some environmental exposures
that someone might be concerned about,
they may fall into where we can, you know,
either get a regular CT scan.
There are some other payment options in terms of things,
but it's worth having the conversation
with your primary care doc.
OK, great.
A lot of conversation about smoking and whatnot,
what's happening with the vaping?
The vaping these days.
It's funny, my husband said someone might ask me
that question this morning, so here we go.
So, you know, the problem with vaping
and cannabis, and that's probably the other one
that people would want to know about.
It's really hard to tease out that data.
Not everyone clearly, but you know,
especially if the vaping,
perhaps they smoked before and used it to quit
or what have you, there's a lot of confounding variables.
So we just don't know how risky those behaviors are.
We do not have good data,
cigars and pipes do increase your risk of lung cancer.
So just FYI.
Are there any additional topics that you wanted to cover
that have come up throughout our chat?
I just, I think the things that I want to stress
we've covered, but certainly, I mean,
people should definitely have a good relationship
with their primary care physician
so they can have this conversation for starters, you know,
the number one way to reduce the incidence of lung cancer
in the United States is by quitting smoking.
And even, I mean, there's even data
that if people cut back on the number
of cigarettes they smoke, they will lower their risk.
It won't be negligible obviously, but you know,
continuing less is more, as we say, in terms of,
if you can just even cut back by half,
you're doing yourself a favor you're lowering your risk.
Ideally quitting altogether is huge,
but know that I know a lot of people get scared to do
a screening test because they're afraid
they're going to find something.
But the whole point is if we find it early enough,
we can cure you.
Yeah, when patients come to you,
there's an addiction component,
I'm seeking help for quitting.
What counsel, what programs do we have here at Rush
to help patients quit smoking?
Within the Department of Preventive Medicine
there's definitely people available to help with that.
There's the Illinois Quit Hotline.
You know, individual providers
also give a lot of counseling.
I know that I am always talking to people
and trying to convince them of the benefits of it.
And we strategize, obviously there are some
mostly over-the-counter tools available
in terms of gum and patches.
And there are some medications that work a little bit.
They're not my big favorite, but at any rate,
but there are ways that we can talk, you know,
talk through and help people come up with a plan,
a quit date and get them committed.
I always tell them it's the best thing
they can do for themselves.
- Yeah, and so with the the holiday coming up,
Thanksgiving will be around families
and will you be sort of taking this message, you know,
on the road, wherever you're traveling
about the importance of consider smoking,
not to consider, consider quitting.
- You know, I was about to say, thankfully, you know,
none of my immediate family smoke,
certainly in terms of things, I have some in-laws that have,
or do, and so maybe they'll hear this message.
We do have one question from the online audience.
And so this is great, thank you.
Do you have to have a physician referral for this screening?
Oh gosh, that is a good question.
I actually don't know.
I know that Rush does have a self pay option
that is pretty affordable.
I believe it's $139, but I don't know where the order,
I don't know.
I'd have to get back to them, I'm not sure on that.
OK, I'm sure we could add that information
to the chat later and certainly want to direct people
to rush.edu, to find out more about primary care,
find a primary care at Rush, as well as information
about lung cancer awareness and screenings.
And so I don't see any more questions coming through,
and this has been good.
And so happy holidays,
anything that you want to say to the family
now that we're Facebook famous.
You're all helping me with Thanksgiving dinner.
Awesome.
Thank you so much, it was nice to chat with you today.
That's great.