November 11, 2016
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Lung Cancer Screening
Kim Sandler, Assistant Professor of Radiology and Radiological Sciences and Co-Director of the Vanderbilt Lung Screening Program disucsses lung cancer screening. Learn more about the Vanderbilt Lung Screening Program.

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Laura Osterman: Welcome to this edition of the Vanderbilt University Health and Wellness Wellcast. I am Laura Osterman with Health Plus. Screening test can help find cancer at an early stage before symptoms appear, and I am here today with Kim Sandler, Assistant Professor of Radiology and Radiological Sciences and Co-Director of the Vanderbilt Lung Screening Program. Thanks for joining us today. Dr. Kim Sandler: Hello, thanks so much for having me. Laura Osterman: Can you give us some background information about lung cancer screenings? Dr. Kim Sandler: Sure, lung cancer screening is based on evidence from a trial that was published in 2011 in The New England Journal of Medicine. They did a trial where they looked at over 50,000 patients enrolled in over 30 medical centers, and they compared doing annual CT scans to annual x-rays to see if they could detect lung cancer before it was in a progressive stage, and what they found was a 20% reduction in mortality in the group that was undergoing screening with CT as opposed to x-ray, and they also found a reduction in overall mortality from other causes using CT. Patients who undergo lung screening have to be high risk for lung cancer based on their smoking history. That includes patients who are between the ages of 55 and 77 who have greater than a 30-pack year at 30-pack year history which is on average a pack a day over 30 years and are either currently smoking or quit smoking less than 15 years ago. Laura Osterman: What do screening results mean for patients? Dr. Kim Sandler: Screening CT allows us to see lung cancer at a very early stage. We cannot see everything. So, having a normal screening exam cannot prove that the patient does not have lung cancer or would not develop lung cancer, but we can see cancer before it causes patient symptoms. What we also see on our screening exams are other causes of mortality such as cardiovascular disease or other things that need to be brought to the patient’s provider’s attention, and often, these things are smoking related as well. The drawback to lung screening is that we also see things in the lungs that are abnormal but not necessarily cancer. So, often, these studies will have an abnormal result that does not necessarily mean cancer, and for that reason, it is very important that when patients come to Vanderbilt and are part of the lung screening program that they are truly enrolled in our program. We meet with patients prior to the exam. We describe all of the risks and benefits. We want to make sure that patients fully understand the benefits and potential harms of screening before undergoing the study and also how important it is to come back to see us annually for followup exams while they continue to qualify based on their age and smoking history. We also discuss false positive results and what those may mean and what additional tests that patients may need to undergo, but for us and for the patient, we feel it is very important that lung screening is seen as enrollment in a program. It is not simply one test to have one time and then to move on without continuing to be enrolled. Laura Osterman: You mentioned risks and benefits here. Can you tell us more about some of these risks and what the benefits are with the screenings? Dr. Kim Sandler: Absolutely, so to discuss risks first, the biggest risk is having additional procedures and potentially invasive procedures for benign disease or disease that is not cancer. So, what we look for are pulmonary nodules which are little marks in the lung parenchyma that could potentially represent cancer. Now, the lung screening trial did show that the vast majority of these findings are benign and that patients often underwent additional CT scans or even biopsies or other invasive procedures that eventually yielded benign results. So, it is a risk that the patient may have to undergo a procedure to only determine that they have benign disease which is great that they do not have cancer, but we do know that we would be exposing them to invasive procedures. The other risk is radiation exposure which is of course always a concern when we are doing CT scans. We use a very low dose technique, and our newer scanners can provide the results that we need at less than a third of background radiation that a patient would have just living in Nashville over the course of the entire year. So, it is a very, very low dose, and the older we get the less susceptible we are to radiation-induced changes. So, by targeting patients at an older age range, we do feel that the benefits of having an exposure really do outweigh the risks. The greatest benefit is to detect cancer early. We know that these patients are high risk and we truly believe that these studies allow us to see cancer much earlier than we would have with an annual x-ray and we prove on that, and also, we want to make sure that we are finding cancer at an early stage so that it may be surgically resected and treated and we can prevent patients from having to undergo additional therapies that they may need for a later stage. Laura Osterman: Any recommended resources that you can tell us more about? Dr. Kim Sandler: Absolutely, so, patients can visit vanderbiltlungscreening.com which is a website here at Vanderbilt and not just patients anyone who is interested in learning about lung screening. If you are interested in about the test for yourself, if you feel that maybe you have a parent or a loved one who would qualify for lung screening because they have been a smoker, if you have additional questions, we have a number of resources on that website. You can always contact us directly, and we are more than happy to answer any questions. We also have a link for medical professionals or providers. It is important that patients understand that for this exam they need to have an order from their provider and we are always happy to answer questions for those providers if they have specific questions as to whether or not someone would qualify. Also, if there are people who go to the website and feel that they qualify but they do not have a primary care provider, you can contact us and we are happy to help you obtain an order for the exam, and we will follow up those results for you. Laura Osterman: Thanks so much for your time today. Dr. Kim Sandler: Thank you so much for having me. Laura Osterman: Thanks for listening. Please feel free to leave us any comments on this Wellcast on the form at the bottom of this page. If you have a story suggestion, please email it to us at health.wellness@vanderbilt.edu or you can use the “Contact Us” page on our website at healthandwellness.vanderbilt.edu. -- end of recording (06:43) --