Danielle Lee: Good evening Jacksonville, and happy Saturday. I’m Danielle Lee, and welcome to the conversation with Dr. Ali Kasraeian. As always, you too can join the conversation. Just give us a call, 340-1045. How are you today, Dr. Ali?
Dr. Kasraeian: I am good. How are you?
Danielle Lee: I am well. We’re talking about smoking today, I hear.
Dr. Kasraeian: We are talking about smoking, and many other things related to smoking. Today we’re talking about a very interesting study that came out, honestly, in kind of a prerelease to a presentation that is going to be done at a conference coming up. It’s called the ASOCOs, the American Society of Clinical Oncology, in June. This study found that in 2016, fewer than two percent of those eligible to undergo screening for lung cancer in the United States underwent such screening.
Why is this significant? Lung cancer is, by far, the leading cause of cancer related death in the United States. To put that in perspective, in the United States, predicted in 2018, we’ll have 234,000 new cases of lunch cancer this year. Of those, unfortunately, 154,000 deaths will be related to. That is, like I said, by far, the leading cause of cancer related death. We’ve talked about a lot of different … we’ve talked about breast cancer, we’ve talked about prostate cancer.
Breast cancer remains the leading cause of cancer in women, prostate cancer used to be the leading cause of cancer in men, but with the screening controversies, I think it’s in second place now. But if you put colon cancer, breast cancer, and prostate cancer, and combined all the deaths related to those cancers together, each year, more people die of lung cancer than all of those cancers combined. When you put all that together, it seems baffling that only two percent of people get screened for lung cancer each year.
Globally, and this is 2018 data from the World Heath Organization, the WHO, lung cancer effects 1.69 million deaths. It effects 1.69 people who pass away from lung cancer. And by far, tobacco and smoking is the leading cause of that. That is profound. You talk about smoking, it’s kind of the cause of smoking. We’ve talked about smoking being a big cause of not just lung cancer, but other cancers. We’ll talk about that. We’ll talk about the study. We’ll talk about smoking, the implications of smoking, not just of lung cancer, and lung health, but also, how that translates into our behavior in all health.
One thing we’ll talk about is, interestingly, one third of deaths from cancer are due to five leading behavior and dietary risks. The World Health
Organization kind of talked about this, where tobacco abuse is the single most important risk factor related to cancer. It’s responsible for 22% of cancer related deaths. Other things we can think about is alcohol use, diets that are low in fruit and vegetable intake, lack of physical activity and associated high body mass index, which is obesity. All of these things can be attributed to cancer and cancer related death. When you put all this together, these are all preventable issues, and preventable things that we can do things about in a proactive manner through the course of our life to prevent cancer, and smoking is one that is really one of the best things you can do in your life, if you are a smoker, is to quit smoking, and if you haven’t started smoking, is to keep from smoking and stop smoking, and that’s something that you really, really can help someone in your life.
Two people that are really gonna help us in this discussion. One is near, and one is afar. In the studio, we have Dr. Alex Vasquez who’s a pulmonologist, and a lung cancer expert. He is really on the front line after the primary care physician, to deal with people who are dealing with not just lung diseases from a functional aspect with difficulty with breathing, but dealing with that first line of diagnosis and management of lung cancer. And then, by phone, from Orlando, Florida, my dear friend and fellow urologist and health expert and wellness master of the internet and social media, and all things health oriented, is my good friend Dr. Jamin Brahmbhatt. I want to thank both of you for being in studio with us today.
Dr. Vasquez: My pleasure.
Dr. Kasraeian: So first, I-
Dr. Brahmbhatt: Thanks, Ali.
Dr. Kasraeian: Oh, thank you for being with us. One thing we’ll get through the course of this show, Dr. Jamin Brahmbhatt and his partner, Dr. Sijo Parekattil are beginning in June, their yearly drive for men’s health, which tries to get men to engage in healthier lifestyle choices by driving incredible cars through the amazing country that we have. This year, they’ve changed cars, so we’ll talk about that and see how they’re trying to engage people into being healthier. Not for the men themselves, but for the men in their lives. Alex, when you read this study, one, does it surprise you?
Dr. Vasquez: It doesn’t. As you said, I’m in the front lines of diagnosing lung cancers, and it is perplexing, right? We have these guidelines that say if you smoke for a certain amount of years, if you’re starting this age, that you should be screened on at least one scan, and if not anally, if you meet these criteria. Unfortunately, there’s a lot of roadblocks to get to that point. One is obviously having the physicians ordering it. Two, a lot of times it has to do with the insurance companies. Sometimes there’s a lot of pushbacks as far as getting these screening tests actually performed. Those are the things that we see in the front lines. It’s a bit perplexing in the sense that we’re not doing more.
Dr. Kasraeian: And again, the criteria, it’s not new. In 2013, the US preventative services task force recommended that individuals who are at risk for cancer, 55 to 80 years of age, with a smoking history, which is a 30 pack year history or longer. That means that essentially how much you have smoked equals 30 years or longer. It’s either a pack per day for 30 years or longer, or two packs for 15 years, something that equals in that capacity. People who are currently smoking, or that they have quit within the past 15 years. Anyone who meets these criteria would be a candidate for annual screening with a low dose CT scan, which is a CAT scan. They thought this would be more sensitive in picking up small lung nodules, and would be better than just a chest X-ray, for example.
Dr. Vasquez: You’re right. This dates back to a previous VA study. The VA started a study many years ago where they screen individuals for chest X-rays, and they realized along the study that chest X-rays had no value as far as screening for lung cancers. And then, a couple years after that, they compared chest X-rays to CAT scans. The study was so profound as far as its results that they actually stopped the study midway and said, we need to screen individuals with this criteria, that you just mentioned, at an early basis. It’s been an initiative to get this started.
Obviously we’re failing as screening if we’re only screening two percent of the population. I think the deal is, one, as I for mentioned, insurance and screening, and two, has to do with a lot of times, smoking is thought to be a ‘naughty’ behavior. I smoke, so I don’t really want to say I smoked over 30 years, or I try to downplay how much I actually smoked. Which in this case, if you smoked and you stopped, this is not the time to downplay how much you smoked. There’s no other screening test. There isn’t.
Dr. Kasraeian: So there’s no blood test. There’s no other way to find out if something related to your smoking that may be a malignancy of the lungs, there’s no other way to … there’s no PA test, for example. Again, it’s very similar to the mammography. I’ll put it out there, why do people get the mammograms, they don’t get the CT scan or the chest X-rays for the lungs?
Dr. Vasquez: Actually, unfortunately it’s antedated as far as I know. I never, hardly ever order an X-ray as far as that, but CAT scans is one of my first lines. If I know you smoked, I know you’re gonna meet the criteria, why don’t I just screen you? Because I don’t have any breath test. As you mentioned, I don’t have any blood tests to screen for this. Unfortunately we’ve fallen behind the eight ball on the leading cause of cancer in the world. There’s no there cancer kills more people than lung cancer, and unfortunately, that’s where we’re at.
Dr. Kasraeian: So Dr. Brahmbhatt, this kind of brings up something that we do with men all the time, the initiative to go be seen by a physician. Men don’t go see a doctor. Here it’s kind of a different twist on the same coin, or the same problem. People are worried about the stigma associated with their behavior that may result in a cancer. You have a fear of cancer, and then you’re worried about the fact that something that you actually did, and a choice that you made could potentially have a really, really detrimental effect on not only your health, but a significant problem that may impact your family. There’s a thing called an ostrich effect, where you put your head in the sand to avoid the potential result of that test that may be down the line. But here it’s a little bit different than that because you’re worried about-