Clearing The Smoke On Lung Cancer

Smoking is the main risk factor for developing lung cancer, yet between ten- and twenty-percent of lung cancers happen in people who have never touched tobacco.  Learning about lowering your risks and improving your lung health can be lifesaving.

In observance of Lung Cancer Awareness Month, host, Jonathan Fialkow, M.D. gathered a panel of experts to talk about the latest news in screenings, treatments and support for caregivers.

Guests:

• Federico Albrecht, M.D., medical oncologist with Miami Cancer Institute
• Brenda Gonzalez, M.D., pulmonologist and vice-president of the medical staff at Doctors Hospital
• Lori Adelson, workplace counsel and board member of the American Lung Association

"Saved By The Scan"
Thanks to a new scan, lung cancer can be detected early when it's more curable.  If you smoked, get scanned. To find out if you're a candidate visit Baptisthealth.net/LungScreening.

Transcript

Speaker 1:
At Baptist Health South Florida, it's our mission to care for you when you're injured or sick and help you stay healthy and fit. Welcome to the Baptist HealthTalk podcast, where our respected experts bring you timely practical health and wellness information to improve your family's quality of life.

Jonathan Fialkow:
Welcome Baptist HealthTalk podcast listeners. I'm your host, Dr. Jonathan Fialkow. I'm a preventative cardiologist and lipidologist at Miami Cardiac and Vascular Institute, where I'm also chief of cardiology at Baptist Hospital and the chief population health officer at Baptist Health.

Jonathan Fialkow:
Lung cancer is by far the leading cause of cancer related deaths for both men and women. We all know that smoking is a main contributor to developing lung cancer. But about 10 to 20% of lung cancers happen in people who never smoked.

Jonathan Fialkow:
Learning about lowering your risks and improving your lung health can be lifesaving. To kick off lung cancer awareness month, I recently hosted an episode of Baptist Health resource live program for a discussion centering on this disease.

Jonathan Fialkow:
My guests were Dr. Federico Albrecht, medical oncologist with Miami Cancer Institute, Dr. Brenda Rodriguez, a pulmonologist and vice president of the medical staff at Doctor's Hospital and Lari Adelson workplace council and board member of the American Lung Association.

Jonathan Fialkow:
Let's hear what they had to say. Federico let's start with you. Most people think that really lung disease is a disease of smokers. And we know that smoking does drastically increase one's risk of getting lung cancer.

Jonathan Fialkow:
But according to the CDC about 10 to 20% of lung cancers happen to people who never smoked or really smoked fewer than a hundred cigarettes over their lifetime. Can you speak a little bit about lung cancer in non-smokers? Are there any identifiable causes or risks? How prevalent is it?

Federico Albrecht:
We know that lung cancer is caused by smoking in the majority of patients, 80, 90%, as you say, but not all. So why a person that has never smoked or has never been exposed to secondhand smoking develops lung cancer. Why?

Federico Albrecht:
Well, if you look and go to the big institutions webpages like the CDC or the American Cancer Society and you put what are the causes of non not related to smoke for lung cancer? You will see a list of reasons that make actually cause lung cancer.

Federico Albrecht:
And that is the gas rate on, some air pollutants, some air contamination, for example diesel exhaust and things like that. But those causes and those actually causes cause lung cancer by the same mechanism that smoking causes lung cancer, it produces an irritation of the cells and produces a DNA damage of the cell.

Federico Albrecht:
But you know that in the United States, the air is fortunately very... I mean, it's good. So I do not believe that and we oncologist and thoracic oncologist, we don't believe that that's the real cause of lung cancer in non-smoker. There has to be some other cause.

Federico Albrecht:
Some other cause that we should identify. And I think that cause is actually, not only I think but is a cause that is recognized more and more and I'm referring to the genetic alterations that lead to lung cancer growth.

Federico Albrecht:
So when we talk about those genetic alterations that make that cancer growth, we actually name them mutations. And we actually tell them driver mutations because is actually driving the lung cancer cells to become malignant and actually to progress to lung cancer.

Federico Albrecht:
And are those driver mutations that alterations and a mutation is DNA damage that actually tells the cancer to divide and to invade. And those driver mutations generate lung cancer. And it is a type of lung cancer that Jonathan is biologically different from the classic smoking related lung cancer.

Federico Albrecht:
They usually present in younger patients. They usually present in females. They have a different presentation and different growth rate and they can do metastasis in different organs. And actually the prognosis is quite different, is actually can be better treated with oral therapies.

Federico Albrecht:
So the short answer now, Jonathan is that most likely is a genetic alteration. That is why when we see a new, a newly diagnosed lung cancer patient that has never smoked, we need to do and we always do genetic profiling to identify those driver mutations.

Jonathan Fialkow:
But we don't want to diminish the impact of smoking on lung cancer risk. But as we said, I think the take home point is not all lung cancers from smokers and as you allude to, the genetic composition determines a lot of the workup in treatment and certainly at the Miami Cancer Institute, this is part and parcel of the evaluation of patients with lung cancer.

Jonathan Fialkow:
Lori you've had a personal experience with lung cancer. Looking back on when your mother was first diagnosed, what was your mom going through, what were the symptoms that were first noticeable that led towards a lung cancer diagnosis?

Lori Adelson:
Well, what was interesting segueing from Federico conversation is she had a driving mutation. So my mother did not have any symptoms. My mother at the time she was diagnosed with stage two lung cancer had been diagnosed through a mammogram.

Lori Adelson:
Her OB-GYN had taken her routine exam and saw a spot on her lungs. So not withstanding the fact that it wasn't an actual lung scan, she was saved by the scan. And very fortunately she caught it at an earlier stage.

Lori Adelson:
Unfortunately for us she still only had a five to seven year prognosis, but after the chemo, from the first treatment for the lung that had been resected, she developed a pulmonary fibrosis.

Lori Adelson:
And thereafter had a recurrence on her second lung. So while we were grateful that it was caught at that first stage, the rest of the treatment for which we were not very educated on and the rest of what happened, the events were surprising to us.

Lori Adelson:
We were really shocked. My mother was a non-smoker her entire life and she was healthy. She played tennis, she was active. She was 70 years old living the country lifestyle. And we were really sad and disappointed because she was our heart center of our family.

Lori Adelson:
And then not having had the education, my mother ended up taking the shingle shot, which she should not have because at the time it was a live vaccine and it caused her to get chicken pox, pneumonia and ultimately fail within six months.

Jonathan Fialkow:
Oh boy.

Lori Adelson:
So this to me my mission is to educate others because had we known more, we think we would've had my mother, maybe not for 20 more years but at least through the prognosis that she was originally given.

Lori Adelson:
And I got involved with America Lung Association because of this. I sat to one of their first luncheons was moved to tears at the stories and couldn't believe that I didn't know all that went on behind the scenes.

Lori Adelson:
And so grateful for Baptist South for putting this on today because more people need to know, I mean 8% awareness rate. That's shocking. It's the number one cancer killer.

Jonathan Fialkow:
And thank you for sharing that personal experience and having that experience catalyzed you to develop this passion for education and early identification lung cancer and support, which is well noticed and much appreciated. Brenda, so Lori's mom found this out in an incidental finding. A finding on mammogram. Is that usual or do more often we find patients present with symptoms that then go on to discovery of lung cancer? What's the usual experience that you see?

 Brenda Rodriguez:
Yeah. Unfortunately as you mentioned, at early stages of lung cancer patients are frequently asymptomatic. Symptoms become more frequent as the cancer becomes more advanced. That was the case of my uncle who passed at the age of 40 with lung cancer.

 Brenda Rodriguez:
He was diagnosed at very advanced stage. 60 to 70% of lung cancer patients were not diagnosed until cancer was advanced. The most common symptoms that patients can present are cough, coughing up blood, which we call it [inaudible 00:10:09], shortness of breath and chest pain.

 Brenda Rodriguez:
So any patients with risk factors especially former smokers or smokers who present with cough and [inaudible 00:10:22], that should trigger an evaluation for lung cancer. And obviously as the lung cancer progress and spread to other areas of the body patient can have other symptoms, especially I mean, if they've spread to their brain, liver, bone, they can have electrolizing balance.

 Brenda Rodriguez:
Sometimes you go to the physician and they found a patient had abnormal calcium levels, normal sodium levels and a high risk patient even if they don't have any other symptoms that probably should trigger an evaluation looking for lung cancer.

Jonathan Fialkow:
So from a context standpoint it's fair to say, "Not everyone with a cough has lung cancer."

 Brenda Rodriguez:
Correct.

Jonathan Fialkow:
Not everyone who cough blood is lung cancer, but that would be a little bit higher risk for it. If someone has those symptoms and they see a doctor, what's the general workup, is it chest x-ray is the first step. And if so, how reliable a chest X-rays is?

 Brenda Rodriguez:
Well, a good conversations with a patient, how long do you have the cough? What other symptoms [inaudible 00:11:35] obviously, if you had an infection with an infection and your coughing and so history is the clue.

 Brenda Rodriguez:
And once you go through the channels of evaluation, then depending if you have a high risk patient, then you should undergo some surveillance, some screening, which we many organizations had guidance to continue monitoring, especially long screen CT scans. But the first is a good conversation with your physician.

Jonathan Fialkow:
Appreciate that. And again, we may come back towards some of the screening in [inaudible 00:12:16]. Lori I'd like to come back to you and to follow up on your personal experiences and your journey of having a loved one with cancer.

Jonathan Fialkow:
A lot of emotions go through a cancer diagnosis for both the and the family. What advice or what kind of information would you want to educate people about regarding that journey from diagnosis towards treatment, ultimately towards success and remission or other outcomes?

Lori Adelson:
So thank you. So most importantly, I raise awareness by sharing my story, right? So I feel that no person facing lung cancer should go through it alone. And I really hope that this conversation motivates people to listen to their bodies, advocate for themselves and their loved ones and talk to their physicians about getting lung cancer screening.

Lori Adelson:
Work with your doctor to make treatment decisions, make sure you doctor knows your preferences and what know what to expect, whether you have a healthcare surrogate or what your needs are and what you want in the event that it's an end stage situation.

Lori Adelson:
The Lung Association is a great first place to go for people who are newly diagnosed. They're staffed with nurses and respiratory therapist who can connect with resources. And they also have lung association as a partnership with [inaudible 00:13:40] angels who connect people with lung cancer, with lung cancer survivors. So they're able to see that there is hope and the connection is so valuable to people who are particularly newly diagnosed.

Jonathan Fialkow:
Yeah and again I think very [inaudible 00:13:55] everyone's an individual and everyone's journey will be different and everyone's desires and wishes should be and will be identified and supported, but there are certain commonalities that we can express and people do have opportunities to be educated and for support as well. Which again, remains the take home message.

Jonathan Fialkow:
So again, thank you [inaudible 00:14:15] answer. Federico we know about you alluded to some of the treatment options regarding the genetic makeup of cancer, Lori mentioned mom had surgery, talk a little bit about what the treatment options for cancer patients are. They're rapidly evolving. What goes into creating a treatment plan that individualized to a patient of lung cancer?

Federico Albrecht:
So we when we diagnose a new patient, we see them in our multidisciplinary cleaning, which is actually a concept... Is a concept that Dr. [Sinar 00:14:55] our CEO implemented since the beginning.

Federico Albrecht:
Because we believe that a patient and a patient with lung cancer should be approached in a comprehensive perspective, [inaudible 00:15:10] the perspective of different specialties including not only medical oncology, but also thoracic surgery, radiation, oncology, neuro-oncology and many others like pulmonology with the health of radiology and pathology.

Federico Albrecht:
So we discuss the case among us. The team with this team approach to define the best approach, the best way to treat this unique patient, that individual patient to give the individualized treatment and actually leading to that we can give the best outcomes to that patient.

Federico Albrecht:
And among those methods Jonathan we have well, again this is very complex, but at the beginning we analyze the extension of the tumor. We know where that is. And then we define the staging then we can ask if the patient can be or that tumor can have a minimally invasive surgery that means can be resected, could it be resected surgically?

Federico Albrecht:
And we have a team of experts in robotic surgery here that has actually improved the [inaudible 00:16:32] recovery of these lung cancer patients. So that is an important method and approach.

Federico Albrecht:
And if the tumor cannot be removed surgically, then we discuss different options like adding radiation therapy, here at the Miami Cancer Institute we have available a full spectrum of techniques in radiation therapy up to the famous proton B accelerator.

Federico Albrecht:
So that is amazing. And if the patient cannot, I mean and always patients will have what we do, I mean that genetic profiling that we were talking at the beginning, trying to identify if there is any driver mutation, that driver mutation that could be targeted, that means that could be treated and treated with oral therapy.

Federico Albrecht:
So again, I do chemotherapy biologics, immunotherapy, chemotherapy continues to be playing a significant role in lung cancer, continues to be the backbone of medical oncology, but we are adding a new intravenous medication called immunotherapy and people are hearing because there is a lot of advertising on immunotherapy and that immunotherapy actually has revolutionized our treatment.

Federico Albrecht:
There are patients with very advanced disease that respond very well to immunotherapy that can have a survival for many, many years. And we see that and actually the concept is a novel concept because is an intravenous chemotherapy... I mean, intravenous immunotherapy, not chemotherapy that will allow the patient's own immune system to be activated. And that is the start immune system that goes against the cancer cells and pre event growth.

Jonathan Fialkow:
So the multidisciplinary approach, but also the availability of all the different technological advancements and treatments really makes the unique... The Miami Cancer Institute experience relatively unique. Lori can you speak a little bit about the saved by the scan partnership between Baptist Health and the American Lung Association?

Lori Adelson:
Sure. So the goal obviously is early detection and to raise awareness. Fortunately, even though I said awareness is only 8%, it's up from 3%. So we've had a big increase through this promotions, through these joint partnerships with Baptist, for with save by the scan.

Lori Adelson:
And so although my mother's treatment wasn't necessarily a lung scan, it was a scan that ultimately led to early detection. I believe that if we include lung scans as part of our preventative care, we can increase the rate for early detection, increase the awareness rate and increase the lifespan of individuals affected by lung cancer.

Lori Adelson:
The partnership is a great opportunity for people to get screened for early detection and through the American Lung Association and back to health, we're doing our part to educate and raise awareness that this is an option and it's available for folks and should be discussed from even at the primary care stage, right? With your primary care doctor and part of your total health care screening from your physical, go get that lung screen so that you can avoid not learning about the possibility of lung cancer when it's too late

Jonathan Fialkow:
To our listeners, remember that you can send us your comments and suggestions for future topics at Baptist HealthTalk at Baptisthealth.net. That's Baptist HealthTalk at Baptisthealth.net. On behalf of everyone at Baptist Health thanks for listening and stay safe.

Speaker 1:
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