The two main causes of lung cancer

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Welcome back to Sarah Has Questions. Today's topic is lung cancer.

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You may have been a smoker in the past and think you're out of the

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woods because you quit. Well, it might not be that simple, and

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turns out there is something in our homes that could be contributing to your

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risk. We have a lot to cover in this episode. So let's

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get into it. I'm Sarah King, and I have a lot of questions.

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What exactly happens when you orgasm physically? Will popping a knuckle or a

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joint give us arthritis? What can we learn from our poop? The size

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of your body doesn't necessarily indicate your measure of health. Yes. And

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what are your thoughts on that? Cleansing. Do we need to do anything

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special to our nether regions? In this

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show, I get to ask all these questions to WakeMed doctors

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who happen to know everything about everything. Sarah

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has questions is a production of Capital Broadcasting Company and Mix

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101.5. It's presented by WakeMed. Today,

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I am talking with doctor Vicki Fowler. You are a family medical

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physician with WakeMed, and we were just talking off here how important fed

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family medicine is. As a family medicine physician, I'm sure

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you you see lung cancer from time to time.

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Apparently, it is the leading cause of cancer deaths

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worldwide. Why do you think that is? There's a lot of

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factors contributing to the leading cause of death being from lung

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cancer and, as you mentioned, lung cancer is a

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leading cause of death for, leading cancer cause of

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death in the United States, in North Carolina, and actually

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in the world, variety of factors. And one of the things I

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wanna really talk about today with you is the importance of

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knowing your own risk and how to find

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out through your physician if you qualify for screening

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as well as ways to lower your risk. Okay. Well, let's

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start with how you figure out someone has lung cancer. What are the

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symptoms? What could we be looking out for? Well, the symptoms of lung cancer, and

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this is one of the issues, can be very, common and they can be

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associated with other conditions such as asthma, emphysema.

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The issues that you want to go to your primary care

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physician and mention if you develop them is a persistent cough

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Okay. That does not resolve. Certainly, if you're coughing up

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blood Oh. That is something that needs attention.

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Yeah. Shortness of breath, that is new.

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Some of the more concerning would be unexplained weight loss is another thing to be

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watched out for and if you are having weight loss that's not

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explainable by diet and exercise, you want to check with your physician.

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Unfortunately, something like unexplained weight loss would be a later

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sign. Early signs are basically often

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associated with other conditions such as asthma

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and allergies, but you wanna get that checked out. So like wheezing, because I think

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asthma, I think wheezing and like, being hoarse. Yeah. And that's

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true. Hoarseness. The bottom line is if you have a

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symptom that's going on and you don't know what it's from, rather than

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googling it, looking it up on the Internet, maybe trying to treat yourself,

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that's why we, I emphasize all my patients, you know, how important it is to

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have a primary care physician or a trusted health care provider that you could go

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talk to about these symptoms and figure out what's causing it. And do you think

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that the fact that it it mirrors all these other

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ailments that is why it takes often a lot of time to get a a

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lung cancer diagnosis? There's a lot of factors involved. Number

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1, one of the reasons I'm really excited to be here and the fact that

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we have November's lung cancer awareness month. And I see that you're wearing turquoise

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Yes. And you have the white ribbon, not the pink ribbon, the white ribbon. That

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is lung cancer awareness. Yes. That is correct. So the the big

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issue about lung cancer is the lack of awareness by,

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many people about the burden of lung cancer, the

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risk factors an individual may have for lung cancer. So knowledge is power.

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Yes, always. Knowing that lung cancer is the leading cause

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of death and that it can be cured if detected early

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and ways to know if you're at risk is key. So some of the

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risk factors for lung cancer are basically some things that are out of our

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control. Okay. The number one cause of lung

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cancer is in our control largely, which is smoking.

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Tobacco use is the number one cause of lung cancer, but the second

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leading cause of lung cancer is environmental exposure to radon.

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Oh. Radon. Where do you find radon? Where does that happen? Radon

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is radon is everywhere to some

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degree. It is the breakdown of

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uranium in the soil and it is

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prevalent in certain areas more than others. Interesting.

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You own it's odorless, it's colorless, and you have no

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idea if you're breathing radon, unless you actually check

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your home for radon. Radon concentrations are higher in

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certain areas of our state, such as where I'm from, the northwestern corner of the

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state. Wonderful. But really in throughout the southeast is a high area of

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radon, exposure. The important part is smoking being the number

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one risk factor,

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But if you smoke and you have radon in your home, it

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actually is tenfold risk. Wow. The other thing to

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consider is if your home has radon and you

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smoke, you're actually putting other members of your family at risk, especially

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children. So there is an increased lifetime risk of lung

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cancer in a child exposed to secondhand smoke and

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exposed to radon. Well, I mean, I grew up in the

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eighties in the south. Yes. Yes. So, yeah, I I

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had a lot of secondhand smoke in my day. Yes. So, but, I mean, like,

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I don't smoke it as an as an adult, so I'm assuming that's gonna help

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me out. Absolutely. Okay. So one of the,

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complicated factors factors about talking about lung cancer screening is at present time,

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we have guidelines for screening for lung cancer. But right

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now, our main focus is on the highest

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risk individuals, which are individuals who have smoked during their

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lifetime. So over a decade ago, we had clear cut

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guidelines of the individuals that are high risk, the screening that's

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recommended, and unfortunately, the uptake of that

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screening is very very low. So while radon exposure is

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a risk factor, your genetics are a risk factor and your behaviors are

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a risk factor, the most controllable risk factor is smoking.

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Okay. So, I wanna make sure those people who do

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smoke, not secondhand smoke, but those people who have smoked in their

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lifetime or do smoke understand what their risk may be and if they need

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to get screened. And so so basically, by doing that, you would, you would

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just go to your doctor and say, I used to smoke in college, you know,

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not all the time, but sometimes I might be talking about myself. You know?

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Yes. Like if I was at a party, I'd be known to have a cigarette,

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so I should tell my doctor this. Well, it's that's important. Absolutely.

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But we have clear cut guidelines and it's very simple.

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The number is something called 20 pack years and you may I

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may want to talk to you about pack years. Yeah. What is a pack year?

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So obviously We had one last year with NC State. It was quite the pack

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year. It was a great pack year. And this is a whole different pack

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year. Okay. But, and we hope we have another great Oh, heck yeah. Wolf

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pack year. Anyway, sorry. Back to our topic. But our topic, tobacco

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so with many things, it's it's the dose

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of your exposure. For instance, radon. I mentioned radon exposure.

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Sure. If you have a high radon exposure, which is over a measure of

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4 picocuries, then you should have your

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home mitigated, the radon exposure lowered.

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So if you if you wanna know more about that, there's certainly

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websites available. Okay. So one can figure out how to test their home, who

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to go to test their home Okay. To lower that risk. However, we don't

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include radon exposure in our risk factor

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calculation because it is a risk factor, but we have to really

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focus on the highest risk individuals on screening. It's also very difficult to measure. Like,

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if you you can't go to every single patient's house and measure their radon. Yeah.

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They have to do that. Yeah. That takes But also, we have to talk about

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where schools Yeah. Where do you work? Yeah. So we there are

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policies pushing forward trying to get schools tested. So I hope so. That would be

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important. Yeah. We don't we don't really have that. But the individual factor, the most

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important risk factor is a 20 pack year smoking history. And

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I know a lot of your interest is on women's health. Yes, of course. And

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of course, me as a woman and a female physician taking care of many

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women. I, will point out the reason we have the

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guideline, which I'll explain called 20 pack years, is

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that women and actually black individuals are

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at higher risk of lung cancer at a lower exposure.

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Meaning, our previous guidelines over a decade ago

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said that you needed to have, 30 pack years.

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30 pack years and that's basically smoking a pack of

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cigarettes per day for 30 years or

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2 packs of cigarettes a day for 15. Gotcha. Simple math.

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Gotcha. But if you've exposed your lungs to the carcinogens in

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tobacco, in cigarette smoke, if you had exposed your lungs

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to those cancer causing chemicals Uh-huh. To that degree, you were at much

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greater risk. Well, studies were done looking at

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different populations and it turned out that in women and blacks,

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it was much lower risk. We were missing those individuals. So now the

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risk factor is 20. If you smoked a pack of cigarettes a day for

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20 years, say you started in college Yeah. But then you stopped when you were

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40. It's 20 years. 20 years. I know 20 years creeps up on you. It

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does. So it did. It has for me. I don't know about you, but it

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has for me. Oh my gosh. Yeah. So, now

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there are different guidelines, and that's where the

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importance of going to your doctor and discussing it.

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And also, my importance as a physician who's an advocate for cancer screenings,

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can point out. The US Preventive Services Task Force

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says, that if you have stopped smoking more than 15 years

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ago, that you don't need screening. Oh, and you don't believe

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that? Well, no. Yeah. You don't believe that. The

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American Cancer Society came out with new guidelines last year in

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November, November 1st, and it said, based

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upon clear, observational

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studies and information that we can see in the past,

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even though it is good to quit smoking, and even though your risk goes down

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over time, it doesn't go away. Yeah. And individuals,

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even after 15 years, as they age, still have

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elevated risk. Mhmm. So I really now,

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in for importantly, your insurance companies and the payers,

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they are pretty much bound to follow USPSTF

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guidelines. Who is that? That's the in the US Preventive

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Services Task Force. Gotcha. And they make the guide they make the guideline of if

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you've quit smoking 15 years, you don't your risk has gone

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down and you don't need screening. What is probably gonna happen, I

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think, in the next few years Mhmm. Will be this

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agreement. I'm I'm hopeful there'll be an agreement. Okay. And an individual can be an

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advocate. You know, you can say to your doctor, well, well, I understand that my

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insurance may not cover this because I quit smoking 20 years ago,

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but if you think I'm at risk, how much does that cost me? Yeah. And

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how do I get screened? Yeah. Like, you may wanna know. Well, we need yeah.

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We're gonna get to that for sure. That is made me think of the adage

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that I learned a long time ago that you will pay for what you did

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in your twenties when you're in your fifties. Yes. Yes. Yes. I were my family,

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doctor when I was growing up, I joined him in practice when I went back

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home, and he used to say to his patients, you know, those

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first 40 years are pretty easy, but those last 40 years take work. So we

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do and I love that part of of I love that adage. I love that.

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I I actually take care of a lot of patients over 40. Yeah. A lot

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of people in their twenties thirties as well, but but I find that individuals in

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their forties fifties start really seeing Looking the

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you know, wanting to be active and be healthy and be well in

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their seventies Yeah. So they can travel after they retire Exactly.

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And really start becoming more aware. Interestingly enough,

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this is one of the really important reasons we need to advocate

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for limiting tobacco exposure to our youth Yes. And

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limiting, you know, vaping with our youth. That was my next question. Yes. So you're

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mentioning the chemicals in tobacco smoke. Yes. Does that include

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vaping? Because I've heard of this thing called popcorn lung. Yes.

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Yes. I know it's kinda 2 questions in 1. So 2 in 1.

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So one thing I'll I'll point out to, like, any health care professionals listening

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or patients that are interested, some people smoke cigars, they smoke cigarillos,

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they don't smoke cigarettes. They smoke marijuana.

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But there are ways of looking at someone's cigarette use

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and their cigar use and figuring that exposure. Now when you talk

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about vaping, we

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don't know the long term implications of

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vaping. And the other thing that's really concerning, I've had some patients of

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mine that are trying to quit smoking, and very wisely,

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they say, I have friends who transitioned to

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vaping. I've had people tell me that their doctors have told them.

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Early in the days of vaping. It was early on that they said that vaping

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is safer, and they just took that and ran with it. Well, there

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are an incredible number of toxins and carcinogens

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in a cigarette. Like, the first time in training that I

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saw the graph of the number of carcinogens in a cigarette, and I'm remembering my

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tobacco farm I grew up on and my dad raised tobacco. Right. And it didn't

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look so dangerous out in the field. Sticky, leafy plant. Yeah. It's not so bad.

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Well, it's not so bad, but all of the chemicals that go into

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either, you know, there's pesticides in raising the tobacco, but then in the process

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and what happens to form that cigarette, there's a lot of carcinogens. So they they

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pack a lot of carcinogens in that little tiny thing. So that's the real,

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one of the real risks. But as far as vaping, especially

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whatever materials they're using in that vape pen, we know

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that some of those materials, especially certain flavors, certain

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additives, they're not supposed to be in your lungs. Yeah. These

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chemicals were never meant to be in your lungs. Taste them.

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Yes. So they're meant to be tasted, not inhaled. Yes. So inhaling these

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chemicals, the long term implications are something we're

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gonna find out about. And the other factor, some of my patients who wanna quit

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smoking say, you know, I don't wanna transition to vaping because

236
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I've noticed my friends actually vape a lot

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more than they used to smoke because they can vape in

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places that don't allow smoking. That's true. So you actually

239
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get a higher, tendency to become addicted to nicotine. If

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you're vaping like a nicotine product, you're using it more. Interesting. And

241
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nicotine is very addictive. Yeah. It is. And, you know, just like, I mean, that

242
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makes me think of the whole semaglutide Ozempic thing. It's so new. We're

243
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looking we're waiting on the long term. So everyone who's doing it now,

244
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vaping included, you're basically a guinea pig. Yeah.

245
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Well, we do know, I mean, from popcorn lung and you've mentioned I mean, it

246
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popcorn lung? Lung? Popcorn lung, I I the the lung on an x-ray

247
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looks like popcorn is my, you know,

248
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remembrance. Holes in it? It just is scarred and it looks abnormal,

249
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which gets around to imaging. Like, you you know, we talked about if you go

250
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to your physician, you're coughing up blood, you know, we first start

251
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often with an x-ray. Okay. But unfortunately, chest

252
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x rays, while they might show popcorn lung and they might show pneumonia, they

253
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often miss cancer. And I can remember back in the early 2000s

254
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when I was back practicing in my hometown, there was a

255
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huge study, you know, going on looking at a better way to look

256
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for lung cancer. Okay. And many institutions in our state were involved in that work.

257
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Low dose CT. Low dose CT scans are the

258
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way we find early lung nodules and things that are

259
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going to turn into cancer or maybe cancer. What is a CT scan?

260
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Ah, CT. Like the CAT scan. You hear people talking about a CAT scan. So

261
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is that different than an MRI? Yes. Okay. And an MRI is the tube.

262
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Well, you lay on a table. The MRI is the tube that's very

263
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closely, like, you're very close. To get to get to get to get to get

264
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to get to get to get to get to get to get to get to

265
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that. So, CT stands for,

266
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basically computed tomography.

267
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Okay. It's a way of looking at your body, kinda slicing it up into pieces

268
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and looking at the pieces as an x-ray. Gotcha. So you can and you can

269
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have thin slices, you can have thick slices. Interesting. Okay. And a low dose CT

270
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means that there's less radiation involved. That's wonderful. Right? So basically, the risk

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the risk of I mean, there's risk from radiation. Of course. Of course.

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And the if you went for a CT scan every

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year, every single year, regular dose CT, you actually can increase your

274
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risk of cancer Right. Because of the radiation exposure. So that's a

275
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concern. So the low dose CT is basically equivalent

276
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to getting on an airplane in North Carolina and flying to California,

277
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that amount of radiation exposure. So you can do these low dose

278
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CTs annually for many years and not feel

279
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like you're providing necessarily an increased risk of cancer.

280
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Gotcha. We actually have that information. We I

281
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would talk to my patients about that. If you enroll in this program, we're

282
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monitoring you every year over a certain amount of time. There is some

283
00:17:29.990 --> 00:17:33.830
increased risk, but it's very low and the benefits of fighting cancer

284
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early most of my patients The benefits outweigh the risk in most cases.

285
00:17:37.270 --> 00:17:41.005
Exactly. And there is a shared decision making. I mean, with everything you do

286
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with your primary care physician or healthcare provider, there needs to be

287
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shared decision making. Am I at risk for lung cancer? How do we

288
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screen for that? And if you find cancer

289
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or a precancerous appearing nodule, is the patient

290
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healthy enough to undergo biopsy and treatment and will

291
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they go through biopsy and treatment? It's a lot of factors to factor

292
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in. That's why you need a physician, a primary care physician to go through this.

293
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And our pulmonologists are wonderful and our CT surgeons here at WakeMed are wonderful,

294
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and they all have the skills to also do that. Mhmm. But they generally

295
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see patients after the diagnosis. You're not going to a pulmonologist to find out

296
00:18:18.270 --> 00:18:22.020
if you're at risk. Right. You're going your fam your medical Medical provider. Yeah.

297
00:18:22.020 --> 00:18:25.700
Exactly. We'll be right back because you know I have more

298
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questions.

299
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So how often are non smokers diagnosed percentage

300
00:18:35.955 --> 00:18:39.795
wise? Exactly. Well, of course, there's 2 different kinds of

301
00:18:39.795 --> 00:18:43.235
lung cancer. There's small cell lung cancer, which more

302
00:18:43.235 --> 00:18:46.835
associated with smoking Okay. And there's non small cell lung cancer, which

303
00:18:46.835 --> 00:18:50.570
often people hear about, like, adenocarcinoma. That is

304
00:18:50.570 --> 00:18:54.330
the most common type of lung cancer. Non small cell lung

305
00:18:54.330 --> 00:18:58.090
cancer is about 75 to 80% of cancers. It's

306
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less aggressive. Good. It metastasizes and

307
00:19:01.450 --> 00:19:05.075
grows slower. Mhmm. So that's wonderful. Mhmm. If we

308
00:19:05.075 --> 00:19:08.915
find it early, it's often curative and and it's it it has a better

309
00:19:08.915 --> 00:19:12.275
prognosis. Okay. Small cell lung cancer is about

310
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20% of lung cancer. So there's 2 different kind. Small cell lung

311
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cancer is more aggressive. Okay. It's more associated with smoking.

312
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Okay. But those are the 2 different types. Okay. Okay.

313
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And your question was My question was is how

314
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often is a nonsmoker being diagnosed in general? So generally speaking,

315
00:19:31.040 --> 00:19:34.514
80%, even maybe in some studies up to 90%, but at least

316
00:19:34.514 --> 00:19:38.294
80% of lung cancer is associated with smoking. Wow. That's a big percentage.

317
00:19:38.355 --> 00:19:42.054
Yeah. That's why that's your number one risk. Yeah. 20% of cancers

318
00:19:42.595 --> 00:19:45.975
and unfortunately, this may be growing, but 20% of cancers

319
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are not associated with smoking. Other factors,

320
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the main one being radon exposure. I just think that's so crazy that something

321
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that we have, we can't even notice. Like

322
00:19:57.830 --> 00:20:00.470
you need to take it when you're house shopping basically. Get your radon to get

323
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rid of it. Number 1, in North Carolina, actually, our,

324
00:20:04.135 --> 00:20:07.435
we advocated in the state of North Carolina and the real estate,

325
00:20:08.455 --> 00:20:11.975
organization in North Carolina, to be a real estate agent in North

326
00:20:11.975 --> 00:20:15.655
Carolina, you must be trained on radon, the importance of

327
00:20:15.655 --> 00:20:19.360
radon, and you have to talk with your home

328
00:20:19.360 --> 00:20:22.960
buyers have to know, are supposed to know the amount of radon in the home

329
00:20:22.960 --> 00:20:26.640
they're going to buy. You can ask for that information. Did not

330
00:20:26.640 --> 00:20:30.320
know that. And if it is high, you can ask the owner

331
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to put it in a mitigation system, which is basically fans.

332
00:20:34.065 --> 00:20:37.505
Fans that you are installed so that this gas, this

333
00:20:37.505 --> 00:20:41.105
odorless gas is pushed out from under the foundation. It

334
00:20:41.105 --> 00:20:44.945
basically comes up from the ground, water, and and and soil, and

335
00:20:44.945 --> 00:20:47.904
it gets into your home through cracks in the foundation. Oh my god.

336
00:20:48.304 --> 00:20:52.020
So You've got me wanting to get a detector for my house. How

337
00:20:52.020 --> 00:20:55.380
much radon is here? No. I mean, I don't know. You don't know. Well, you

338
00:20:55.380 --> 00:20:58.020
need to do that. We actually some people you can buy them at your hardware

339
00:20:58.020 --> 00:21:01.700
store. You can get them from your health department. You can check

340
00:21:01.700 --> 00:21:05.335
for 24 hours. You can check for a month. There's actually a

341
00:21:05.335 --> 00:21:08.295
company here in Raleigh, they'll come out to your house and check for you and

342
00:21:08.295 --> 00:21:11.815
if you're high, they can put you in touch with people. You really want a

343
00:21:11.815 --> 00:21:15.335
reputable person to do the mitigation. Yeah. Of course. Yeah.

344
00:21:15.575 --> 00:21:19.255
Okay. So So there you go. Lung cancer's number 1. Radon

345
00:21:19.255 --> 00:21:22.980
and genetic factors are also a risk. And then

346
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occupational exposure. Oh my goodness. Firefighters,

347
00:21:26.720 --> 00:21:30.420
individuals who work in construction. Airline people, it sounds like. Yeah. Asbestos

348
00:21:30.720 --> 00:21:34.320
exposure. There are other factors that are important to

349
00:21:34.320 --> 00:21:38.135
consider. Okay. Mhmm. And can you can you do your own

350
00:21:38.135 --> 00:21:41.815
mitigation in terms of lung cancer? Like, is diet

351
00:21:41.975 --> 00:21:45.735
how does how does diet and exercise affect your chances? Yeah. Well,

352
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you know, diet and exercise actually

353
00:21:49.495 --> 00:21:52.710
are critically important for reducing the incidence of

354
00:21:52.870 --> 00:21:56.649
basically all cancers Yeah. Cardiovascular disease and dementia.

355
00:21:56.789 --> 00:21:59.590
So It's just good for you. It's just good for you. So I spend a

356
00:21:59.590 --> 00:22:03.190
lot of time talking with patients about diet and exercise Sure. And lowering

357
00:22:03.190 --> 00:22:06.595
stress because all of these factors can play in.

358
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The number one thing that a person can do though is, radon

359
00:22:10.895 --> 00:22:14.735
mitigation, avoiding tobacco use, stopping smoking if you smoke as far as

360
00:22:14.735 --> 00:22:18.340
lung cancer. Also, knowing your family history. We

361
00:22:18.340 --> 00:22:21.879
don't count family history in the specific calculation.

362
00:22:22.259 --> 00:22:26.100
Well, I'm saying the insurance companies don't count it. Well, who's gonna

363
00:22:26.100 --> 00:22:29.879
pay for it because if you're in America and it can destroy you. Yeah. Insurance

364
00:22:30.019 --> 00:22:33.799
companies will pay for your CT if you meet the,

365
00:22:34.235 --> 00:22:37.115
you are over the age of 50. We didn't get to that. It's 20 pack

366
00:22:37.115 --> 00:22:40.955
years and between the ages of 5080. Those are the

367
00:22:40.955 --> 00:22:44.635
basic requirements for your insurance. I see. Medicare, Medicaid. They

368
00:22:44.635 --> 00:22:48.075
will pay for an annual low dose CT if you're over the age of

369
00:22:48.075 --> 00:22:51.799
50 and under the age of 80 Okay. And if you've smoked

370
00:22:51.799 --> 00:22:55.559
at least 20 pack years and currently it still has that 15

371
00:22:55.559 --> 00:22:59.179
years since quit. Okay. That's the insurance.

372
00:22:59.320 --> 00:23:02.779
But I was gonna say, if you want to pay for it yourself,

373
00:23:03.225 --> 00:23:06.845
there are many, many imaging facilities here in Wake County

374
00:23:07.145 --> 00:23:10.105
that you can just go in. Well, your doctor would have to order it. Okay.

375
00:23:10.265 --> 00:23:13.945
But your doctor can say, well, Sarah, if you think because, you know, these

376
00:23:13.945 --> 00:23:17.625
members of your family and your radon and, you know, x, y, and z Just

377
00:23:17.625 --> 00:23:20.430
want some peace of mind. You you and your doctor may say no, Sarah. You

378
00:23:20.430 --> 00:23:24.030
have nothing to worry about, like smoking in college, you know, but if they looked

379
00:23:24.030 --> 00:23:27.870
at all the factors and you had a a decision, but that again is

380
00:23:27.870 --> 00:23:31.330
just someone that I talk about, you know, we're talking more and more about personalized

381
00:23:31.470 --> 00:23:35.205
medicine and precision medicine. Which I'm very excited about because we are all

382
00:23:35.205 --> 00:23:38.965
so very different. Yeah. So I think it's more of a conversation, but the

383
00:23:38.965 --> 00:23:42.805
real important push for the American Cancer Society and and

384
00:23:42.805 --> 00:23:46.425
all the organizations I work with and as a healthcare provider

385
00:23:46.965 --> 00:23:50.730
is the age 50 to 80, 20 pack years and

386
00:23:50.730 --> 00:23:54.490
I do wanna emphasize that it's important for a patient to know

387
00:23:54.490 --> 00:23:58.250
their family history, but to also understand their smoking history. Yeah.

388
00:23:58.250 --> 00:24:01.955
And when they talk to their healthcare professional that they say, well, you know,

389
00:24:01.955 --> 00:24:05.395
I'm only smoking a half a pack a day now because if you go into

390
00:24:05.395 --> 00:24:08.995
my office and you tell my staff, well, I've been smoking since I

391
00:24:08.995 --> 00:24:12.835
was 20 and I smoke a half a pack a day and say you're

392
00:24:12.835 --> 00:24:16.640
45, you know, or 40, they're gonna look at that and they're

393
00:24:16.640 --> 00:24:19.460
go, okay, 20 years, half a pack, 10 pack years.

394
00:24:20.160 --> 00:24:23.840
Well, be honest. Well, in your twenties to thirties, if you were

395
00:24:23.840 --> 00:24:27.280
smoking a pack and a half, you actually met the

396
00:24:27.280 --> 00:24:30.985
criteria. This is being this is throughout all of our health

397
00:24:30.985 --> 00:24:33.885
care systems. Yeah. We have trouble as your physicians

398
00:24:34.585 --> 00:24:38.425
getting that information. Well, because there's shame attached to it. Yes. We

399
00:24:38.745 --> 00:24:42.205
so we try to use words now instead of you're a smoker.

400
00:24:42.649 --> 00:24:46.409
We try to say person who smoked or a person who

401
00:24:46.409 --> 00:24:49.130
smoked. No? Oh, because I guess it wouldn't matter if you do that to chew

402
00:24:49.130 --> 00:24:52.809
and stuff. Well, that's more oral cancers. Yeah. But person who

403
00:24:52.809 --> 00:24:56.570
smokes, means you smoke, but that doesn't

404
00:24:56.570 --> 00:25:00.245
define you, if that makes sense. That makes absolute sense. You're not you're

405
00:25:00.245 --> 00:25:03.285
not a smoker. You're a person. You're a person who smokes. And so it's not

406
00:25:03.285 --> 00:25:06.725
your identity. Yes. And I do think there's number 1, there's a lot of fear

407
00:25:06.725 --> 00:25:10.565
about lung cancer. Yes. Because people think it's a death sentence. And it's not

408
00:25:10.565 --> 00:25:14.059
if you have the non small cell. Well, it is it is well, the non

409
00:25:14.059 --> 00:25:17.899
small cell chances. Non small cell is less aggressive, but the point is

410
00:25:17.899 --> 00:25:21.740
if you catch either non small cell or small cell cancer at early

411
00:25:21.740 --> 00:25:25.365
stage and we can talk a little bit about that, stage 1

412
00:25:25.365 --> 00:25:29.205
cancers are curable. Curable with,

413
00:25:29.205 --> 00:25:33.045
you know, seeing our lung cancer surgeons, you know, seeing our specialists and you can

414
00:25:33.045 --> 00:25:36.645
remove the cancer and you can be cured. We talk a lot

415
00:25:36.645 --> 00:25:40.450
about breast cancer screening, colorectal cancer screening, which is a law in it

416
00:25:40.450 --> 00:25:43.570
that I have you know, we spend so much time working on those. Very important.

417
00:25:43.570 --> 00:25:47.010
Yes. Very important. Our our breast cancer screening rates in the

418
00:25:47.010 --> 00:25:50.690
country, our colorectal cancer screening rates in the country are like

419
00:25:50.690 --> 00:25:54.375
75 to 80%. Now they should be a 100% for everyone. But still better than

420
00:25:54.455 --> 00:25:58.135
lung cancer. So our survival at 5 years for breast cancer and

421
00:25:58.135 --> 00:26:01.835
colorectal cancer is up in the 75 to 80%. Fabulous.

422
00:26:02.295 --> 00:26:06.135
Our screening rates in the country and in North Carolina for lung cancer screening of

423
00:26:06.135 --> 00:26:09.275
the at risk population is around 8 to 14%

424
00:26:10.309 --> 00:26:14.070
and the risk of that being the risk the likelihood of

425
00:26:14.070 --> 00:26:17.510
you still being alive once you've had a lung cancer

426
00:26:17.510 --> 00:26:21.350
diagnosis currently because of the lack of knowledge

427
00:26:21.350 --> 00:26:24.950
and awareness about screening Sure. And, like, catching it early matters. Catching it early

428
00:26:24.950 --> 00:26:28.715
matters, is the mortality is basically like 26 percent Oh,

429
00:26:28.715 --> 00:26:32.475
wow. At 5 years. But if you catch it at stage 1, the

430
00:26:32.475 --> 00:26:35.695
mortality is maybe like, you know, your survival is probably

431
00:26:36.075 --> 00:26:39.760
70 to 90%. Okay. Yeah. You can get your

432
00:26:39.760 --> 00:26:43.600
early lung cancer diagnosed, get a lung resection and be back on the

433
00:26:43.600 --> 00:26:47.060
golf course in a week and that's straight from one of my colleagues,

434
00:26:47.120 --> 00:26:50.880
Doctor. Alden Mayer here at WakeMed. She did that? She,

435
00:26:50.880 --> 00:26:54.405
she's amazing. She's our, yeah, she is, we have

436
00:26:54.405 --> 00:26:57.845
wonderful lung cancer screening team, and and, you know,

437
00:26:57.845 --> 00:27:01.685
they really advocate for primary care physicians to talk to

438
00:27:01.685 --> 00:27:04.985
their patients, patients to bring up the question. But we all know,

439
00:27:06.350 --> 00:27:10.130
visits are rushed. There's a lot to cover. What I was getting ready to say.

440
00:27:10.190 --> 00:27:13.950
There's a lot to get in there. Everybody's talking fast. Go. Go. Yeah. So this

441
00:27:13.950 --> 00:27:17.550
is why that annual wellness visit with your health care

442
00:27:17.550 --> 00:27:21.245
professional get a long period of time and you just talk about yourself. You know,

443
00:27:21.245 --> 00:27:25.085
longer in our in our long in

444
00:27:25.085 --> 00:27:28.765
the current framework of medicine is 30 minutes. But, you know, you

445
00:27:28.765 --> 00:27:32.205
know, instead of that 15 minute visit, you get that 30 minute visit. But what

446
00:27:32.205 --> 00:27:35.860
what what many people do with that wellness visit is they bring

447
00:27:35.860 --> 00:27:39.700
up 3 or 4 problems that they've been holding on

448
00:27:39.700 --> 00:27:43.080
to. Yes. I'm guilty. Well, see, that's the problem.

449
00:27:43.539 --> 00:27:47.225
Some of my patients will come in and they go, well, you know, for the

450
00:27:47.225 --> 00:27:50.265
last 4 months, I've had this, and for a year, I've had that, and then

451
00:27:50.265 --> 00:27:53.785
this rash came up, and can we go through that today? Okay. And what I

452
00:27:53.785 --> 00:27:57.305
usually say is, well, we're gonna it's gonna cut into the

453
00:27:57.305 --> 00:28:01.065
prevention part of our time together. Yeah. So I tell patients, don't hold

454
00:28:01.065 --> 00:28:04.320
them off or just ask as you go. Well, just come in. Yeah. Come in

455
00:28:04.320 --> 00:28:07.600
and see us if you have a problem, and then devote that 30 minutes or

456
00:28:07.600 --> 00:28:11.060
40 Mhmm. To all of these things. Okay. Yeah. Well,

457
00:28:12.080 --> 00:28:15.060
real quickly, why are blacks more susceptible?

458
00:28:15.825 --> 00:28:19.365
So there's a lot of issues to consider. We feel like there's,

459
00:28:20.145 --> 00:28:23.585
you know, the inequities for lung cancer are pretty

460
00:28:23.585 --> 00:28:27.345
profound. Basically, whereas white

461
00:28:27.345 --> 00:28:30.929
men are more likely to have breast have lung cancer, black

462
00:28:30.929 --> 00:28:34.690
men are more likely to die of lung cancer. So some of it is

463
00:28:34.690 --> 00:28:38.470
access. Yeah, of course. You know, access to care, social determinants

464
00:28:38.529 --> 00:28:41.830
of health, they're probably genetic factors where less tobacco

465
00:28:41.970 --> 00:28:45.345
exposure leads to more likelihood of developing

466
00:28:45.345 --> 00:28:48.965
cancer, but right now, if you look in North Carolina data,

467
00:28:49.825 --> 00:28:53.605
you can evaluate what's the likelihood of being diagnosed early.

468
00:28:54.385 --> 00:28:57.809
You know, you're more likely, if you're black, to be diagnosed at a later time.

469
00:28:57.809 --> 00:29:01.330
It may be because of not having access to care, maybe not

470
00:29:01.330 --> 00:29:04.930
asking the right questions, maybe not realizing that a lower PAC year

471
00:29:04.930 --> 00:29:08.309
history is a risk factor for you. So

472
00:29:08.655 --> 00:29:12.255
we're working on that and also in North Carolina, it turns out

473
00:29:12.255 --> 00:29:15.855
that our Native American population, they really have a

474
00:29:15.855 --> 00:29:19.535
higher incidence of, lung cancer and there's a lot of research going

475
00:29:19.535 --> 00:29:23.050
on to try to make sure access is improved, Yeah.

476
00:29:23.050 --> 00:29:26.890
Awareness campaigns. So socioeconomic things. Socioeconomic. You know,

477
00:29:26.890 --> 00:29:30.730
20% of a person's, health is defined by the time I spend with them

478
00:29:30.730 --> 00:29:34.410
in the exam room and the medicines we prescribe. 80% of it is their

479
00:29:34.410 --> 00:29:36.308
habits, their genetics, and their environment. Okay. So November's a month that's really important because

480
00:29:36.308 --> 00:29:39.635
there's a lot of social media important because

481
00:29:39.835 --> 00:29:41.958
there's a lot of social media campaigns, there's a lot of outreach. People may say,

482
00:29:41.958 --> 00:29:43.395
how do I access these services? How do I find a place to get a

483
00:29:43.395 --> 00:29:46.835
low dose CT? Yeah. And WakeMed has a

484
00:29:46.835 --> 00:29:47.895
wonderful, wonderful,

485
00:29:54.160 --> 00:29:57.520
lung cancer screening program. Okay. They get referrals from all

486
00:29:57.520 --> 00:30:01.280
over. You know, I think that and I work with the, you

487
00:30:01.280 --> 00:30:04.640
know, the advisory committee for cancer coordination control for the

488
00:30:04.640 --> 00:30:08.465
state and we do a lot of outreach with federally qualified health

489
00:30:08.465 --> 00:30:12.305
centers, health departments, regional areas. So just because you're

490
00:30:12.305 --> 00:30:16.085
rural North Carolina, there are resources. You can get resources.

491
00:30:16.145 --> 00:30:19.825
It's about knowing who to ask, where to go, and that

492
00:30:19.825 --> 00:30:23.160
there is a need. Okay. And I have one last Sure. Short question.

493
00:30:23.960 --> 00:30:27.080
You mentioned that tobacco use is the number one thing you need to to cut

494
00:30:27.080 --> 00:30:30.440
out, right, because of all the stuff put in there. Does that mean that if

495
00:30:30.440 --> 00:30:34.120
you smoke, quote, unquote, natural cigarettes, the ones that are, like, just

496
00:30:34.120 --> 00:30:37.934
straight up tobacco in the packs? Because I know someone's gonna want me to ask

497
00:30:37.934 --> 00:30:41.375
this question. Oh, it's a good question. Know the answer that if if that's gonna

498
00:30:41.375 --> 00:30:45.215
lower your risk at all? Well, I don't know the answer. Okay. That's

499
00:30:45.215 --> 00:30:49.054
good to know. That's a good question. Fine. I know that in

500
00:30:49.054 --> 00:30:52.514
my reading that it's clear that people who roll their own tobacco

501
00:30:53.100 --> 00:30:56.940
and certainly, well, we do know that people who roll tobacco

502
00:30:56.940 --> 00:31:00.620
for, like, religious ceremonies, there is data showing that there

503
00:31:00.620 --> 00:31:04.160
is less likely likelihood of cancer

504
00:31:04.539 --> 00:31:08.245
thought to be with those. I don't think that reduced risk is none, but it's

505
00:31:08.245 --> 00:31:11.804
certainly less of a risk than your normal cigarettes you go buy over the

506
00:31:11.804 --> 00:31:15.645
counter. Okay, perfect. So I think that the keys I want people to

507
00:31:15.645 --> 00:31:19.404
take home is don't smoke. Don't smoke. If you do smoke, stop.

508
00:31:19.404 --> 00:31:22.269
If you don't start to begin with. Also,

509
00:31:22.889 --> 00:31:26.269
many resources in the state of North Carolina and certainly here at WakeMed

510
00:31:26.490 --> 00:31:28.429
for assistance with cessation.

511
00:31:30.009 --> 00:31:33.309
People have a lot of guilt. Mhmm. Individuals

512
00:31:33.690 --> 00:31:37.002
will say, I can do this. I just have to set my mind to it.

513
00:31:37.002 --> 00:31:39.955
It's not easy sometimes. And I try it easy sometimes. It's not and it's not

514
00:31:39.955 --> 00:31:43.575
something to be shamed about. We have a wonderful,

515
00:31:44.195 --> 00:31:47.955
program here at WakeMed that I try to encourage my patients to go

516
00:31:47.955 --> 00:31:51.575
to talk to. It's basically, in many or many areas have this,

517
00:31:51.950 --> 00:31:55.790
1800 QUIT now is through the state. An individual will work

518
00:31:55.790 --> 00:31:58.510
with you by your phone, you don't have to go anywhere and they'll talk about

519
00:31:58.510 --> 00:32:01.550
it. Make it as easy as possible. They'll talk to you about what are your

520
00:32:01.550 --> 00:32:05.310
triggers, how can we help you when

521
00:32:05.310 --> 00:32:08.934
you have that trigger to smoke. Always smoke after I eat a meal. I always

522
00:32:08.934 --> 00:32:12.535
smoke when I'm out at a party. How do we work with those triggers to

523
00:32:12.535 --> 00:32:16.294
decrease that? I have a patient who only smokes in his car, but

524
00:32:16.294 --> 00:32:19.655
he smokes really fast in his car. Like, you can smoke 3

525
00:32:19.655 --> 00:32:23.030
cigarettes in your car as you drove over here. But, you know,

526
00:32:23.030 --> 00:32:26.390
people will have those triggers. Yeah. But most of the time, they also

527
00:32:26.390 --> 00:32:30.150
have individuals in their lives who love them. And,

528
00:32:30.470 --> 00:32:34.230
the American Cancer Society has this wonderful campaign is I love you get

529
00:32:34.230 --> 00:32:37.705
screened. I love you get screened. And so it's like I love you stop

530
00:32:37.705 --> 00:32:41.305
smoking. Yeah. And and people know that they should quit. Yeah.

531
00:32:41.625 --> 00:32:45.305
But knowledge isn't enough. They need resources. So we have

532
00:32:45.305 --> 00:32:49.065
a smoking cessation program at WakeMed that's very helpful. Okay. These are trained

533
00:32:49.065 --> 00:32:52.480
individuals. Medications help. Most people

534
00:32:52.480 --> 00:32:56.080
can't crack that nicotine habit by themselves. Yeah. But there are

535
00:32:56.080 --> 00:32:59.620
medications like, Chantix and,

536
00:33:00.160 --> 00:33:03.615
you know, nicotine replacement over the counter. But, you know, is there

537
00:33:03.855 --> 00:33:07.215
even as a physician, I would want guidance on Yeah. Of course. The dose, you

538
00:33:07.215 --> 00:33:10.975
know. Of course. We actually have, ways of calculating if

539
00:33:10.975 --> 00:33:14.735
you had a certain amount of cigarette exposure, like you smoke a half a pack,

540
00:33:14.735 --> 00:33:18.415
how much nicotine should you replace it with? Right. There has to be

541
00:33:18.415 --> 00:33:22.039
some Yeah. You don't wanna just take, like, 5 pieces of gum Yeah. And then,

542
00:33:22.039 --> 00:33:25.720
like, keel over from nauseousness. Yeah. That's exactly right. Right. Right. So, you

543
00:33:25.720 --> 00:33:29.240
know, there's a lot to unpack. Lung cancer screening is the most

544
00:33:29.240 --> 00:33:32.835
complicated screening I've ever, dealt with in

545
00:33:32.835 --> 00:33:36.675
my career because there's so many factors to consider. Breast

546
00:33:36.675 --> 00:33:40.515
cancer, it's a woman, she's a certain age, let's screen. Right. This

547
00:33:40.515 --> 00:33:44.135
has this is all about how many, how long. It's so complicated.

548
00:33:44.355 --> 00:33:47.800
It is, but it's not impossible. And the most important thing is to talk to

549
00:33:47.800 --> 00:33:51.240
your physician. Well, I appreciate your time today. This has been I could ask you.

550
00:33:51.240 --> 00:33:54.040
I I literally have a whole another page of questions I didn't have time to

551
00:33:54.040 --> 00:33:56.520
get to. Oh gosh. So that means we have to have you back. That'd be

552
00:33:56.520 --> 00:34:00.325
great. Radon, pack years,

553
00:34:00.325 --> 00:34:04.085
who knew? I'm off to order some radon testing kits

554
00:34:04.085 --> 00:34:07.925
from my house right now. Doctor Vicki Fowler was my guest today,

555
00:34:07.925 --> 00:34:11.280
and you can find her at wake med.org. We'll link to some of the things

556
00:34:11.280 --> 00:34:14.960
she mentioned in the show notes, including a link to WakeMed's smoking

557
00:34:14.960 --> 00:34:18.560
cessation program. It's virtual, so you don't have to live here in Raleigh to do

558
00:34:18.560 --> 00:34:21.760
it. Speaking of links, we'd love it if you shared the link to this episode

559
00:34:21.760 --> 00:34:24.960
with a friend. Just hit the share button and pass it along. See you next

560
00:34:24.960 --> 00:34:25.460
time.