1. Joseph J. Muscato, MD, FACP Medical Director Stewart Cancer Center, Boone Hospital

2. There will be 240,000 new cases of lung cancer in the U.S. in 2014. There will be 160,000 deaths due to lung cancer (vs. 40,000 from breast cancer). The leading cause is smoking, although 15% of lung cancers occur in non-smokers.

3. The average smoker will die between the ages of 40-79. Ultimately, almost 20% of smokers will get lung cancer. Most lung cancers are found in a more advanced stage where cure rates are low or zero. They are not symptomatic in early stages, the most curable stages.

5. There is only one known way to prevent lung cancer, and that is to not smoke. Second-hand smoke should be avoided. Therefore we would suspect benefit from laws against smoking in restaurants. Rare causes: Radon gas, uranium, asbestos.

10. The only current way to reliably cure lung cancer is surgery on small cancers. (Even then, the cure rate is only 60-70%.) Routine chest X-rays are of no benefit for early detection. Most cancers found on X-ray are not curable. More recently, studies have shown that low- dose CT scans (LDCT) can find some cancers early enough to decrease the death rate.

11. A major problem in lung cancer screening is that we are looking at only one point in time and hoping to see an early cancer. At the same time, a CT will show many tiny nodules that are not cancer. The rules for follow-up of an abnormal CT are complicated.

12. People eligible Current or former smokers aged 55-74 At least 30 pack years history of smoking (a “pack- year” = 1 pack per day for one year) Former smokers had to have quit less then 15 years before (risk falls with time off smoking). They were randomized to get either a CT scan or a chest X-ray yearly for 3 years

13. 292 lung cancers190 lung cancers

15. Depending on the size of the pulmonary nodules different follow-up is indicated. If nodules are small, perhaps another CT at 6 months (this one with IV contrast). If larger, might get a CT sooner, or if getting close to 1 cm in size, a biopsy or bronchoscopy. If a cancer is diagnosed at an early stage then surgery will be the recommended approach.

19. Of those who were still smoking at the time of entrance in the trial, 10% quit smoking at 1 year but 7% of former smokers started again. There was no change in risk perception over time. A negative scan does not appreciably reassure smokers that their risk is lower.

22. This follows the NLST recommendations Current or former smokers 55-74, 30+ pack-year smoking history and quit less than 15 years ago. Current or former smokers 50 or over with 20+ pack-year smoking history and additional risk factors. Yearly low-dose CT yearly x 3 years. If abnormal then repeat CT, PET and/or biopsy depending on CT findings.

24. http://youtu.be/yRCGhpAeoCI

25. Lung cancer is the major cancer killer in the world. More than 1 million people a year die world-wide, and more than 160,000 die in the U.S. Smoking is the huge risk factor. After stopping, the risk decreases over the next 15-20 years, but never back to the level of never-smokers.

26. Prevention (not smoking) is the best approach. For those at risk, early detection and treatment improves survival. Our methods still require screening a large number of patients to find one with treatable lung cancer.

27. The Stewart Cancer Center Lung Screening Program has been carefully developed to deliver the best care for this problem. Coupled with the low-dose CT is a team of radiologists, pulmonary physicians, technicians and a nurse navigator to allow for timely and appropriate evaluation of these patients. If a nodule is found, the Nodule Clinic is ready to aid in the process.

28. If you have any questions, don’t hesitate to call the Nurse Navigator at 573-815-3583.