0:01

Why is this course important

0:02

and what, why it should it be important to you?

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As a radiologist or in radiology practice?

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Lung cancer is the leading cause of cancer death, both

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among men and women in the United States.

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And in fact, in most of the world, most people don't realize

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that it's the leading cause of cancer death in women.

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While there are many risk factors for lung cancer, the one

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that we know the most about is cigarette smoking,

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and that's responsible for about 80% of cases

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of lung cancer, but that means one in five people

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or 20% of people who develop lung cancer

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don't smoke cigarettes or have not in the past.

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And for them, lung cancer screening is

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not currently an option.

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As I mentioned, lung cancer is the leading cause

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of cancer death, and if you look at this graphic,

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you'll see the top bar represents lung cancer.

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If you combine several of the next most common causes

0:55

of cancer death together, they do not represent the totality

0:59

of all the people who die from lung cancer.

1:01

Each year we see lung cancer primarily in white

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and black non-Hispanic individuals,

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but there are also high rates in individuals

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of American Indian, Alaskan

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and native non-Hispanic ideolog backgrounds such as Asian

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and Pacific Islanders

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and Hispanics, unfortunately by population patients in areas

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who are under-resourced

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and underserved have a higher rate of presenting

1:25

with advanced stage cancer.

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Early detection is the key to survival

1:30

through lung cancer screening

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and the management of incidental lung nodules.

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And we're going to focus on lung cancer screening

1:36

as a program of early detection.

1:39

It's the difference between this early stage screen detect

1:42

cancer on the left

1:44

where we have a small discreet lung nodule on the background

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of emphysema in an individual who smokes cigarettes,

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this early stage cancer is treatable

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with a high survival at five to 10 years.

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Late stage cancer when presenting

1:59

with symptoms is often large central mass like

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and is spread to other parts of the body,

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making treatment much more challenging.

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And while late stage lung cancer is more difficult

2:09

to survive, there have been many advances in immunotherapies

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in particular, which are creating survivors at 10 plus years

2:17

for people who are now presenting with late stage cancer.

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So we like to say that lung cancer should no longer be seen

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as a cancer where it's hopeless lung cancer,

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because of early detection

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and advanced treatments that are based on biomarkers

2:31

and immunotherapy, is really changing the lives of people

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who have a lung cancer diagnosis.

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Most commonly we see a patient like this.

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This 55-year-old woman with a 25 pack year history

2:44

of smoking had three months of a non-productive cough,

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and she had left hip pain when she presented for imaging

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and to her physician, the cause of the hip pain was evidence

2:55

and that she had a lytic lesion in the bone surrounding her

2:59

hip joint as well as in her iliac crust.

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She had a large central mass in her lung narrowing her

3:05

bronchus and spread

3:07

of multiple tumors into the opposite lung

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and in the same lung as well as into her liver.

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This is what we're trying to avoid through early detection.

3:17

This is an example

3:18

of screen detected lung cancer in a patient

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who was screened annually for three years.

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This patient has a ground glass nodule,

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a smudgy looking ill-defined nodule

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that's higher density than the background tissue

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through which we can still see the

3:32

normal vascular structures.

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It's mean. Diameter is about 20 millimeters,

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and we can measure nodule volumes

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to get more precise measurements

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of nodule size in three dimension.

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A year later that nodule was unchanged minimally larger

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by 0.5 millimeters

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and minimally larger by volume measurements.

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And then again, at the third annual screen,

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the nodule has minimally changed.

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This is the kind of nodule that if it were to be a cancer,

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would represent a adenocarcinoma in situ, the type of cancer

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that a person can live with

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and does not need to have resected

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to extend their life expectancy.

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This is a very important concept in lung cancer screening

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because not all nodules need to be resected.

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It's appropriate to understand their size, their likelihood

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of growing and their morphology,

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and making assessments of whether we continue

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to follow these nodules over time

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or whether we need to take them out

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because they're likely to become aggressive

4:29

in an individual patient.

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And we'll talk about this more with Lung Reds talk.

4:34

Radiologists and radiology practices play a key central role

4:38

in lung cancer screening.

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Of course, we perform the lung cancer screening tests

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with high quality and low radiation dose,

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but we can be an integral part

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of our lung cancer screening program, ensuring

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that high risk individuals are appropriately screened

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that patients with abnormal screens return for follow-up,

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and that any incidental findings

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that are significant are appropriately managed.

5:00

The 2022 President's cancer panel looked at cancer

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screenings as its primary topic

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and the challenges very important coming off

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of the COVID pandemic

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where many people did not receive their

5:12

preventative health services.

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So in trying to reignite screening across the country,

5:17

focused on this working to improve

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and align communication with patients,

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primary care providers

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and those who deliver screening tests like radiology

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practices, importantly

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to strengthen those workforce collaborations

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to facilitate equitable access.

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As we know that cancers often strike people of limited means

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and in under-resourced areas

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with difficulty in reaching healthcare

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or staying with healthcare,

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and to create effective IT health solutions

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that can help us in this journey of lung cancer screening.

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We'll use the Lung RAD schema for interpretation,

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and this is fundamental Lung RADS is the schema develops

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Specifically around lung cancer screening,

5:59

structured reporting and management,

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whereas we might use other criteria

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for incidentally detected pulmonary nodules such

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as the FLEISCHNER criteria.

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The FLEISCHNER criteria, for example, are used

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to manage a patient with serial cts based on the risk

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of a nodule being cancer

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and then stopping that follow up at a period in time.

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Whereas long RADS is based on screening a person annually

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and applying this schema since as early as 50 years of age,

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up to about 80.