Dr. Madtes: Jack found out that he has no evidence in his lungs to suggest a lung cancer at this point.
What’s that mean? Does he have to come back next year?
Dr. Madtes: Right now the data that we have from the National Lung Screening Trial, which was a large National Cancer Institute Trial, would indicate that annual CT scans are appropriate in this high risk category; again defined by age and tobacco exposure.
Are most institutions doing this or not?
Dr. Madtes: Not yet. Different institutions are beginning to put their programs in place. There are some who have been in place for many years as part of earlier National Cancer Institute Trials, but to have routine CT screening become more available in the community is a work in progress. We at the SCCA are one of the first to offer CT screening here in the Puget Sound area.
As a doctor, is lung cancer frustrating for you because most of it is preventable?
Dr. Madtes: Yes absolutely. Ninety percent of lung cancer cases occur in smokers. The best way to avoid lung cancer is to not smoke or if you’re a smoker to quit smoking.
Are there any of those facts that you don’t think people know? Is there anything you know that if people knew this they would never touch a cigarette?
Dr. Madtes: Yes, a couple of facts. The American Cancer Society this year estimates that the number of new cases of lung cancer in Americans is going to exceed two hundred and twenty five thousand patients. Also in this year, they estimate that there’s going to be more than a hundred and fifty seven thousand lung cancer related deaths. So lung cancer is the biggest cancer killer in the United States. It represents more cancer related deaths than prostate, breast, colorectal and ovarian cancers combined. It is by far the biggest cancer killer. So if we can help people to understand that and help them to stop smoking which to me smoking cessation, quitting smoking is a very important part of the CT Screening Program and part of what we offer here.
Is lung cancer a hard death?
Dr. Madtes: It’s very hard. It’s hard for the patient and for the family. The chemotherapies that are available can be very difficult especially in the older population, which is where lung cancers tend to be more prevalent and diagnosed. It’s extremely difficult.
When you see kids smoking do you just want to smack them?
Dr. Madtes: I want to educate them. You know children see themselves as immortal right. We all did when we were teenagers. So trying to get them over that notion is a very difficult challenge, but I must say we have smoking cessation specialists here at the Seattle Cancer Care Alliance that do a fabulous job in trying to educate patients and family members
One thing that I would say is really important is not only the availability of the CT Screening Program, but having a team of experts in place to deal with the findings of the CT scan. When you think about it, any facility that has a CT scanner can open up a CT Screening Program for higher risk patients for early diagnosis or detection of lung cancer. It’s really about knowing what to do with the findings, the results of the scan, which is so important. So what really needs to be in place is a multi-disciplinary team of lung cancer experts that can look at that CT scan and can interview the patient. Find out what would be the next steps in the care of that individual. Because with CT screening we’re going to detect abnormalities and the issue is having providers with the judgment and the experience to know what to do with those abnormalities so that you don’t put patients in harm’s way for unnecessary procedures. You don’t run up the cost of health care by doing unnecessary procedures. So having that kind of team in place is really important.
Do you have any price comparison of catching a cancer early or catching a cancer late?
Dr. Madtes: That’s a really good question. I’ve seen numbers that are kind of all over the board. My understanding is that if we can detect a lung cancer early and surgically resect it the cost is less than half of what it would be to have someone with advanced stage disease who then goes through combination chemotherapy, radiation therapy and ultimately dies of their disease.
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