 How important is early detection when it comes to lung cancer? Lung cancer is the number one cause of cancer mortality in the United States in 2015. If you were to add up the number of deaths from the next leading causes of cancer mortality, namely breast cancer, colon cancer and prostate cancer, you would add up all those deaths per year. And then take the next two leading causes beyond that. You take the next five leading causes of cancer mortality. You still have more deaths from lung cancer every year. We have mammography for breast cancer. We have colonoscopy for colon cancer. We have PSA screening for prostate cancer. So at the end of the day, most breast cancer, most colon cancer, most prostate cancer is diagnosed in an early and surgically curable stage. We should be screening for lung cancer. We could change the equation that I just described to you in terms of how many people are dying every year from lung cancer as compared to these other common cancers. Is there an effective screening test for the early detection of lung cancer? The effective test is a simple CAT scan. When I say simple, it's simple because the entire test can be done in a single breath hold, 10 to 15 seconds. No bowel preps like we have when we screen for colon cancer. No discomfort, as is often the case with mammography. The test is very simple and easy to do. The other thing about this test is it is more effective in reducing mortality from lung cancer than any of the other screening tests are for reducing their associated mortality. It is the only screening test ever to be shown to reduce overall mortality. In other words, it reduces the cumulative number of deaths in the group that gets screened. That's never been shown for any other screening modality. Breast cancer reduces the number of breast cancer deaths, but it's never been shown to reduce the total number of deaths in a population that is undergoing mammography. Same is true for colonoscopy and PSA testing. So it's the only test that's ever been shown to reduce overall mortality, not just cancer-specific mortality. It has only recently been recognized and the adoption of the screening method has been slow to come to fruition. Don't CT scans expose people to excess radiation? The amount of radiation exposure with these very brief scans, 10-second exposure, is no more than the radiation exposure that a woman experiences when she goes for her annual mammography. It's also less than the excess radiation exposure that one experiences if they live in Colorado as compared to if they would live in New York just by virtue of the altitude difference. So I'm not going to say that there's no radiation exposure, but it's a radiation exposure that is commonly accepted in other situations without a lot of concern. Who should go for a lung cancer screening test? The recommendation for lung cancer screening is restricted to the smoking population. The recommendation is restricted to individuals between the ages of 55 and 78 that have had a recent within 15-year history of smoking 30-pack years. The individual should also be without symptoms if an individual that has all the risk factors but is all of a sudden having chest pain or coughing up blood or having some other symptom, then they're no longer in the screening category. Those individuals should certainly be evaluated, but that's a medical workup for a problem. We're talking about screening, we're talking about asymptomatic individuals. How much does the test cost? Who pays and is it cost effective? The bottom line to the individual who's being screened is that this test costs zero. The Affordability Care Act has a provision in it that if a cancer screening test is proven to be effective as judged by a task force, the U.S. Preventative Services Task Force, then any insurer that participates in ACA, which is essentially every insurer, must offer the test at no cost, no copay, no cost to the individual undergoing the test. What does it mean to be an ACR-designated lung cancer screening center? The ACR designation stands for the American College of Radiology and that's a minimum certification that a screening site should have. It means that the screening CT scan is performed in a technically appropriate fashion, meaning that the amount of radiation exposure that is delivered is kept at the lowest possible level and that the images that are generated are of a high enough quality that we don't fail to make appropriate diagnoses. There are other designations including the lung cancer alliance certification of excellence, which focuses a little bit more on the management that is built into responding to the findings on the scan. And that gets to the fact that once an abnormality is found, a multidisciplinary team of doctors, doctors that do procedures that allow for biopsies in the lung like pulmonary doctors, pulmonologists, doctors that are specially trained in radiology interventions, interventional radiologists and thoracic surgeons all are coordinated in such a way that a diagnosis can be rendered expeditiously and treated efficiently. So that is another designation that is important to recognize in a screening facility. So even though the availability of commercial radiologists that are basically radiologists that are not attached to a hospital and group of doctors can be a wonderful thing for patients in terms of being near their homes or sometimes providing very efficient service, it doesn't always work out to be the best place for lung cancer screening to be performed because the integration of these multidisciplinary doctors is really intrinsic in a healthcare system. And I think it's important that these screening programs be very closely tied to the appropriate clinicians. Can you walk me through the process of getting screened for lung cancer at Winthrop? So it's really pretty simple. We do insist that each patient in the program has a referring physician. We do try to make it very easy for that physician to both refer patients and to know what to do with results. So the referral process is just a prescription. It can be given to the patient and the patient can actually call a phone number and say I have a prescription from my doctor. The doctor can fax the prescription. We take it from there. At that point, we will screen to make sure that the patient is appropriate by the eligibility criteria that we talked about and we will then schedule the test. Once the test is performed, we then have a system in place to communicate at a sophisticated level with the physician and at a very clear and concise way with the patient so that they understand that the test is either negative, which is the most common finding, but the second most common finding that the test is not fully negative but doesn't mean that you have cancer. And that's something that needs to be communicated in a clear manner so that we don't create unnecessary anxiety over this test. And of course, in the very small minority where an individual is found to have something that does look like a cancer, we have a system in place so that our multidisciplinary team can get involved right off the bat and make it very easy for the referring doctor to utilize the expertise within our institution. What makes Wind Drop's lung screening program different from others? Well, you know, there are a lot of things that make us different. We have so many people that have been integral to this process. We really championed this program at a time when it wasn't a very popular thing to do. We have screening coordinators. We have diagnostic radiologists who worked on this for nothing but the goodwill and benefits that they recognized would come to their patients. So that's what kind of goes behind the program and makes it special is the people that have championed it. Beyond that, we have this rapport within the group so that patients get total service here. The glue to this program is the interactivity between the different disciplines, the different doctors in different specialties, but also the different levels of healthcare workers that we have, the nurses, the radiology technicians, coordinators, people that are involved in our smoking cessation program. So I think that's what really makes it special and in a lot of respects is something that couldn't be done outside of a comprehensive medical center. In the minority of cases when cancer is found, how is it treated? The majority of cancers diagnosed by screening, unlike the cancers that are diagnosed by symptoms for lung cancer are early stage. At Winthrop, we're screening individuals whether they're surgical candidates or not because we have pioneered the use of stereotactic body radiotherapy in the form of a treatment called CyberKnife that proves to be as good as surgery without the knife. So CyberKnife has knife in the name, but it's actually a very sophisticated radiation technique that allows for highly curative therapy of primary lung cancers. So we are screening individuals even if we don't think that they could have surgery because we know we can cure them with CyberKnife if we find an early tumor. So that's the number one goal, either surgery or an effective local treatment modality like CyberKnife therapy. If the patient is found to have intermediate disease, so when you screen, you sometimes find patients that have cancer that has penetrated the lymph nodes, we then may apply the addition of chemotherapy and sometimes chemotherapy and another form of radiation. We have something called intensity modulated radiotherapy, different forms of radiation treatment depending on the degree of involvement that is seen. With screening, we hope to find very few patients that have stage 4 lung cancer, the most advanced form of cancer when the disease has spread throughout the body. Does Winthrop have any advanced therapies for lung cancer? Prior to this video, the majority of patients that we are seeing with lung cancer are patients that have never been screened and unfortunately those patients predominantly have advanced disease for which radiation and surgery are no longer options because the disease is beyond the ability to eradicate the cancer by those modalities. For those situations, historically death has been an imminent consequence. Very recently, we have been involved in a number of studies that have led to the recent approval. First approval of a non-chemotherapy immunologic based treatment that can, and yes, you're hearing me right, can cure patients at about a 20% rate when they have metastatic lung cancer. So this is very, very exciting times where our incorporation of immunologic treatments can actually salvage a minority of patients that were otherwise written off in the past. The other big breakthrough in the treatment of lung cancer has been the incorporation of what we refer to as targeted therapies. These are treatments that are designed to recognize the drivers that make cancers grow and progress in a patient's body and the drivers are incorporated in the DNA. So cancers are comprised of many, many mutations and we can interrogate the cancer by sequencing the DNA and we do this routinely in advanced lung cancer and we can identify the driver mutations and then match a blocking drug that turns off that driver. So this is another highly effective approach in the treatment of advanced lung cancer. These treatments, when they are found, work in the majority of patients. The immunotherapy works in a minority of patients but can give them back their full longevity. The targeted therapies tend to work when we have a match with a drug and a driver mutation close to 100% of the time and the patients will go into a complete response and they can live a year, two years, three years but those patients are generally not rendered cured and they do tend to have relapses and then we have to try to find other drivers or other ways to manage their tumor. So the two big breakthroughs in the treatment of lung cancer are the adoption of immunoconcology drugs, drugs that stimulate the immune system and those drugs are now FDA approved and the incorporation of targeted therapies.