 Joining us for tonight's Your Health segment is Dr. Shelby Steward, Assistant Professor of Surgery, University of Maryland School of Medicine and Thoracic Surgeon at the University of Maryland Medical Center and the University of Maryland St. Joseph Medical Center. Doctor, thank you for being with us. Thank you for having me. This is Lung Cancer Awareness Month. It's the deadliest of cancers and the numbers are just huge. Yeah, absolutely. And they continue to climb. So Lung Cancer is one of the largest killers of people due to cancer deaths that we have to date. And we all think of it in the context of smoking and we think that smoking is declining, but the number of cancers isn't. So there's a bit of a lag time. Because people smoke 10 years ago. Right. So most lung cancers are due to smoking. About 80% of our patients that have lung cancer do have a history of smoking. So certainly there is a definite connection. And although we have found that men in particular are decreasing their amounts of smoking, women are actually increasing their amount of smoking. Did not know that. Yeah. How about secondhand smoke? Oh, secondhand smoke is also a major risk factor to lung cancer. In fact, about 7,000 people die a year due to secondhand smoke. So these are people that are never smokers that have had either family members or people where they work that smoke on a daily basis around them that get lung cancer that we believe is due to their secondhand smoke exposure. And nonsmokers can get lung cancer. Absolutely. So the second most common cause of lung cancer is radon. Radon is a gas that is found naturally in our soil and it doesn't have a smell, it doesn't have a taste, and could be found in our households. But most of our homes we get tested for radon. But it still is the second most common cause for lung cancer, especially in nonsmokers. Okay. As a surgeon who operates on a lot of people with lung cancer, you'd rather see it early. Absolutely. How much of a difference does that make? So stage for stage, it makes a big difference in your survival. So if you, so lung cancer is given a stage when you receive your diagnosis, stage one being the earliest stage, stage four being the most advanced, meaning it has moved outside of the lung and into other tissues and organs. Patients that have stage one lung cancer are likely to have a five year survival of about 75 to 80%, meaning so in five years from now, if you are diagnosed with a stage one lung cancer, with treatment you're likely, most likely to be alive in five years and potentially cancer-free. However, once you start moving into stage two, stage three, that number drops significantly. Just from stage one to stage two, you drop from having a close to 80% survival to closer to just a 50% survival. So certainly finding lung cancer early makes a big difference in your survival. When you see one of those people, I don't know that necessarily requires surgery, I guess it does. How did they, how did it get caught? How was it discovered at stage one? So some people just find them incidentally. I have several patients that have come because they are getting a knee repair or a knee surgery and they get a chest x-ray and lo and behold they find a nodule on their chest x-ray or they're getting studies for some other reason. That's probably the most common way that people are found to have early stage lung cancer. And certainly now we have lung cancer screening which has made a big difference in identifying patients earlier. Who should be screened and how are people screened? So recently we found that there was a benefit to doing low-dose CT scans. So if you are between the ages of 55 and 80 years old, you have what we call a 30-pack year smoking history. So what that means is, so the amount of packs that you smoke per day times the number of years. So if you smoke one pack per day for 30 years, you're a 30-pack year. If you smoke half a pack a day for 60 years, you are, you know, so you do the math that way. So 30-pack year smoking history ages between 55 and 80 and you have smoked within the last 15 years. So even if you quit 14 years ago, you still qualify because you're within that 15-year window to get lung cancer screening. And it's kind of similar to our mammograms, our colonoscopies, they're paid for by your insurance and they do decrease the lung cancer deaths because we hope to find more lung cancers early. You want to see everybody who smokes quit right now. Absolutely. And what happens? Because when we talk about it in the terms of the length of history and the how many packs a day, it seems like stopping today if somebody's a long-term smoker isn't going to pay a lot of dividends. It does because beyond just lung cancer, you have other health problems that are caused by smoking. Heart problems, COPD, and frequent lung infections and things like that. So even beyond your cancer risk, you do have benefits to stopping smoking. And it does decrease your risk of getting lung cancer if you stop. I've seen ads. It may have been a billboard that was advertising, you know, come get your lung cancer screening test, which I imagine was a CT, and it was something you paid for, but it was relatively inexpensive. I mean, the way cigarettes are, it was a few packs, got you the scanning. Is there a risk to the scanning and we think about, you know, radiation, false positives? Right. We always worry about the risk of radiation, which is why for lung cancer screening, it's a low-dose CT. So the amount of radiation that you get for a low-dose CT versus a regular diagnostic CT, so if we are looking for something that we know may be there, the low-dose CT has 15 times less radiation than a normal, or five times less radiation than a normal CT scan. So less radiation for the low-dose CT scan, certainly there is radiation and radiation does have a risk. We believe that the benefit as compared to the risk is significant, especially in this group, right? So if you're in that high-risk group, you certainly will get a benefit from your CT scan beyond the risk of radiation from the screening. Let's take a phone call. White Comico County. This is Donna. Donna, thank you for calling. Go ahead. Yeah. Hi, doctor. I know that you're a surgeon rather than an oncologist, but my 80-year-old mother was diagnosed with stage 4 lung cancer that actually spread to her brain. She had an oncologist at Fox Chates, which she was associated with Temple University, and she had brain surgery, gammon-knife surgery, and then she was put on a patruta. Her tumor, that was two years ago, doctor, her tumor is going from 3.7 to 0.7, and she has just started driving again like four months ago. Yeah. Thanks very much for the phone call. Best of luck. Yeah, that is one of the wonderful things that have happened in the last about five to ten years are the new medications that we have for lung cancer, and the hope is that we can make stage 4 lung cancer like a chronic disease, as opposed to what we used to say was a death sentence. So absolutely, these new medications, these immunomodulators where we use our own immune system to fight off the cancer, these targeted therapies that target the specific markers within the lung cancer tumors, they're amazing. And there are lots of stories where patients have these, you know, what we think are going to be terrible, terrible, I'm going to die tomorrow type of lung cancers, and that's not really the case all the time. And as certainly there are specific groups of people that are able to take these medications. But if you are in that group, it makes a significant difference. Let's get a phone call from Prince George's County. This is Jack. Jack, thanks for calling. Go ahead. Yes, good evening. For years and years, I was involved in going to conferences and things where there's lots and lots of smoking. I've never smoked myself. What is my risk? Good question. You wouldn't remember this, but airplanes just have a smoking section. Yeah. Hospitals. You can barely see through it. Sure. Surgeons, we're operating and smoking in the operating room. Crazy. I mean, yeah. So yeah, secondhand smoke is a real thing, but it's very hard to quantify what your risk is based upon the amount of, because you can't really say, does one person sitting next to you equal five people sitting two feet away from you? We don't know that information yet. We do know that secondhand smoke does increase your risk of lung cancer, but to what amount, we aren't really sure. Had an email question, a viewer wants to know about vaping. So as an alternative, maybe allegedly as a way to stop or recreationally, more and more people you see inhaling stuff. It's a common question, even with my own patients that are trying to stop smoking and move to vaping as an attempt to stop smoking. I think the jury is still out on vaping. Certainly what I tell my patients is your body wasn't meant to inhale anything but air. But certainly if vaping is a bridge to keep you from smoking these carcinogenic cigarettes, then okay, maybe the lesser of two evils, but I do ask my patients that once they stop smoking and they move to vaping to try to decrease the vaping and hopefully go to nothing. Dr. Shelby Stewart, University of Maryland Medical Center, thank you for your time. Your health segments are a co-production of Maryland Public Television and the University of Maryland Medical System.