Fall Allergies Are Real. And They’re Getting Worse.
Speaker To Discuss Lung Cancer Screening
HIGH POINT — LiveLung, a nonprofit organization dedicated to supporting lung cancer patients, survivors and their care partners, will present a program Wednesday on the importance of lung cancer screening and early detection at its monthly educational meeting.
The meeting, which includes a complimentary lunch, will be held at noon at the Courtyard High Point, 1000 Mall Loop Road.
The featured speaker will be Morgan Gable, a thoracic oncology nurse navigator specializing in lung cancer screening. Gable was instrumental in forming the Lung Nodule Review Team at her facility that focuses on early detection and treatment initiation for lung cancer. She has previous experience as an oncology clinical research nurse and emergency department nurse.
Lung cancer patients and their care partners can RSVP to attend the meeting at http://livelung.Org/meetings.
For more information about LiveLung, visit LiveLung.Org.
Advances In Lung Cancer Treatment
Published March 31, 2025 at 5:30 AM EDT
This week Bobbi Conner talks with Dr. Miriam Alexander about advances in lung cancer treatment in recent years. Dr. Alexander is an Assistant Professor of Medicine, and an oncologist specializing in lung cancer at MUSC Hollings Cancer Center.
TRANSCRIPT:
Conner: I'm Bobbi Conner for South Carolina Public Radio with Health Focus here at the radio studio for the Medical University of South Carolina in Charleston. Treatment options for lung cancer include surgery, radiation, chemotherapy, targeted therapy, immunotherapy, and a combination of these approaches. Doctor Miriam Alexander is here to talk about advancement in lung cancer treatment in recent years. Doctor Alexander is an Assistant Professor of Medicine, and she's an oncologist specializing in lung cancer at MUSC Hollings Cancer Center. Doctor Alexander, what are some of the biggest breakthroughs in lung cancer treatment in recent years?
Dr. Alexander: Lung cancer kills more people per year than breast, prostate, and colon cancer combined. One of the main reasons for this is that it's often detected in the late stages, when it's less likely to be curable. Over the last few years, we have seen a decrease in the overall deaths from lung cancer, mainly due to increase in screening, smoking cessation, health literacy and very importantly, biomarker testing or molecular profiling of the cancer.
Conner: And what about the new treatments for lung cancer that are making a difference?
Dr. Alexander: The new type of therapies that have changed the treatment of lung cancer for the better are targeted therapies and immunotherapies. So targeted therapies attack cancer cells based on very unique molecular characteristics, such as genetic mutations or abnormal protein expression. And these therapies spare normal cells, making them more effective and less toxic than traditional chemotherapy. Immunotherapy trains the body's immune system to seek out and destroy only cancer cells. We have even improved the way we deliver chemotherapy by developing therapies that seek out cancer cells before delivering a powerful dose of chemotherapy to it.
Conner: And Doctor Alexander. Given all of these different approaches, treatment approaches for lung cancer, how is it that you decide what is the right thing for an individual patient with lung cancer?
Dr. Alexander: We have to use the patient's specific molecular characterization of their cancer to decide on the right therapies for them. And that's where precision medicine comes in. And that is why it is very, very important for every new diagnosis of lung cancer to get biomarker or molecular testing.
Conner: Tell us about new efforts to catch lung cancer earlier when it's most treatable.
Dr. Alexander: The National Lung Cancer Screening Trial showed a 20% reduction in lung cancer mortality with a low dose CT scan compared to chest x ray. So, with these screening techniques, the low dose CT scan identifies lung cancer at earlier stages where surgical resection and curative treatments are much more effective.
Conner: And what are some of the biggest challenges that remain in lung cancer treatment for individuals?
Dr. Alexander: The biggest challenges that remain is that many cases of lung cancer go untreated because of lack of knowledge from both patients and their providers, as well as the stigma associated with lung cancer. There's fatalism after diagnosis and the cost of treatment, so we know that more than 20% of patients diagnosed with lung cancer receive no treatment at all. So, with more education, screening to move the diagnosis to early stage, comprehensive biomarker testing to offer more precise therapies, we can continue to improve survival rates.
Conner: Doctor Alexander, thanks for this information about lung cancer treatment.
Dr. Alexander: Oh, You're welcome Bobbi.
Conner: From the radio studio for the Medical University of South Carolina in Charleston, I'm Bobbi Conner for South Carolina Public Radio.
Health Focus transcripts are intended to accurately represent the original audio version of the program; however, some discrepancies or inaccuracies may exist. The audio format serves as the official record of Health Focus programming.
'The Earlier, The Better': Use Spirometry To Detect COPD During Lung Cancer Screenings
March 31, 2025
8 min read
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Key takeaways:Due to the destructive nature of COPD on patients' lungs and well-being, timely diagnosis is key, and integrating spirometry at the time of lung cancer screening could help identify this disease early in an at-risk population.
"COPD remains vastly underdiagnosed," Nathaniel Marchetti, DO, professor of thoracic medicine and surgery at the Lewis Katz School of Medicine at Temple University and medical director of the respiratory intensive care unit at Temple University Hospital, told Healio.
"In the U.K., they find that anywhere from 30% to 60% of the people that underwent low-dose CT and spirometry had airflow obstruction, had evidence of COPD, but didn't know it," Marchetti added.
Lung cancer screening population, early detectionThe value of spirometry at the time of lung cancer screening is largely due to the individuals that are recommended to undergo this screening, Marchetti told Healio.
"With the low-dose CT screening population, we have a group that's at an extremely high risk for having COPD because they have a very significant pack-year history of smoking," Marchetti said.
As Healio previously reported in late 2023, a study using the Danish LC Registry and the National Registry of COPD during a 10-year period found a substantial overlap between patients with COPD and individuals referred to undergo lung cancer diagnostics.
Additionally, a study published in 2020 in Annals of the American Thoracic Society reported that 57% of 986 U.K. Individuals from the Lung Screen Uptake Trial had COPD as measured using pre-bronchodilator spirometry.
Of these, 67% had undiagnosed COPD, which was classified as no prior diagnosis of COPD, chronic bronchitis or emphysema but meeting the Global Initiative for Obstructive Lung Disease (GOLD) criteria using spirometry.
Marchetti highlighted that individuals newly diagnosed with COPD at the time of lung cancer screening usually have early rather than late-stage COPD, allowing the opportunity for treatment before the disease progresses.
"With any disease, not just COPD, the earlier, the better," Marchetti told Healio.
Notably, COPD is not the only disease/condition that can be caught early during lung cancer screening. According to Marchetti, interstitial lung abnormalities, thyroid nodules, coronary artery calcifications, liver masses and breast masses could be found.
"If you're paying the money to get a CAT scan of the chest that includes the thyroid, the heart, the lungs, the chest wall and upper part of the abdomen, you should look at everything," Marchetti said.
A study published in Radiology also found that assessment of body composition measurements on lung cancer screening low-dose CT scans revealed patients at high risk for mortality due to lung cancer, cardiovascular disease and all causes.
Impact on careWhen thinking about the impact performing spirometry at the same time of lung cancer screening has on care, Nina A. Thomas, MD, highlighted the burden COPD has on patients and why early diagnosis is helpful in this context.
Nina A. Thomas
"COPD is an independent risk factor for lung cancer," Thomas, director of the Thoracic Malignancy Pillar of Center for Lung and Breathing at the University of Colorado School of Medicine and assistant professor in the division of pulmonary sciences and critical care, told Healio.
"Additionally, the presence of moderate or severe COPD can affect the overall benefit that a patient can have from lung cancer screening due to this comorbidity," she continued. "Identifying, diagnosing and screening for it early can help with lung cancer screening."
Another way in which spirometry at the time of lung cancer screening positively impacts care is through the treatment those who end up being diagnosed with COPD receive, according to Thomas. She told Healio managing disease is key in improving quality of life, especially in those with lung cancer plus another disease/condition.
"With increasing survival that we've been seeing in lung cancer, there's some evidence that health-related quality of life after treatment for lung cancer can be higher with patients who have their comorbidities, like COPD, better managed," Thomas said.
Recent dataOver the past 5 years, several studies have investigated the use of spirometry to identify COPD in patients who underwent lung cancer screening, and both Marchetti and Thomas noted that much of this research takes place in Europe.
One of these studies, published in BMJ Open by Undrunas and colleagues, utilized the Polish lung cancer screening program MOLTEST-BIS (n = 754), whereas another, published in European Respiratory Journal by Tisi and colleagues, utilized the London SUMMIT Study lung cancer screening cohort (n = 16,010).
Both studies were made up of middle-aged adults (Poland, age 50 to 70 years; London, age 55 to 77 years) who reported current or former smoking with a minimum of a 30 pack-year smoking history.
In the MOLTEST-BIS cohort, COPD was found in 19.73% of individuals, and researchers noted few (13.3%) had prior knowledge of this disease.
Similarly, researchers evaluating the SUMMIT Study cohort observed undiagnosed COPD —identified as "those with symptoms, no previous COPD diagnosis and airflow obstruction" — in 19.7% of this population.
The link between airflow obstruction and lung cancer risk was another important finding from the study of the SUMMIT cohort, according to Marchetti.
"If you have airflow obstruction based on spirometry, your risk for lung cancer is significantly higher than someone who has the same pack-year history of smoking that does not have airflow obstruction," Marchetti said.
In addition to studies capturing the prevalence of COPD in lung cancer screening cohorts, European studies have also delved into the feasibility of integrating spirometry at the time of low-dose CT.
A study by Balata and colleagues published in Thorax found that 99.4% of adult ever smokers living in deprived areas of Manchester who attended a lung health check also underwent spirometry testing.
In a study in Leeds, Bradley and colleagues evaluated 151 adults who attended a lung health check and came out with a result of unexplained airflow obstruction plus a referral to a community respiratory team to uncover how these patients respond to this referral and how many do not have airflow obstruction upon further review.
Researchers reported that 46 individuals declined assessment by the community respiratory team, and 29% of those with post-bronchodilator spirometry checked ended up not having airflow obstruction.
"This study highlights the importance of confirming [airflow obstruction] by postbronchodilator spirometry prior to diagnosing and treating patients with COPD," Bradley and colleagues wrote.
In terms of U.S. Studies on this topic, Marchetti told Healio data collected at Temple Health "meshes very nicely with what's been reported in the European studies."
As Healio previously reported at the 2024 American Thoracic Society International Conference, Michaela Seigo, DO, chief pulmonary and critical care fellow at Temple Health, and colleagues used data from the Temple Healthy Chest Initiative lung cancer screening program between October 2021 and October 2022 to evaluate 2,083 individuals with low-dose CT scans and determine how individuals with vs. Without a history of COPD differ based on demographics and pulmonary comorbidities.
This research revealed that more than 75% of individuals who underwent lung cancer screening without a reported history of COPD had airways disease, and airflow obstruction — identified as an FEV1/FVC ratio less than 70% — was observed in 36.5% of those without a history of COPD.
Implementing spirometryWhen preparing to integrate spirometry with lung cancer screening, Thomas told Healio physicians should have an understanding of the two types of spirometry: formal and point of care. The types differ based on resources used, the person performing the test and accuracy level.
"Formal pulmonary function testing is done with advanced equipment and by respiratory therapists who are specially trained," Thomas said. "Point of care spirometry is more accessible but does take a little bit of training for your nursing staff, clinic staff or even providers to be able to instruct and perform. The accuracy of that is relatively good but not perfect when compared to formal pulmonary function tests."
Marchetti noted that spirometry is a regular occurrence in pulmonology clinics. In this setting, medical assistants often perform the test, whereas in the lung cancer screening setting, respiratory therapists typically perform spirometry.
"We're used to doing [spirometry] in some respects," Marchetti told Healio. "What's different is we're not used to doing it in people that are going in for imaging."
Although the training required to perform spirometry could be seen as a barrier to implementation, Marchetti said this should not be an issue in screening centers.
"Any place, any medical center, any hospital that's doing CAT scans for low-dose cancer screening ... Has the capability to do spirometry," Marchetti told Healio. "Most places will have someone already trained."
In terms of time, spirometry takes around 10 to 15 minutes, according to Marchetti.
"In a busy clinical practice, if it takes a half hour, we're not going to do it because it slows everything down," Marchetti said.
Need for collaborationIn order to make spirometry a customary thought at the time of lung cancer screening, collaboration between specialists is required.
Marchetti told Healio pulmonologists should collaborate with internal medicine physicians, family practice physicians, advanced practice providers (nurse practitioners and physician assistants) and primary care physicians.
"This really has to come from the pulmonologist, the primary care physicians and anyone who has contact with a patient who might have a smoking history," Marchetti said.
One example demonstrating the importance of collaborating with primary care physicians comes from a study published in CMAJ that used data from three primary care sites in Ontario to determine how prevalent COPD was in adults with a minimum smoking history of 20 pack-years.
According to the study, 20.7% of the population had a FEV1/FVC ratio less than 0.7 and an FEV1 less than 80% predicted, signaling COPD.
Notably, Marchetti highlighted that Temple University Hospital has started welcoming collaboration between specialists at the time of lung cancer screening ordering.
"If any physician orders a low-dose CT scan, it'll ask, 'do you want spirometry?' so you can order spirometry at the exact same time," Marchetti told Healio.
When thinking about spirometry integration, Thomas said collaboration may be needed more in lung cancer screening programs run by specialties other than pulmonology since there is likely unfamiliarity with performing and interpreting spirometry.
"If it's run by other specialties, there probably needs to be some collaboration and working out of logistics on how to incorporate spirometry into lung cancer screening, and who's going to champion interpreting those results and managing results suggesting COPD," Thomas told Healio.
Thomas noted that despite possible challenges related to training and time, spirometry at the time of low-dose CT could be beneficial in improving patient outcomes.
"It's a tough thing to incorporate because you do need some training and it's additional steps in the lung cancer screening process, but I do think that there can be impact when it comes to managing comorbidities [and] also helping with predicting outcomes with lung cancer screening," Thomas said.
At the end of the day, integrating spirometry with lung cancer screening will require careful thought so that it does not create more obstacles in the mission to get more individuals screened, according to Thomas.
"When we talk about lung cancer screening, there's a lot of barriers to implementation that we already face, so balancing the barriers to implementing lung cancer screening with adding on additional services is a fine line you have to toe," Thomas told Healio.
"If it doesn't dissuade or prevent patients from getting screened and getting in the door, then I think it'll be a great addition, but you have to plan it and implement it in the best way possible," she said.
References:Nathaniel Marchetti, DO, can be reached at nathaniel.Marchetti@tuhs.Temple.Edu.
Nina A. Thomas, MD, can be reached at nina.Thomas@cuanschutz.Edu.
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