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Lung Cancer (transcript)
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(Announcer)  
Major funding for Second Opinion is provided by the Blue Cross and Blue Shield Association; an Association of Independent Blue Plans committed to better knowledge leading to better, more affordable health care for consumers.

[clock ticking]

[music]

(Dr. Peter Salgo) 
Welcome to "Second Opinion", where each week our health care team solves a real medical mystery.  When we close this file a half in a hour from now, you will not only know the outcome of this case, you will be better able to take charge of your own healthcare.  I'm your host, Dr. Peter Salgo.  And our story today concerns Molly.  Now you have already met our panelists, who are joining our cast of regulars, Primary Care Physician Dr. Lisa Harris, and health Reporter Kat Carney.  No one on the team knows the case.  It's right here in the chart, so let's get to work.  Let me tell you a little bit about Molly.  You are seeing Molly Lisa, in your office in the middle of the winter.  It is January, February.  She is 57 years old.  She has gone to you or her primary care physician because she has had a cough.  Had some blood streaking in this cough.  It's been going on for three to five days.  And she is feeling a little feverish and she says she's having night sweats.  What do you want to do?

(Dr. Lisa Harris) 
Well I am a little worried that she has an acute infectious process going on.  So we want her vitals and we want her physical exam.

(Peter) 
Okay.  Her vital signs are perfectly normal.  Her - let me see, her weight is normal.  Looking for her physical exam here.  There is nothing remarkable in the chart about it.  Any history that you would like?

(Lisa) 
Yeah does any past medical history- does she have asthma?  Does - has she had recurrent bronchitis?  Is she a smoker?

(Peter) 
Yeah she was a smoker.  And she quit eight years ago when her daughter had a baby.  As a grandma, you can't smoke around my baby.  She smoked for 30 years.  She smoked in college.  She is physically active.  She eats a healthy diet she says.  And she has had a history of a chronic cough.  And there is some history in her family of lung disease, but there is no -

(Lisa) 
At this point, I - you know you said the physical exam is normal.  So in the absence of wheezing - you know, in my office she is going to get a spirometry because she has got pulmonary symptoms. 

(Peter) 
Okay.

(Lisa) 
A pulse ox.  A good set of vital signs, a CBC, and maybe a chest X-ray depending on what is going on. 

(Peter) 
All right.  Well they are not -

(Lisa) 
Did they place a PPD?

(Peter) 
They did put a PPD on her.  What are you looking for with a PPD?

(Lisa) 
Tuberculosis.

(Dr. Peter Salgo) 
You're looking for -

(Dr. Lisa Harris) 
Or exposure to it.

(Peter) 
Exposure to Tuberculosis.

(Lisa) 
Uh-huh.

(Peter) 
And they got a sputum culture.  And they got the chest X-ray you wanted.  Anybody want to guess what it shows?  Or how about it I just tell you?

(Lisa) 
Pneumonia.

(Dr. Alan Sandler)   
Lung mass.

(Peter) 
A lung mass? 

(Lisa) 
Pneumonia.

(Peter) 
Pneumonia.  Her chest X-ray shows a pneumonia in the upper lobe of her right lung.  Now it comes decision time Lisa.  You are the primary care physician.  You have got this woman in your office.  What do you want to do?

(Lisa) 
I would put her on an antibiotic and have her come back in a week or so to see how she is doing.

(Kat Carney)    
I'm just curious as a lay person.
 
(Peter) 
Yeah.

(Kat)    
How - over what period of time are these tests happening?  Is this all happening within a day? 

(Lisa) 
Right.

(Kat)    
Does this happen immediately?

(Dr. Lisa Harris) 
Yeah.  If she came to my office, I would send her that day to get a chest X-ray.

(Kat)    
Okay.

(Lisa) 
We'd place the PPD the Tuberculosis test, that's got to come back within 48 hours to have that read.  What do her sputum cultures show?

(Dr. Peter Salgo) 
We don't have that back.

(Lisa) 
Okay.

(Peter) 
And she is put on Augmentin an antibiotic and sent home.  And said, why don't you come back in two weeks.  Is two weeks good enough for you, by the way?

(Lisa) 
That's probably too long for me.  I understand why they would wait two weeks, because you want them to get the full course of the antibiotic.  But I tend to err on the side of caution and bring them back sooner.

(Dr. Tim Byers)   
This sounds to me like sort of a garden-variety acute infection in the lung.
 
(Alan)  
For a patient who is otherwise healthy, having pneumonia with an infiltrate or mass is - you know you might have expected with just a mild fever and a cough someone, maybe a bronchitis and a normal chest X-ray.  I think actually the fact that it is abnormal, call it pneumonia, call it a mass whatever, is worrisome.
 
(Dr. Paul Levy)   
The worrisome things here are upper lobe pneumonia, blood in sputum.  The follow-up is critical.  Has the hemoptysis, the blood in the sputum cleared totally rapidly.  And the - really the most important thing here is, what's the X-ray going to look like in six weeks?  Because it has to normalize.

(Lisa) 
Exactly.

(Peter) 
Heather you were once told you had pneumonia.  Tell me about it.

(Heather Saler)    
I actually had some heart palpitations one day while working out on the treadmill.  And they got progressively worse during the day.  I finally landed in the emergency room that night.  My heart was skipping beats every minute or so.  And they took the chest X-ray in the emergency room.  And said great news, you have pneumonia.

(Peter) 
Great news you have pneumonia.

(Heather)    
[chuckles]  It's not your heart, you have pneumonia.

(Lisa) 
Did you have a fever?

(Heather)    
I had no fever.

(Peter) 
Did you ever smoke?  I mean now Molly -

(Heather)    
I never smoked.

(Peter) 
You had no smoking history.

(Heather)    
No. 

(Dr. Peter Salgo) 
And they said good news, you have pneumonia, which again is doctors speak.

(Heather)    
Well good news it wasn't my heart.  [chuckles]

(Peter) 
Okay.

(Heather Saler)    
That they were -

(Dr. Lisa Harris) 
Did you live with a smoker?

(Heather)   
No.  I never lived with a smoker.

(Peter) 
But let me tell you a little bit about Molly.  Molly was put on antibiotics, as you know for her pneumonia.  Returned to her doctor for a follow-up two weeks later.  And at this time, she says she feels better.  But still she is not feeling well.  That's the word that is used in the chart.  There is still some noise on physical exam when they put the stethoscope on her chest.  Upper airway noise is described.  And she's still having night sweats.  So the doctor repeats the chest X-rays.  Shows the pneumonia is getting better.  But now because the pneumonia is clearing, and the X-ray looks a little easier to read, the doctor can see something else.  There on the chest X-ray is a nodule.  A mass in the right upper lobe.  It's about seven millimeters in size and it's about a centimeter-and-a-half in from the pleurae - in from the lining of the lung.  Molly at this point hears the word nodule, thinks she has cancer.  Does she have cancer?

(Paul)   
This is in a background of pneumonia.

(Lisa) 
Right.

(Paul)   
So it's - to be the devil's advocate, it's meaningless.
 
(Lisa) 
Right.

(Paul)   
I mean you need a film in six weeks, not two weeks.

(Lisa) 
Right.

(Paul)   
And you could pull the trigger on a cat scan now, but it is going to be - it's hard to interpret something like that when this background of resolving pneumonia with a nodule.
 
(Lisa) 
Right.

(Paul)   
And you won't know what to do with that.  So you might as well wait -

(Alan)    
But it is getting better they say.

(Dr. Paul Levy)   
Right.  So you might as well -

[crosstalk]

(Lisa) 
Do we have her PPD back yet?

(Dr. Peter Salgo) 
I can tell you that her PPD was negative.  You guys are all - are all focusing of course on what is wrong with her.  Molly has heard this word nodule.  Molly is now worrying about cancer.  Does she have a right to be worried right now?

(Tim)  
I think she does.  She's been told she has a nodule, obviously.  And so nodule means a growth, means a mass.

(Peter) 
If this isn't cancer.  What is it?  What could -.

(Paul)   
If you do CAT scans smokers in her age group, you will find a gazillion nodules.  So we have to be really careful about CT imaging in former smokers.  Because you are going to find a lot of stuff that's meaningless.  The problem is as they say, for every 100 nodules you find, only two or three are cancerous.  And the whole art of this is figuring out where are the cancers, and where is the rest of the stuff that we can simply just watch.

(Peter) 
In terms of cancer deaths in this country, isn't it the leading cause of cancer death?

(Tim)   
Oh by far.  It's two or three fold more important than other cancers in terms of death.  If you add up all the deaths from breast cancer and prostate cancer, the two cancers we hear most about, more than twice as many people die from lung cancer.

(Kat)  
I would be worried if I heard nodule.  And I would want to know, well what - if it is cancer, what are the risk factors if we wait for the CT.  What - you know, what - what are the possibilities at this point?

(Paul)   
I think there is a - what is under appreciated is the diagnostic value of time.  You need a little time for things to clear and then get your scan.  You'll have a lot more meaningful data.

(Peter) 
What are you going to do for Molly right now?  She's in the doctor's office.  Someone mentioned the word nodule.  There is this cloud of death and doom hanging over this whole picture.  Right now, what are you going to do?

(Alan)    
So I have one question.  She received - is this two weeks after her - she originally started -

(Peter) 
Yes.

(Alan)    
Okay.  So she has had two weeks.  And we have a chest X-ray that actually has gotten better with respect to the question of pneumonia.  So I feel much more sanguine about going after a CT scan.  I would proceed.  I would calm her that a majority of nodules and things that we're going to find are benign, not cancerous.  But because of the history of smoking, although it is pointed out that the risk goes down, it doesn't go away when you quit smoking.  But it is much better than if you continue.  So I think with this high risk we should proceed.

(Paul)   
I just want to insert that -

(Alan)    
Yes.

(Paul)   
If we start doing CAT scans on every patient with pneumonia before we have given antibiotics and nature a chance to heal, we're going to be just escalating the whole healthcare cost issue.  Finding things that perhaps are distracting.
 
(Peter)   
What are you going to do right now for Molly?  Are you going to wait?  Are you going to scan her?  What are you going to do?

(Tim)   
Scan her.

(Dr. Peter Salgo) 
Okay.  Two for scan, what are you going to do?

(Lisa) 
You know I am going to scan her.

(Peter) 
Well I will tell you what they did.  They waited.  They told Molly chill out.  You know your lungs - this is what you guys were talking about.  Your lungs have had an insult.  You've had pneumonia.  Why don't you come back in about six months.  We'll do another film.

(Paul)   
I wouldn't have waited six months.

(Alan)   
That is wrong.

(Dr. Paul Levy)   
I want to be very clear.  I wouldn't have waited six months.

(Alan)   
Right.

(Paul)   
And I would have -

(Alan)   
We have that on tape.

(Paul)   
And I would have personally looked at the films.
 
(Peter) 
Oh you would have visualized the films yourself.

(Paul)   
I would have looked at the films.

(Dr. Alan Sandler)   
Six months is absolutely positively wrong answer.

(Paul)   
That's right.

(Alan)    
No matter - there was no defense.
 
(Paul)   
You have to understand okay, the diagnostic approach - okay so if you want to go down the menu of things that can be done to this patient.

(Peter)   
Yes.

(Dr. Paul Levy)   
Bronchoscopy.  It's too small too peripheral.
 
(Peter)   
That's a tube they put down the throat and sucks the...

(Paul)   
Yeah.  We put it in the lungs.  We would be hopeful to get in there.  It's - the low yield there.  Maybe 10 or 20 percent.  Are you going to subject the patient to a needle biopsy under CT guidance?

(Lisa) 
And risk collapsing the lung.

(Paul)   
Twenty-five percent of those patients are going to have a pneumothorax, a collapse of the lung.
 
(Lisa) 
That's right.

(Paul)   
And half of those will have to get a chest tube.  This is not a benign workup.  And if you want to go surgically, remember, every 100 patients you send to the O.R. with this type of problem, three are not going to make it.  Okay.  The operative mortality is three percent.  This is not an easy thing to work through.

(Lisa) 
So get the CAT scan.

(Peter) 
So get the CAT scan.  Let me stop for a second and review what we discussed so far.  First, lung cancer is the number one cancer killer in the United States.  However, when a lesion is found in the lung, doctors are often going to tell you they want to wait before they do a biopsy because the diagnostic testing as you have heard is invasive.  And the risks of the tests are extremely high.  And the risk of the test - sometimes in this case going in to do the biopsy is death.  I mean I just want that to sink in for just a moment.  Let me go back to Molly.  She does come back in six months.  She has had her questions about doing an immediate biopsy answered.  She actually calmed down and came back in six months, whether you would have asked her to come back in two weeks or six.  Six is what happened.  She has another chest X-ray.  And this time they did a CT scan.  The nodule in her right lung is now 10 to 11 centimeters.  So it is bigger.  What is that -

(All)     
You mean millimeters-

(Dr. Peter Salgo) 
Millimeters.

(Peter) 
What does that all mean?

(Alan)    
Well now this is very worrisome.  Because it has grown.

(Paul)   
If we are correct on the comparison that it was smaller by X-ray and now 10 millimeters or more by CAT scan that suggests growth.  So that's worrisome.

(Tim)   
I think the key thing is, is it growing? 

(Lisa) 
Yes.

(Tim) 
Because the common cause of nodules does not lead to nodules that grow.  And so nodules that grow really need to be aggressively pursued.

(Peter) 
Okay.  Now you are talking about aggressive.  What sort of options do you have?  What are you going to do by the diagnostic?

(Alan)    
The CT scan needs to be looked at.  Because she may have more than just that nodule.  If in fact that is the only abnormality on the CT scan in my book, that comes out surgically.

(Peter) 
Okay.  So you want to go in and do it.  What about getting an MRI?  A PET scan, doing anything else, waiting a little while longer.

(Alan)    
No.  No.  No and no.

(Peter) 
That will be no, no, no, and no.

(Alan)    
She's had the CT scan six months ago.  We have already waited.
 
(Kat)    
Well at this point, should she be very worried?

(Peter)   
Well - should she be worried?

(Kat Carney)    
Or concerned?

(Paul)    
She should be concerned.  But again, it is not a done deal.  If it has enlarged over that window period now six months, I would agree, it probably should come out surgically.  But likely, a growing nodule in a former smoker, you might be thinking 30, 40 percent of the time this could be tumor at this point as opposed to the reassuring aspects you were talking about before.

(Dr. Alan Sandler)   
What I tell patients is, I do the worrying.  And when I - I'll let them know when they should start to worry.  But this - this is -

(Dr. Peter Salgo)   
Molly's already worried.

(Alan)    
Right.

(Peter) 
She goes ahead.  And her physicians recommend and she has an exncisional biopsy.  It showed some large lesion.  She has the excisional biopsy.  Was that the only surgery that would have been appropriate here?  Could they have done other kinds of surgery?

(Dr. Paul Levy)   
They would have - the way these are approached, you wedge out the abnormal area.

(Peter) 
You open the chest.
 
(Paul)   
They - well they do it thorax scopically now.  I mean with a - almost like the very common arthroscopy type technique.

(Peter)   
You put a telescope in there.

(Paul)   
Through a telescope, or through a fiber optic tube.  But you can wedge out that is just take almost like a pie shaped biopsy specimen from the lung.  If indeed it is carcinoma at that point, if they do find that it is lung cancer, then the proper management is a completion lobectomy.  They would remove the entire right upper lobe at that time. 

(Peter) 
Heather, the last we left you, you were in the emergency room.  What happened next?

(Heather)   
They told me I had pneumonia.  And fortunately or unfortunately I had had an emergency appendectomy at that same hospital seven months prior.  And they pulled my old scan - had an old chest scan, which showed some - a shadow on my lung at that point.  And it had changed.  So when they saw that they said maybe it is not pneumonia.  Now they actually recommended a CAT scan immediately.

(Peter) 
What did that show?

(Heather)   
That showed a three-centimeter nodule in my upper right lobe.

(Paul)   
Three centimeters?

(Heather)   
Three centimeters.

(Paul)   
That's a mass.

(Dr. Lisa Harris) 
That's a mass. 

(Paul)   
By the way nodule and mass, we should recognize that nodules are pretty small, about a half an inch to an inch maybe.  But three centimeters is big.  That's a mass.

(Dr. Peter Salgo) 
Then what happened?

(Heather)   
Um, they actually - it was a Friday.  And they gave me a TB test.
 
(Peter) 
Okay.

(Heather Saler)   
And I waited over the weekend.  Nothing happened.  And I was scheduled for a CAT scan guided needle biopsy. 

(Peter) 
And how long did it take for you to get a result?

(Heather)   
Ten days.

(Peter) 
Ten days. 

(All)     
Wow.

(Peter) 
What were those 10 days like?

(Heather)   
Horrendous.  I kept telling myself it has to be something else.  I have never smoked.  Only lung cancer - you know, only lung - smokers get lung cancer, which is what I thought like the majority of the public does.  But I - I can't even describe what it was like.

(Peter) 
Is she right?  Only smokers get lung cancer?

(Dr. Tim Byers)   
No she is not right.  In fact non-smokers get lung cancer.  In part because of passive smoking.  But in part as well because of other factors.  Ten or 15 percent of lung cancer is caused by other factors that we don't yet understand.  And the other sad thing is that now about half of the people diagnosed with lung cancer due to smoking have already quit smoking.

(Lisa)   
Right.

(Tim)   
So lung cancer risk does stay up.  Even in former smokers.

(Dr. Peter Salgo) 
In any event, I can tell you what happened with Molly.  Molly's biopsy result came back.  And they don't tell me how long that took.  And it said that she had stage one squamous cell carcinoma.  Isn't that a pretty benign diagnosis?

(All)     
Yes.

(Dr. Paul Levy)   
So you are describing a nodule with lobe resection, and no lymph node metastatic disease?

(Peter) 
That's what it's implying I suspect.
 
(Paul)   
Okay.  So that's stage one carcinoma you know 1A.

(Alan)    
Which is less than three -

(Paul)   
Which is probably the most favorable of the prognostic - even though it is not great -

(Kat)    
Well it sounds like there were a lot of possible appropriate you know ways you can go with approaching this diagnosis.  Does a team discussion like this happen in order to reach the - you know in order to reach -

(Lisa)   
It depends on the primary care physician.  There are some that like to saddle themselves - and we'll say that you know, in their office and try to do the entire workup on their own.  There are others that will you know - they may do what we call a curbside consult, and just call up somebody and say this is what's going on.  What do you think?  Just so you have a couple of other brains involved.

(Peter) 
Right now, with what you know, what is Molly's prognosis?

(Alan)    
She has about a 60 to 70 percent chance of being cured. 

(Peter)   
Is that right? 

(Paul)
Five-year survival, stage 1-A lung cancer.  Right, 60 to 70 percent.  It's the most favorable, even though that doesn't sound that great. 
[crosstalk]

(Peter) 
They did a needle biopsy.

(Heather)   
They did a needle biopsy.

(Peter) 
And you waited.  Then what?

(Heather)   
Then waited.  I got the results from a pulmonologist.

(Peter) 
Okay.

(Heather)   
Who was very kind and sweet and fatherly.  And laid it on me that I had lung cancer.  They thought that it was early stage.  It was an adenocarcinoma, non-small cell.  Assumed that it was stage one and recommended that I see a surgeon.

(Dr. Peter Salgo) 
I really want to make this very clear.  Because you were there.  You are sitting across the desk from the doctor.  And the doctor says those words.  You have lung cancer.  The big "C".  What was that instant like?  Describe that for me.

(Heather Saler)   
It was um, sort of surreal.  And I have described it often as being in the middle of a tornado, where just the air was sucked out of me.  And I kept thinking this can't be happening.  It just can't be happening.

(Peter) 
How unusual is Heather's case?  Non-smoker, three-centimeter tumor?

(Paul)   
It's uncommon, but it happens.  Unfortunately.

(Alan)    
It's more and more common nowadays.  We at least believe it to be more common.  We are waiting for the official data.  But we are much more sensitized now to the never smoking female in particular.
 
(Peter) 
I want to nail this one down once more if we can.  There is Heather getting the diagnosis she has lung cancer.  She didn't smoke.  How common is this?

(Tim)   
About 10 or 15 percent of all lung cancer is not due to smoking.  That means 85 to 90 percent is due to tobacco.  But there is still important other causes that we haven't quite figured out what those are. 

(Peter) 
So non-smokers can get it. 

(Tim)   
Yes.

(Peter) 
But smokers are the big people at risk.

(Tim)   
Oh yes.

(Peter) 
So let's pause for a second and sort of sum things up.  Lung cancer is a potentially deadly diagnosis.  The leading preventable cause of it is smoking.  Yes, you can get lung cancer if you don't smoke.  But smoking vastly increases your chances of developing it.  You've heard it before.  We're going to beat this into the ground again.  If you are smoking, stop.  If you are not smoking, don't start.  You will hear it again from us I am sure.  Let me tell you a little bit more about Molly.  After her excisional biopsy, she is told she doesn't need chemotherapy or radiation.  Now does this mean that they are confident that they got the entire tumor?  It's gone.  We can go home now?  What's going on here?

(Alan)    
I'll answer that by - the quick answer is correct.  She does not need anything else for what that very very early stage.  There are no clinical trials that have ever shown the benefit of chemotherapy.

(Dr. Peter Salgo) 
Heather, what happened to you?

(Heather)   
I had surgery.

(Peter) 
Yep.

(Heather)   
With a thoracic surgeon to remove my upper right lobe.  And they did a complete lymph node dissection.  Removed I believe 12 lymph nodes in that area. 

(Peter) 
What did they find in the nodes?

(Heather)   
Well that day you know when I came out of surgery they said everything was fine.  Stage one.  I was done.  When I came back for my follow-up visit three weeks later, it was sort of dropped in my lap that five of those nodules had in fact come up positive.

(Peter) 
Okay so you had cancer in the lymph nodes.

(Heather)   
Yes.

(Peter) 
So then what happened?

(Heather)   
That took me to stage 3-A.  And they recommended that I have chemo and radiation at the same time for six weeks.

(Peter) 
Okay.

(Lisa) 
So your lymph nodes were outside of your lung?

(Heather Saler)   
Yes.

(Dr. Peter Salgo) 
At any point Heather, did you stand up or sit down in front of the doctor and say, just be frank with me.  How much time do I have?

(Heather)   
No.  I didn't want that number in my head. 

(Peter) 
Why not?

(Heather)   
What good would it do?  I mean it is not going to do me any good.  I didn't want that in my head with the count down going.  This is all the time I have left.
 
(Peter) 
What were the other issues in your life that were concerning you at that time?

(Heather)   
I was a single mom.  I was divorced.  And my son was just six years old.

(Peter) 
My goodness.

(Heather)   
At the time.

(Peter) 
Well let me bring you back to Molly.  Its now two years later.  And she is battling with lung cancer in her own mind.  She has a question.  She quit smoking eight years before this diagnosis.  Now she wants to know if her lungs will ever get back to their pre-smoking state.
 
(Dr. Alan Sandler)   
I'll address the issue with the risk of cancer, which again, never goes back to zero or a non-smoker.  But lungs have a wonderful way of healing.

(Peter)   
Let me interpret - what I think she is asking.  Will my risk of further lung disease - probably cancer - ever go down to the same as a person's risk who never smoked?

(Paul)   
No.

(Dr. Peter Salgo) 
Other than not smoking, are there any preventive things you can do to keep yourself as likely as possible never to get lung cancer?

(Alan)    
Probably wouldn't work as a - work in a bar.  I probably -

(Peter) 
Okay so that is second -hand smoke.

(Dr. Tim Byers)   
Not - staying away from people who smoke reduces risk.

(Paul)   
I think the bottom line is that most lung cancer is tied in with smoking.  And that's where you get your bang for your buck.  If you don't smoke or you don't live with a smoker or your exposed to passive smoke.  The other areas of prevention are small as far as incremental gain.

(Peter) 
You know, all along we have been talking here about relatively small tumors that are surgically resectable, you go to the O.R. you take them out.  A lot of lung cancer is bigger than that.  And surgery really isn't an option.  What do you do for those folks, and do they have hope?

(Alan)    
It's a great comment, because 70 percent of all patients with lung cancer have cancer that may not be amenable to surgery.  So the important message that I would have for anyone diagnosed with lung cancer is to be absolutely certain that you get to see your medical oncologist and take part in a multi-disciplinary program involving radiation therapists, surgeons, pulmonologists, so that a very informed decision can be made about it.  Because we - chemotherapy prolongs survival.

(Peter) 
You're willing to say yes there is hope.

(Lisa) 
It depends on the type of cancer and where it is.  And all the other health factors.  And even with someone who has co-morbid problems, so someone who has a lot of medical problems still has a very good chance.

(Dr. Paul Levy)   
I mean you are really dealing with the individual patient and individual situation.  I mean it's hard to make these blanket statements.
 
(Peter) 
And with that, let me sum up a little bit of where we are at this point.  There is hope - I think we can take away from this discussion - for people with lung cancer if it is caught early.  But finding it early is difficult because it is often A-symptomatic.  Now the best way to slow down the rate of lung cancer cases in this country is to get people to stop smoking.  I am going to say it again.  If you smoke, quit.  It is never too late.  And if you don't smoke, don't start smoking.  I think - is that the takeaway message from everybody here?

(All)     
Certainly. Absolutely.

(Tim)   
If we were talking about heart disease, it would be the same message.

(All)     
That's right.

(Peter) 
Same message.

(Dr. Lisa Harris) 
And not only for you.

(Dr. Peter Salgo) 
Heather, we can't leave without talking to you.  How are you doing?  What's going on with you right now?

(Heather)   
I am doing okay.  We actually have been tracking some nodules in my lungs now for the last 18 months.  And the last six months, everything has been stable.

(Peter) 
That's great.  Have you found other people with your problem?  Does that help, talking to them?

(Heather Saler)   
Oh absolutely.

(Peter) 
Talk about that.

(Heather)   
I am in a support group.  A lung cancer support group.  It is very helpful.  Just to be with other people that can relate.
 
(Peter) 
And I guess I'm going to join all of the folks here at wishing you the best of luck.

(Heather)   
Thank you.

(Peter) 
It's been quite a journey, hasn't it?

(Heather)   
It has.

(Peter) 
Well I want to thank you so much for sharing all of this with us.  And I want to thank all of you for being here.  A great discussion.  We covered a lot of ground.  Let's just sum up some of the things we discussed.  Lung cancer is the number one cancer killer in the United States.  However, when a lesion is found I the lungs, doctors will often wait to do a biopsy because diagnostic testing is invasive.  And the risks of the test can be very high.  Lung cancer is a deadly diagnosis.  At least potentially.  And the leading preventable cause of lung cancer is smoking.  You can get lung cancer if you don't smoke.  But smoking vastly increases your chances of developing it.  There is hope for people with lung cancer if it is caught early.  But finding it early is difficult because it is often A-symptomatic.  Again, the best way we can slow down the rate of lung cancer cases in this country is to get people to stop smoking.  If you smoke, quit.  It's never too late.  And if you don't smoke, don't start smoking now.  And of course our final message is this.  Taking charge of your health means being informed and having quality communication with your doctor.  I'm Dr. Peter Salgo.  And I'll see you next time for another "Second Opinion".

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Search for health information and learn more about doctor/patient communication on the "Second Opinion" website.  The address is pbs.org.

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Major funding for Second Opinion is provided by the Blue Cross and Blue Shield Association; an Association of Independent Blue Plans committed to better knowledge leading to better, more affordable health care for consumers.