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Welcome to “Should I Call a Doctor?” The podcast where we dive into trending health topics to separate fact from fiction. We bring in experts to talk about all things health, to empower you with knowledge and answer your questions hosted by Inova Health.
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Welcome to should I Call a
Doctor?
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The podcast, where we dive into
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the questions you have about
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your health and today's trending
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health topics.
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To separate fact from fiction.
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I'm one of your hosts, Doctor
Samuel Galli, an internal
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medicine physician at Inova.
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I'm Tracy Schroeder.
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I lead communications for Inova.
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Doctor Sam will give you the
clinical perspective while I ask
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the questions that keep patients
up at night.
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In today's episode, we are
meeting with Doctor Amit
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Mahajan, otherwise known as
Doctor Bobby Mahajan.
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Bobby Mahajan is nationally
recognized as a leader in
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interventional pulmonology, and
he is also the medical director
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of the Interventional
Pulmonology Program at Inova Um.
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His areas of expertise include
procedures for diagnosing lung
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cancer, treating cancers within
the airways, management of
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airway complications following
lung transplantation, and a
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procedure known as Bronchoscopic
lung volume reduction blvr for
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patients with severe emphysema.
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He also oversees Inova
Incidental Lung nodule program
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um, which is essentially when a
lung nodule is noted not with
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intent for looking for IT and
lung cancer screening program.
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So just to kick us off, Bobby,
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just what kind of drew you to
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focus on the lung cancer side of
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things?
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Lung research?
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Care?
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Sure.
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Um, well, thanks for having me,
everyone.
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I actually was went to med
school there in Toledo, Ohio,
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then was at, um, in University
of Chicago for eight years doing
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my pulmonary critical care
fellowship in residency.
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And then I did, uh,
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interventional pulmonary
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fellowship at Mass General in
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Beth Israel.
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And that was kind of a
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subspecialty of pulmonary
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critical care.
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I mean, if we look at what
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interventional pulmonary is, it
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has actually only been around
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for like twenty to twenty five
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years.
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And in general, when we look at
a pulmonologist or a critical
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care doc, they're focused on
just general kind of, um,
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diagnostics of the lungs.
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And critical care docs take care
of people who are critically ill
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in the ICU.
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And in the past, there's been a
small component of that which
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has been procedural, meaning
they'll do procedures on the
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pleural space they'll do, which
is the space around the lung,
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but between the chest wall or
within the lungs.
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For biopsying different types of
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lung masses and tumors that are
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in the airways, things of that
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nature.
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So about in two thousand is when
the actual profession really
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developed as having
interventional pulmonology, of
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only doing procedures on the
airways, within the lungs,
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within the pleural space.
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And it ends up being, um,
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relatively I wouldn't say always
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high risk, but they're higher
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risk procedures because you're
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dealing with the airway and
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usually.
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So, um, what we've seen, what
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has evolved in the last twenty
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years is that the technology has
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evolved immensely, meaning that
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we can, you know, biopsy nodules
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that are three millimeters in
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size.
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Whereas in the past we were
biopsying things only if it was
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about three centimeters in size.
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That's the only way we can get
to them.
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Um, we are doing robotics now.
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We have airway tumors that are
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blocking the airways that we can
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actually really endobronchially
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resect.
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Uh, but a lot of that comes to
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the fact that we're taking care
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of patients with cancer, mostly
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lung cancer.
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Lung cancer itself is very
challenging to take care of and
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treat and cure, mainly because
there are no symptoms in its
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early stage, right?
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When people develop symptoms,
it's usually because they're
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having advanced disease and
they're getting symptoms
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because, you know, tumors have
moved out of the lung.
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So incidental lung nodules, lung
cancer screening, things of that
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nature is trying to develop ways
of finding these nodules early
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when they can be diagnosed, uh,
surgically or radio or radio
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treating with radiation oncology
and actually curing them.
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The problem is how do we find
them early?
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And that's really what we've
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been focusing on a lot at Inova
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Schar, but also at this center
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as well.
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So let's maybe dig into that
just a little bit more.
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So how do you think about the
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patients that should come and
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see you and qualify for that
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early screening.
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Yeah.
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So that's a great question.
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I think we run into it's complex
like an onion.
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Lots of layers there.
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Right.
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So if we look at what are the
high risk individuals for lung
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cancer, what we typically will
look at, who are individuals who
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should get screened are people
who are between fifty and eighty
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years old, okay.
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They've smoked and we consider a
significant amount and we call
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it twenty pack years.
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And that really means you
multiply the number of years you
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smoked by the number of packs
you smoke a day.
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So, for example, if you smoke
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two packs per day, if you smoked
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it smoked for ten years, you
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multiply those two is twenty
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pack years.
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Okay.
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Same thing is, if you've smoked
a pack a day for forty years,
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forty pack years.
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So someone above twenty pack
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years would qualify for lung
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cancer screening.
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And then last, someone who is
currently smoking or has quit in
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the last fifteen years.
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Okay.
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So that's what we kind of look
at is the the task force for
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lung cancer screening.
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Now these are constantly
evolving.
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So for example, the American
Cancer Society has actually said
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look, in the near future we're
going to take away the smoked in
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the last fifteen years.
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Right.
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Because really you can have
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plenty of patients who have quit
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within, you know, after prior to
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fifteen years who get lung
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cancer.
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So that's about eighty percent
of the people who get lung
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cancer are smokers.
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So if you fall into those three
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categories, you fill all of
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those.
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You should get screening for
lung cancer, get screened.
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Even more challenging now is we
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have a significant number of
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individuals who get diagnosed
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with lung cancer who have never
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smoked.
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So we have twenty percent of
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people with lung cancer have
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never smoked.
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And are you seeing that?
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That's because of pollutants
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they're exposed to in the field
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of work.
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You're just sort of combination.
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Can't figure out why.
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Well, combination.
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But the I mean, for better or
worse, we're starting to get
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more and more data.
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So I don't think it's new that
it's been going on.
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We just never really paid
attention to it.
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And part of it's because we just
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didn't have a way of knowing who
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they were.
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And as time has gone, kind of
time has kind of collected and
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we get this data more and more.
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We've seen that individuals with
significant genetic mutations
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have a higher incidence.
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And the main one is what we call
EGFR.
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Okay.
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Um, and if we look at EGFR
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mutations that's seen in
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patients, they have a higher
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incidence of getting lung
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cancer.
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Now, the majority of individuals
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who have an EGFR mutation that
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leads to a lung cancer are Asian
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females.
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So the DMV has a significant
population of Asian females.
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You also see an Asian males and
sometimes you see a non-Asian
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individuals as well.
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But the predominance occurs in
Asian males and females.
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So you kind of say, well, am I
supposed to get screened?
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Now we look at the data
longitudinally over the last ten
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to fifteen years where we've
looked at lung cancer screening.
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If you screen everyone, you end
up getting a ton of false false
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positives, meaning that, you
know, the lungs are one of the
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few organs that are exposed to
the air, right?
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So you go into a bar, you go
somewhere.
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You know, Sam, I'm sure, has
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been exposed to all these
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things, right?
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But, you know, you breathe in.
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Yeah, but you inhale something
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that's irritating your body
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naturally creates a little bit
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of a granuloma or a wall around
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it.
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Right.
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And it looks like a nodule.
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Right.
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So if we screen everyone, right,
you're going to find a lot of
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nozzles and one, you're not
gonna you're not going to biopsy
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them because they're low
likelihood, but two, you freak
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these people out appropriately.
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They say, oh, you have a nodule.
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And what is our answer?
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Well, yeah, we don't know
exactly what it is yet.
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So we have to get more data.
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The challenge, even more so is
that a patient who has a high
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risk for lung cancer falls in
those category of a high risk
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patient who should get lung
cancer screening, twenty six
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percent of those people will
have a nodule.
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Yeah.
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Okay.
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So you look at it, you see the
nodule.
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And appropriately they're a high
risk person.
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They have a nodule.
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People get worried.
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Only one percent of those that
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twenty five percent actually has
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cancer.
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So again it becomes a situation
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where yeah, don't get me wrong,
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lung cancer screening is in its
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infancy, right?
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It's only been about since
twenty eleven.
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So fourteen years compared to
breast cancer.
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Colon cancer.
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But it's a it's a hard kind of
screening process to do because
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it's not just by age.
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It's by risk factors as well.
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So you know we say should you
get screened.
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The people I recommend screening
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are again, Definitely the people
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who fall into that category, and
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it's a real quick, low dose CT
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scan.
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We do them here at Inova all
day, every day.
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Um, and then the other group,
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because they don't necessarily
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fall into the high risk
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category.
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We usually say people who have a
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family member who has had a
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nonsmoking lung cancer, if
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you're a sibling, a daughter, or
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some of that son, we recommend
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getting screened.
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Um, but unfortunately, you know,
again, guidelines are for people
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who don't do this every day.
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Right?
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For us, we say that, yeah, if
you have that risk factor, we
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want to get you screened.
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The insurance doesn't always
cover that.
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Right.
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So we are fortunate at Inova in
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Northern Virginia, we've created
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a kind of a program that if you
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want to get screened, even if
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you don't qualify, you're paying
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about one hundred and fifty
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dollars for the screen as
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opposed to, you know, getting
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denied in other places around
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the country.
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Pay like a thousand dollars for
a CT scan.
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So we're trying to make it
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easier, partly because it's just
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accessible.
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You know, it's it's hard to set
up a lung cancer screening
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program because it takes a lot
of resources, but it's just the
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right thing to do.
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Um, and, you know, there's also
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this stigma around lung cancer
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screening where people have
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smoked were like, look, either
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they don't want to know or, um,
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they say, look, I did this to
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myself.
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Right.
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You know, I shouldn't have
smoked one.
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Smoke is an addiction.
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So it's not like something you
just, you know, you stop.
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Okay?
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People who can stop right away,
more power to them.
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But it's very challenging.
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The second part is if you look
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at American culture, you know,
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in the last, you know, half a
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century, smoking has been part
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of, like, the fabric of what we
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do.
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There were doctors smoking.
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We smoked on planes not that
long ago, like twenty years ago.
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Right.
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So, you know, what I tried to
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tell people is, look, this is
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not something that you're doing
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to yourself, but frankly, we can
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do a screen and we can find it
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early.
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This is curable.
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Early stage disease, ninety five
percent cure rate in five years.
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We just got to get them in and
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make it feel comfortable for
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them to come in and talk about
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it.
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So that's part of my job going
back to, um.
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Thanks, Bobby.
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That's very helpful.
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You know, as you're talking
about the nonsmoking.
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Incidence of lung cancer.
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And I know it's a complicated
question, and you've sort of
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answered a little bit of the.
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Why are we just catching more of
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these lung cancers in
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nonsmokers?
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Because we're just doing more
CTS.
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And is there a way to great
question.
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That's you know, that's a deeper
dive into it.
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But really, if we look at data
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and incidental lung nodules and
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like you said, Sam, you're
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totally right.
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It's a nodule that gets detected
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for when you're looking for
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something else.
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So for example, someone comes in
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with chest pain to the ER,
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right.
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Everyone gets a CT scan nowadays
because again, CT scans give us
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a lot of data.
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It's not a bad thing right?
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But you end up finding a nodule
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that, um, we didn't expect to
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see.
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Right.
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So in in all honesty, if we look
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at the data and we do a lot of
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data with incidental lung
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nodules here, Fairfax and Inova
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system, because we just have a
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lot of patients coming through
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our ERS.
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Um, we in the last five years or
so and we just submitted this
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paper for review.
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We have about ten thousand
nodules that came through.
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And of those ten thousand
nodules, there's about one to
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two percent developed or found
to have cancer.
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Now one to two percent of one
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hundred, not that many, but one
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hundred one to two percent of
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ten thousand is a lot of
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patients.
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The challenge we run into is
about fifteen percent of those
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are metastatic disease from
somewhere else, which again,
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they didn't know about.
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We find a nodule in the lung and
we diagnose it ended up being
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breast cancer or colon cancer or
another that the rest of that,
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that other, you know, eighty
five, eighty percent end up
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being primary lung cancers.
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We broke that down a little bit
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further, and about only about
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thirty percent of those
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individuals actually would have
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qualify for lung cancer
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screening.
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Most of it's by age.
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So that means that they are
younger than the fifty to eighty
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cutoff, or they're older than
the eighty years old.
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So we want to screen them.
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But again, it makes you look at
this even further that about
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twenty percent of those people
as well, just like we talked
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about from a numbers.
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Never smoked.
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Had no reason to have a cancer,
right?
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We we we tested them once we
diagnosed them.
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And it ends up being about sixty
percent had an EGFR mutation.
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So, um, I think that it's not
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that we're not looking for it as
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much.
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I think two factors.
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One, when someone had lung
cancer and they never smoked in
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the past was like, oh, well,
that's just a fluke.
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But now we're actually putting
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all this data together from
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different institutions that do a
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lot of lung cancer screening and
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IP and thoracic oncology, like,
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oh my God, like we are seeing
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this twenty percent change,
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right?
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The second part of that is I
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think that, you know, like you
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said, we're just seeing so many
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patients, right?
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And they're getting tracked.
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And the problem is eighty five
percent of people normally, if
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they get diagnosed with lung
cancer is at an advanced stage
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because there's no symptoms.
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Right?
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So when we end up now in the
increased incidental is that
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statistic still hold now with
the increase of.
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So with screening and increased
incidental finding it's still
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about eighty five percent.
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So we've again looking at our
data.
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We've actually done really well
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sixteen percent will get early
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stage.
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So if you have an incidental
lung nodule program that's
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really organized and developed,
you know, it's about twenty six
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percent early stage.
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So you make that huge what we
call stage shift.
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You're early diagnosing them
earlier.
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Again incidental programs are
not easy to develop.
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Takes a lot of resources.
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Right.
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So if we can implement these we
ship that stage earlier disease.
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But I think that what we're
running into unfortunately, is
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that with the advent of kind of
understanding the genetic
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mutations that are associated
with lung cancers, that's where
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it's really picked up in the
last fifteen, twenty years,
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like, oh my God, like, why are
these patients coming in and not
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having lung cancer?
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The fact that we've established
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these mutation analysis, that
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can show why I think people are
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really starting to pick it up,
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because it used to be like,
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yeah, we can't do anything about
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it.
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You got lung cancer like it's
terrible.
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But, you know, unfortunately we
couldn't look for this.
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Now that we have mutation
analysis where we can say, look,
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if you have an EGFR mutation,
you're a non-smoker, you're
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relatively healthy because
you're non-smoker, right?
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Sometimes you're just taking a
pill as treatment with
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metastatic disease all over the
place, and patients have better
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disease free survivals.
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And sometimes these tumors just
melt away, right.
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So it's a it's a totally
different world we live in than
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ten years ago.
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So we try and tell our lung
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cancer patients, honestly, I
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have these I have these
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conversations all day, every day
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telling people they have lung
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cancer, right.
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Because we biopsy them.
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I know usually in the recovery
area, based on what we saw in
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the room, that this lung cancer
or not, I talked to them and
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this is the first time they're
hearing they have lung cancer.
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I really do tell them.
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It's like, look, it's not a
question of diagnosing you.
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It's getting the more kind of
granular data about what your
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mutation analysis is.
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Because if your mutation
analysis shows that you have one
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of these other, you know,
there's seven or eight mutations
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that are really actionable,
you're going to do just fine.
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We're going to turn this into a
chronic disease, okay?
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It's not going to be the death
sentence.
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It was ten years ago.
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Yeah.
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So all of the mutation analysis
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kind of how we treat that is
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late stage.
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Right.
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We still look at it for an early
stage because frankly, you know,
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you never know.
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In the future, if it recurs,
you'll be able to treat late
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stage disease as well.
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With those early stage disease,
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the standard of care is still,
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you know, minimally invasive
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surgery or radiation because
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there's that's where survival is
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really exceptional.
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Now what you really look at is
can we get you to a disease free
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state that you might have
disease in your lymph nodes, you
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might have disease in your
lungs, all of your body.
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Our goal is to try and targeted
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mutation, which is a targeted
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therapy, so that you don't have
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the same side effects as
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chemotherapy.
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Try and clear it from wherever
it can in your body.
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And then if we can treat with
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radiation or surgery that
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primary site, we consider that
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disease free.
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And that's where a ton of people
live.
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There's a lot of people living
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around that are walking around
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doing normal activities,
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functioning, and are in disease
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free state because they
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benefited from these kind of,
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uh, different types of
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treatments.
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And have you been doing these
treatments long enough to sort
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of see, like, what's the
lifespan of a patient that is
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considered disease free.
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So disease free is one.
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It's super individual meaning
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that some people I mean, I know
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patients ten years have had
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disease free states and they
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were diagnosed, started on EGFR,
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a drug.
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And again, they're getting
checked on a regular basis.
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Right.
Speaker:
But they're not uh, they're not
imminently dealing with the side
Speaker:
effects of cancer.
Speaker:
Um, but I mean, the data will
show that there's no improvement
Speaker:
in survival, but there's an
improvement in disease free
Speaker:
survival, meaning that the
amount of time they actually
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have disease is minimal compared
to the time they die, compared
Speaker:
to someone who, again, had
raging disease, unfortunately
Speaker:
passed away early, but they were
miserable and symptomatic.
Speaker:
Walk us through kind of what
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it's like for a patient who, um,
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maybe the incidental lung nodule
Speaker:
program.
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Right.
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And incidental.
Speaker:
It could be either.
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Maybe they have similar, similar
trajectories.
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Um, proper.
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Like a qualified screening.
Speaker:
What happens next?
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Or you got a call or follow up.
Speaker:
You know, perfect example.
Speaker:
Someone like you said goes to
the ER, gets a CT looking for
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something else completely.
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They're discharged home.
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Doing great.
Speaker:
Doctor Mahajan, we'd like this
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person to see you in your in
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your office.
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We found a lung nodule.
Speaker:
Sure.
Speaker:
How does that go?
Speaker:
What's the timeline for that?
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What are the steps?
Speaker:
And I know it's not obviously
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the same for every patient, but
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high level.
Speaker:
Like what?
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That look like.
Speaker:
So, I mean, luckily, again, we
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have a relatively robust
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research program.
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So we have all this data.
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We've looked at it at Inova to
make sure that it is the best
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and the shortest amount of time
for all of that.
Speaker:
So if you look nationally in
general, if someone gets
Speaker:
identified with a lung nodule
and this is crazy to me, but
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this is how the world works.
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Unfortunately, if someone gets
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found to have a lung nodule to
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diagnosis, the average is about
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six months, which is ridiculous,
Speaker:
right?
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Someone comes in with a and
again, depending on the size,
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there's a that's an average.
Speaker:
But if you just because of wait
times getting people in wait
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times, I'll tell you.
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We look at the care continuum.
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Most places someone gets a
Speaker:
nodule from the E.R., what do
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they do?
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They only thirty percent of
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patients are actually told they
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have that nodule or follow up on
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that nodule.
Speaker:
So seventy percent of patients,
they don't even know it, right?
Speaker:
Then they have to go see their
primary care doctor.
Speaker:
And their primary care doctor
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says, oh yeah, you have a
Speaker:
nodule.
Speaker:
We got to do something about
this.
Speaker:
So what do they do?
Speaker:
Understandably, they send them
to an oncologist.
Speaker:
Oncologist is like, I can't do
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anything until I get a biopsy,
Speaker:
right?
Speaker:
They send them to the the person
to biopsy, and it might not be
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the right person to biopsy
because there's tons of us who
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do different biopsies.
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They finally get the biopsy
again.
Speaker:
They wait a couple of weeks to
get that biopsy.
Speaker:
Then they go back to the primary
care, who then sends them back
Speaker:
to the oncologist and then says,
oh, well, you know what?
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To actually know what to do
next.
Speaker:
We have to do another test.
Speaker:
That's why I kind of just draws
out for a long time.
Speaker:
So six months, I think stress
point.
Speaker:
Yeah.
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It's not even a question of you
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hear that you have a C word the
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fastest.
Speaker:
The only want the most is to
have quick answers.
Speaker:
And I know you want to know.
Speaker:
Right?
Speaker:
And it the, the the actual
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mental anguish that goes with it
Speaker:
versus the procedures is like
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nothing, right?
Speaker:
The procedure is nothing.
Speaker:
But the language is terrible.
Speaker:
Right.
Speaker:
And then once you actually get
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diagnosed, depending on what it
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is, then you either go to
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oncology or you go to surgery or
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radiation.
Speaker:
Now the terrible part about this
is that six months, right?
Speaker:
Every three months you jump a
letter in the staging, right?
Speaker:
So, for example, if you were to
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say in three months you go to
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Tooby and in three more months
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you've now graduated to three A,
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which is considered advanced
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disease.
Speaker:
Right.
Speaker:
So the amount of time it really
is critical, right.
Speaker:
So if you and then you're you're
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this is what we found that
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eighty four percent of people
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are metastatic.
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They might not have been
Speaker:
metastatic when they first found
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a nodule.
Speaker:
But they then can fall into that
category for how long it takes
Speaker:
to get in.
Speaker:
Right.
Speaker:
So is Inova doing things to
shorten that process?
Speaker:
So we're incredibly lucky that
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we have the support to actually
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develop these.
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And luckily our oncology
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department, our radiation
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department, and most importantly
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and I you know, I can say this
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to the big man deacon has been
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very supportive of developing
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this.
Speaker:
So there if you look at this, if
someone finds a nodule, say
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someone goes to er, they get a
nodule on the CT scan, they say,
Speaker:
well, whose job is it to follow
up on that?
Speaker:
So what we have and what is
really state of the art now is
Speaker:
that we have software that every
time someone says the word lung
Speaker:
nodule in, in a radiology
report, it gets dropped into a
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bucket for us.
Speaker:
And this is within the health
record.
Speaker:
So meaning let's use your
Speaker:
example in the last month I'm
Speaker:
totally making up numbers right
Speaker:
now.
Speaker:
One hundred patients go through
our ERS get discharged.
Speaker:
Lung nodule is noted on a
radiology report.
Speaker:
And let's, for the sake of
argument, pretend that they
Speaker:
didn't get a follow up arranged
or nobody even told them.
Speaker:
But the software within your
program would catch.
Speaker:
Yes.
Speaker:
So someone logs into the
Speaker:
computer, sees ten patients, by
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the way, have rolled through our
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ERS, and they have a report that
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says lung.
Speaker:
And that's about what we see
every day.
Speaker:
So in all the acute care kind of
Speaker:
facilities in the nervous
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system, they will drop into a
Speaker:
bucket.
Speaker:
And we have four different
Speaker:
navigators who look through this
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every single day, about ten
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every day.
Speaker:
And they will then look at the
size of the nodule, look at
Speaker:
their risk factors.
Speaker:
If it's low risk, the patient
and their primary care doctor
Speaker:
will get a note, a letter, and a
message that this person has a
Speaker:
nodule just to let you know, uh,
low risk, but it's something you
Speaker:
should follow up on.
Speaker:
Anything above six millimeters
or so, or high risk factors.
Speaker:
That person automatically gets a
call and gets told, look, this
Speaker:
nodule is found.
Speaker:
You're in a high risk category.
Speaker:
Either we can have you follow up
your primary care, but what we
Speaker:
have in Nova is a dedicated lung
nodule clinic, an incidental
Speaker:
lung nodule clinic.
Speaker:
And again, like you said, what
do people say is like, yeah, I
Speaker:
want to get seen.
Speaker:
They can get seen that same week
in the nodule clinic.
Speaker:
Right.
Speaker:
And what is the reason for the
option?
Speaker:
The reason for the option is
there are some people who say,
Speaker:
look, man, I like I don't really
they might not be a part of the
Speaker:
Nova system, right?
Speaker:
They came from somewhere else.
Speaker:
They're like, no, I'll go, I'll
follow.
Speaker:
I have this other resource I'll
make sure I follow.
Speaker:
And my primary care doc.
Speaker:
No problem.
Speaker:
Right.
Speaker:
So we say that's not a problem
at all.
Speaker:
We just want to make sure it's
taken care of.
Speaker:
So if you feel comfortable
Speaker:
following them and they get the
Speaker:
report, they get the letter as
Speaker:
well.
Speaker:
Okay.
Speaker:
And frankly, our our navigators
Speaker:
will contact their primary care
Speaker:
if they want within forty eight
Speaker:
hours.
Speaker:
So most prefer for an
appointment.
Speaker:
And the incidental lung clinic
for the high risk slash greater
Speaker:
than six millimetres.
Speaker:
Correct, would be forty eight
hours in the incidental correct.
Speaker:
And the reason for that is
again, you need to be able to
Speaker:
risk assess them.
Speaker:
You need to be stratify them.
Speaker:
But our ER docs also know about
this program.
Speaker:
So I can't tell you how many
patients who are literally
Speaker:
they'll they'll get a CT scan.
Speaker:
It shows for example a four
centimeter mass.
Speaker:
Right.
Speaker:
And they're outpatient.
Speaker:
They the er doc will call us and
Speaker:
we'll see them that day in
Speaker:
clinic.
Speaker:
Right.
Speaker:
Because they came in for some
chest pain.
Speaker:
There's no it's not, it's not
heart related.
Speaker:
But there's a mass.
Speaker:
They'll just come over and get a
diagnosis.
Speaker:
No longer is it six months.
Speaker:
It can be six hours.
Speaker:
So.
Speaker:
Yes.
Speaker:
Well, and they were taking the
so that to your point, the
Speaker:
timeline is obviously a crucial
part of this, right.
Speaker:
Both because of the the
Speaker:
psychological effect that dating
Speaker:
so long can have, but equally
Speaker:
importantly, the fact that
Speaker:
cancers grow if it's in fact the
Speaker:
cancer.
Speaker:
But you're also correct me if
Speaker:
I'm wrong, taking a lot of the
Speaker:
complexity of healthcare out of
Speaker:
the equation.
Speaker:
Totally.
Speaker:
You're not putting on the
Speaker:
patient or the constant
Speaker:
redirecting of is it the
Speaker:
oncologist?
Speaker:
Is it the primary care?
Speaker:
Is it the pulmonary doctor?
Speaker:
Yeah, the program sort of takes
that on.
Speaker:
And you say you just land here
Speaker:
and we're going to navigate this
Speaker:
for you.
Speaker:
Well, and that's where it comes
down to is like literally we cut
Speaker:
out all of the, the confusion
because again, I'm not going to
Speaker:
lie, it's hard to be a patient
coming on the air with a
Speaker:
diagnosis and you're supposed to
follow it up.
Speaker:
It's very challenging no matter
the best health system ever.
Speaker:
Right.
Speaker:
But you're waiting regardless
because health systems are busy.
Speaker:
So we really cut out the
middleman.
Speaker:
And and I will admit, you know,
Speaker:
the way I look at it is like
Speaker:
this is the best thing for the
Speaker:
patient, right?
Speaker:
It is.
Speaker:
And the patient likes it.
Speaker:
So the patients are very happy.
Speaker:
And so we look at our finding
the nodule to diagnose this time
Speaker:
is about forty days.
Speaker:
Right now I still think forty
days is high for me.
Speaker:
Right.
Speaker:
The challenge ends up being not
Speaker:
so much the, um, the getting the
Speaker:
patient in the biopsy, but
Speaker:
sometimes the patient be like,
Speaker:
look like I want to wait a
Speaker:
little bit.
Speaker:
I want to look at this like, I,
Speaker:
I'm not ready to go for a biopsy
Speaker:
tomorrow.
Speaker:
Right there are the fastest you
I mean so so looking for fastest
Speaker:
for, you know, other than to say
remove that out of the equation.
Speaker:
Yeah.
Speaker:
So assuming a patient who is on
Speaker:
board ready to go I'm you're
Speaker:
immersing.
Speaker:
Yeah.
Speaker:
What would that timeline look
like.
Speaker:
It can be.
Speaker:
It could be five days.
Speaker:
So there is a patient that last
week and again two weeks ago um,
Speaker:
ended up having uh, a nodule.
Speaker:
It was, it was actually more I
Speaker:
would say it's a mass, um, had a
Speaker:
brain lesion.
Speaker:
The reason they came in is
Speaker:
because they were having a
Speaker:
tremor.
Speaker:
That was all of a sudden new.
Speaker:
We saw them on a Wednesday.
Speaker:
Um, they had some cardiac
Speaker:
issues, so we had to get cardiac
Speaker:
clearance.
Speaker:
We biopsied them on, um, Monday.
Speaker:
My pathologist, uh, doctor, me
and Benitez, Romanian as well.
Speaker:
They have really fought hard to
Speaker:
get all of that testing that's
Speaker:
done in-house.
Speaker:
So we could do an EGFR test in
at Inova, whereas sending it out
Speaker:
right here about sending it out.
Speaker:
Yeah, most of everywhere.
Speaker:
Most places in the country
Speaker:
outside of like, major academic
Speaker:
centers, it takes about three
Speaker:
weeks to get those mutations
Speaker:
back, which again, is terrible,
Speaker:
right?
Speaker:
Yeah.
Speaker:
Um, got the EGFR mutation back.
Speaker:
Yeah.
Speaker:
For the patient.
Speaker:
Yeah.
Speaker:
Back on Wednesday, she started
Speaker:
on Tarceva, which is the
Speaker:
treatment that EGFR pill on
Speaker:
Friday.
Speaker:
Right.
Speaker:
So we have the capabilities of
it.
Speaker:
And you know, we don't treat our
horns enough from an oncology.
Speaker:
Our oncology docs are amazing.
Speaker:
And it is one of those
Speaker:
situations that I say, look, you
Speaker:
know, Rahm, I mean, I biopsied
Speaker:
this person.
Speaker:
They have cancer.
Speaker:
Can you see them tomorrow?
Speaker:
Right.
Speaker:
They literally would be like,
yep, put them in.
Speaker:
I actually messaged me last
week.
Speaker:
I'm like, all right, there's a
patient.
Speaker:
Can you see him next week?
Speaker:
He goes, why do you want to wait
till next week?
Speaker:
And my brother fine.
Speaker:
But I mean like they'll see you
in two days, right?
Speaker:
So it is one of those situations
where you know, is doing the
Speaker:
right thing is not always the
easy thing to do.
Speaker:
Like, you got to fight, you got
to build this infrastructure.
Speaker:
And we've spent ten years
Speaker:
building this infrastructure,
Speaker:
right.
Speaker:
So now when it comes to lung
Speaker:
care, not only from an oncology
Speaker:
standpoint, but if someone needs
Speaker:
to get resected again, I will
Speaker:
call someone in the recovery
Speaker:
area.
Speaker:
That is early stage disease.
Speaker:
It's in one spot.
Speaker:
I'll call Mike Ryan, my partner,
and he'll get them in the next
Speaker:
week for surgery.
Speaker:
Right.
Speaker:
So it is it is treating not only
Speaker:
the disease process, which is
Speaker:
important, obviously, but the
Speaker:
mental part, the kind of the
Speaker:
treating the family because they
Speaker:
don't know what's going to
Speaker:
happen.
Speaker:
You don't want to wait six
months to have that happen.
Speaker:
You want to know right away.
Speaker:
And again, you know, in some
Speaker:
ways, um, we make it a little
Speaker:
less sustainable for the staff,
Speaker:
right?
Speaker:
It's hard on the staff.
Speaker:
Like I tell my coordinator,
Speaker:
like, can we get them in
Speaker:
tomorrow to biopsy them and see,
Speaker:
you know, you know, the oncology
Speaker:
department and surgery next
Speaker:
week?
Speaker:
Like, dude, you don't have any
Speaker:
openings there making things
Speaker:
happen.
Speaker:
And, uh, it is, but they find a
way, right?
Speaker:
So it is a full team, right?
Speaker:
The doctors again, don't get me
Speaker:
wrong, we're there to do what we
Speaker:
are trained to do, but none of
Speaker:
it happens without all the staff
Speaker:
in charge of making sure these
Speaker:
things happening.
Speaker:
Right.
Speaker:
Like it.
Speaker:
And it doesn't mean just people
in charge.
Speaker:
Like, I can be like, I need to
get cardiac clearance.
Speaker:
They got us cardiac clearance
with our oncology, with our
Speaker:
cardiologist in a day.
Speaker:
Right.
Speaker:
They know that this time is
essence.
Speaker:
They know that it was on their
side.
Speaker:
We would do it for them.
Speaker:
Um, so it really is a very
Speaker:
unique, uh, not only program but
Speaker:
like, institution we work in
Speaker:
right now.
Speaker:
Yeah.
Speaker:
So we are just about out of
Speaker:
time, and I think it would be
Speaker:
awesome.
Speaker:
Leave our listeners with a what
should they take away from this?
Speaker:
If they're hearing this and
Speaker:
they're like, gosh, am I at
Speaker:
risk?
Speaker:
Like, how should they be
thinking about that?
Speaker:
I think that, you know, one of
the biggest things for a patient
Speaker:
to do is to advocate for
themselves in a lot of ways.
Speaker:
Meaning that if you are
concerned that you might be at
Speaker:
high risk for from a smoking
standpoint, whether it's, you
Speaker:
know, fifty to eighty years old
again, twenty pack years quit in
Speaker:
the last fifteen years or
currently smoking, you know,
Speaker:
talking to your primary care
doctor about lung cancer
Speaker:
screening is essential.
Speaker:
But also feel free to call
Sybil.
Speaker:
Call the hospital.
Speaker:
Get a be an advocate for
yourself and say, I want to come
Speaker:
in for lung cancer screening.
Speaker:
Right.
Speaker:
Thank you so much.
Speaker:
That's so insightful.
Speaker:
Thanks, Bobby.
Speaker:
That was great.
Speaker:
We appreciate it.
Speaker:
Thanks for tuning in.
Speaker:
We hope you enjoyed this
episode.
Speaker:
If you liked what you heard, be
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