The Importance of Risk-Based Lung Cancer Screening for Prevention: Prof. Dr. Peter Kleine on Changing Trends

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00:00:35: Today we are talking about a very important topic, lung cancer prevention and modern therapy procedures.

00:00:43: Our guest is Professor Dr Medpeter Kleiner Chief Physician of Thoracic Surgery at the Sunner Clinicum Offenbach.

00:00:51: He's considered a distinguished expert in minimally invasive lung surgery And complex thoracic surgical procedures.

00:00:59: It's great to have you with us today professor Kleiner.

00:01:02: Hello and from my side as well, I'm truly delighted that we have the opportunity to discuss this very important and highly topical subject here today.

00:01:10: Professor Kleiner what is approximately the number of people suffering from lung cancer in Germany?

00:01:16: Yes there are figures available from the Federal Statistical Office for twenty-twenty four which clearly indicate that in the past year fifty eight thousand individuals were newly diagnosed with lung cancer.

00:01:26: This means quite simply If we break down these numbers further, there are about twenty-four thousand five hundred women and thirty three thousand Five Hundred men.

00:01:40: This means more Men than Women get this type of cancer.

00:01:45: However the number of women is steadily increasing while The Number Of Men Is experiencing a slight decrease.

00:01:50: Overall Lung Cancer is the second most prevalent Type of Cancer in Germany following Female Breast Cancer.

00:01:57: Could you briefly explain what exactly causes this lung cancer rate?

00:02:02: Well, traditionally it was always commonly said that lung cancer is a self-inflicted form of cancer due to smoking.

00:02:09: Today however we are much more nuanced and differentiated in our understanding.

00:02:14: there are genetic factors specific mutations within our human genome which can also be significantly responsible for the development of lung cancer.

00:02:23: And not least because of this, we have observed a significant development leading to a convergence in the traditional gender roles regarding disease prevalence.

00:02:30: Women are now suffering from the condition more frequently and men less so primarily because women exhibit these specific genetic alterations at higher rate compared to men.

00:02:40: Well... We approach that subject with great deal nuance today but smoking undoubtedly continues play an important role in developing and onset lung cancer And the most effective means of preventing this disease in yourself is to maintain a lifestyle of non-smoking.

00:02:54: What role do environmental influences play anymore?

00:02:58: Right, so its important particulate matter is certainly very an important topic.

00:03:02: Asbestos is still an issue even though it hasn't been used in Germany for thirty years but the latency period between asbestos exposure and cancer is upto forty years... ...and clearly more people get lung cancer in cities than on countryside!

00:03:18: A malignant tumor associated with lung cancer typically does not cause any pain in the early stages.

00:03:25: How can patients, both male and female recognize or determine for themselves if there is potentially something wrong or amiss?

00:03:35: Yes unfortunately ninety percent of all lung cancer diagnoses when they are in the earlier stage where a curative treatment still possible our completely asymptomatic and this naturally leads us to our topic for today.

00:03:49: We really need to focus on prevention before any symptoms even show up, And the typical symptoms when we're talking about lung cancer are often of course a persistent cough but This is a symptom that many people experience Even those who do not have lung cancer at all If the sputum you cough up as bloody.

00:04:08: That's certainly something that requires immediate and thorough diagnostic investigation But unfortunately, most lung cancers only cause symptoms when metastases have already developed.

00:04:20: Why does lung cancer continue to represent such a significant medical challenge?

00:04:24: Both in terms of early detection and its effective treatment?

00:04:28: Yes!

00:04:29: In Early Detection due the complete absence of symptoms.

00:04:33: And it's treatment because Lung Cancer is very aggressive tumor that if left untreated can lead death within just few months and that is what makes it so difficult.

00:04:45: However, we have made very significant progress in the treatment of lung cancer not only surgically but also through pharmacological treatment meaning that we are now achieving a significantly greater number of successes even in advanced tumor stages.

00:05:00: But nevertheless It remains an aggressive cancer

00:05:04: And for which patient groups do you recommend a regular preventive health checkup?

00:05:09: or should everyone simply be aware and have their lungs thoroughly examined?

00:05:14: No, there are clear criteria.

00:05:16: that has now been established by the Joint Federal Committee which is a body comprising health insurance providers medical experts and politicians who precisely defined what patients should undergo preventive health screenings.

00:05:29: This firmly rooted in extensive empirical studies conducted not only in USA but also across Europe And the patients who have been smoking for a considerable period of time benefit, what does that mean?

00:05:42: This should be done from the age of fifty.

00:05:45: For younger patients this is currently not recommended and if you've smoked a pack of cigarettes for more than twenty years... ...this means someone who smokes only half-a-pack needs twice the time forty years to reach that!

00:06:00: A person who smokes two packs daily needs only ten years.

00:06:05: So, we are talking about chronic smokers.

00:06:08: And if you eventually stop smoking which we observe in many patients an elevated risk still persists for fifteen years.

00:06:18: so If your fifty-years or older and have smoked a pack of day For more than twenty years You should go for lung cancer screening even if you have no symptoms.

00:06:30: What is the diagnostic procedure at your hospital?

00:06:35: So first of all, when we discuss the topic of screening there are very clear guidelines because unfortunately in a regular x-ray image and this is quite different from breast cancer where we use mammography.

00:06:45: We often cannot identify lung cancer.

00:06:47: that is precisely why a computed tomography scan is absolutely necessary.

00:06:52: This is now possible with radiation exposure That's roughly equivalent to a single X ray image.

00:06:59: were referring to what's known as low dose CT where only a minimal amount of x-rays are utilized.

00:07:06: No contrast medium needs to be administered, and this allows us detect whether tissue changes have formed in the lungs.

00:07:13: We call these round lesions because they initially appear quite round And then these CT scans are evaluated by specialist X-ray doctor A radiologist.

00:07:26: Should there be any suspicious findings, these must be verified at a specialized lung cancer center such as the one we operate here in Offenbach.

00:07:34: Then – A decision is made!

00:07:35: Is simple follow-up sufficient or do need to immediately initiate further diagnostic procedures meaning obtaining tissue sample?

00:07:44: The sample can be acquired through minimally invasive procedure and sometimes via bronchoscopy which essentially a lungscope.

00:07:52: so you can already hear that several specialized disciplines are necessary.

00:07:56: The thoracic surgeon, then the pulmonologist who performs these bronchoscopies and the radiologist.

00:08:01: These three must work together very closely So that entire process leads to high quality results.

00:08:08: One more thing I forgot to mention which is also established Nowadays all CT scans for lung cancer screening Are evaluated by artificial intelligence.

00:08:20: It checks the entire lung tissue for round lesions and sometimes detects even the smallest ones, which we can barely see with the human eye.

00:08:30: This is a fundamental requirement for lung cancer screening.

00:08:33: Since when have you had this method of artificial intelligence?

00:08:37: This has developed over the course of last two years making it something that's very current & relevant.

00:08:42: However...it now being offered by manufacturers nearly all CT examinations And become an established standard practice today and not solely in the context of lung cancer.

00:08:53: Let's address the topic what happens if there is an actual diagnosis of lung-cancer?

00:08:58: Which surgical therapy methods do you then employ?

00:09:02: Yes, we've now taken a significant step forward.

00:09:05: We actually detected lung cancer as part our routine preventive examination.

00:09:09: The treatment plan will therefore once again be coordinated by several specialized medical disciplines The pulmonologist, the oncologist that is cancer specialist, thoracic surgeon and radiation therapist all sit together at a table.

00:09:24: They are joined by other specialized disciplines for example pathology which has taken thoroughly examined tissue sample with everyone present.

00:09:33: team then determines provides most appropriate treatment plan surgical procedures primarily utilized especially during very early stages.

00:09:42: That's why I'm sitting here as a thoracic surgeon involved in lung cancer screening, because through this process we genuinely hope to identify patients at much earlier stages.

00:09:52: Then the cancer itself is removed and if present any metastases of lymph nodes are typically operated on as well.

00:09:59: The smaller the tumor is ,the less invasive surgical procedure will be.

00:10:03: Could

00:10:05: you perhaps tell us more about your methods once again?

00:10:09: I'm specifically referring to the minimally invasive procedures.

00:10:13: You have a very particular technique that you consistently apply.

00:10:17: Yes, perhaps you could elaborate on that for us once more.

00:10:21: That's right.

00:10:22: So open surgical procedures For early tumor stages are now A thing of past.

00:10:27: Previously we didn't fully possess The necessary technology for minimally Invasive surgery.

00:10:33: Nowadays, however we operate in these early stages using what is known as the VATS technique.

00:10:40: That means video-assisted thoracic surgery and through keyhole incisions a camera is introduced into the chest cavity.

00:10:48: today it can provide us with images using three D technology or at least HD technology And With this We Can See Better Than With Open Surgery exactly where the cancer has grown, how the blood vessels run and so on.

00:11:06: For patients this offers the advantage of less pain quicker recovery and faster discharge from the hospital.

00:11:13: And when we talk about cancer treatment Hospital stays are always something We want to avoid.

00:11:19: nowadays a special procedure that we also offer here in Offenbach is robotic surgery.

00:11:27: Even more gentle surgical interventions are possible.

00:11:30: It would probably go into too much detail to describe each one of them right now, but whenever possible we utilize the robot because it causes even less pain and thanks to improved camera technology provides images that never have ever dreamed before.

00:11:48: This is quite a significant difference compared with conventional methods you've used.

00:11:53: Yes so in this area as well To ensure we can clearly recognize all the individual details, All of us here use magnifying loops which already enlarge everything by two to three times its original size.

00:12:05: And yet The human eye simply cannot deliver or capture these truly excellent images that We now have available for all our minimally invasive surgical procedures.

00:12:15: Well then there are Of course These complex operations such as Slevery sections Or combined interventions on the chest wall.

00:12:25: Could you perhaps elaborate a little more on those?

00:12:29: Right.

00:12:30: We're now at the complete other end of the spectrum, specifically advanced lung cancer cases where the tumor has already grown beyond its original point of origin.

00:12:42: These operations are typically performed as open surgeries though nowadays with incisions that are not as extensive as they once were.

00:12:52: Here, we've also developed our own specialized techniques to ensure the procedure is as gentle as possible for patients.

00:12:59: Sleeve resection means a tumor, for example originated in upper lung lobe and has progressively grown until it reached main bronchus And then... The goal not remove the entire lung but instead one still only removes the upper lobe reattaches other lung sections back on top.

00:13:18: This particular approach requires a highly experienced thoracic surgeon, but it provides the patient with the distinct advantage that the cancerous growth is removed just as radically while a significant portion of healthy lung tissue is preserved.

00:13:33: And what exactly are potential risks associated all these methods?

00:13:38: So, um Naturally the risk increases with the complexity of the procedure But generally lung operations today are very safe procedures With a mortality rate in Germany Of under two percent.

00:13:52: that means over ninety eight percent survive this operation.

00:13:57: Our patients naturally feel A great deal of apprehension when they Are about to undergo such as surgical procedure The chest cavity is opened and the Lung Is operated on but generally, it's quite well tolerated.

00:14:09: The risks that still exist are primarily found in the patient's co-morbidities and impairment of their lung function.

00:14:16: When we consider our most patients have actually smoked then rest lungs simply not fully healthy anymore And patients therefore more susceptible to developing pneumonia after surgery.

00:14:30: Then maybe necessary administer antibiotics for a longer period or perhaps intensive physical therapy.

00:14:36: Then the hospital stay is significantly extended, but today with these modern minimally invasive operations you can generally be discharged and go home after only four days.

00:14:47: And what exactly does the aftercare involve?

00:14:49: or to put it another way?

00:14:50: What are patients required to do after they have undergone an operation or a treatment?

00:14:56: Yes so after the operation we will discuss the findings again with our partners specifically the pulmonologists everything I've already described to you, and then a decision will be made as to whether further treatment is still necessary.

00:15:11: Today that doesn't necessarily mean chemotherapy anymore.

00:15:15: in lung cancer immunotherapy has now considered appropriate for almost all patients And what's more it is significantly gentler and better tolerated than traditional chemotherapy?

00:15:26: For those specific genetic alterations which i initially describe to You As A risk factor we now have very specialized medications available.

00:15:35: Patients can take one tablet a day, and that's even more effective than anything else.

00:15:40: but unfortunately only about twenty to twenty-five percent of our patients has such a gene mutation.

00:15:47: however as new medications are constantly coming onto the market this will certainly become more common in future.

00:15:56: In any event Even if patient does not require specific post treatment care The patient must still regularly undergo CT examinations and attend follow-up appointments so that we can detect any potential recurrence at an early stage.

00:16:09: Hopefully, At some point in the future it will no longer be necessary to conduct a full CT examination but rather just simple blood test.

00:16:18: Herein Offenbach We are scientifically working on this.

00:16:21: Unfortunately...at this moment..we haven't quite reached that point.

00:16:25: So for time being patients still regularly need their CT scans.

00:16:30: So, with a blood test you could check.

00:16:33: okay there might be something genetic or something like that?

00:16:37: We are looking specifically for the presence of tumor DNA.

00:16:41: Now DNA is our fundamental hereditary material and the tumor cells are fundamentally different from normal healthy human cells.

00:16:49: And what we do then is carefully monitor this situation because if tumor DNA once again detectable within patient's bloodstream then that indicates the tumor must be actively growing somewhere in the body.

00:17:02: Unfortunately, this is not reliable enough at the moment.

00:17:05: For many patients we are unable to find it in their blood even though the tumor has already grown back or metastases have formed elsewhere else.

00:17:13: We're currently working on analyzing the genome of each individual patient In a way allows us specifically search for those tumor genes distinct from normal ones.

00:17:25: This is still somewhat of a future vision, but we have recently initiated a study and are very hopeful that will be able to make significant progress in this area.

00:17:36: We need get the stage where perhaps eventually dispense with entire CTS system.

00:17:41: Regrettably at point-in time it's not feasible yet!

00:17:46: Professor Kleiner, if you could offer one crucial piece of counsel to our listeners what would that be?

00:17:52: specifically regarding the topics of disease prevention proactive health screening or general risk awareness?

00:17:59: What are the most important aspects they should be mindful of.

00:18:03: It's absolutely essential that preventive care for lung cancer is at least as important.

00:18:11: We know from the results of large-scale clinical trials that preventative screening significantly reduces risk for mortality associated with lung cancer.

00:18:19: This means every patient who decides to undergo this specific preventive measure will subsequently have a much higher probability, greater chance simply living longer and healthier life!

00:18:31: So…who exactly are people I recommend this screening procedure?

00:18:35: Once again... female smokers, and specifically those who are past a certain age namely fifty years old.

00:18:43: If for example in your professional life you frequently deal with fine particulate matter In earlier times this was primarily in mining but even today we still encounter fine dust pollution toxic fumes for painters and similar situations then You should have Your body checked very thoroughly And in case of any doubt it's always better to To Have to go once again For such preventive medical examination.

00:19:07: Professor Kleiner, who is it that has allowed to come and consult with you?

00:19:11: So the patient in the process of enrolling them into this specific lung cancer screening program will most likely be managed predominantly by specialized pulmonologists.

00:19:21: but every general practitioner is able to refer the patients.

00:19:25: To send them for lung cancer screenings examinations if they fulfill all the required inclusion criteria which means they must be older than fifty years.

00:19:35: Should any abnormalities be detected there, the findings are then sent to a specialized lung cancer center and at that point The time has come for us to actively approach an engage with the patients.

00:19:47: Conversely Patients who may have received a CT scan For other reasons where a pulmonary nodule is observed Are all very welcome here for further diagnostic assessment and evaluation.

00:19:58: Is it something that just needs to be monitored or as more intervention required?

00:20:03: Professor

00:20:04: Kleiner, I sincerely thank you for these truly fascinating insights into modern lung cancer prevention and in to the various available therapeutic possibilities.

00:20:15: You are very welcome and i thank you too!

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