Doc Discussions with Dr. Jason Edwards
THIS is the podcast you have been looking for! "Doc Discussions" are just what the title says they are: physicians from a wide range of specialties, talking about relevant, up-to-date medical topics, not to mention tips on habits to help you live your best life. Your host, Jason Edwards, MD, is a board-certified radiation oncologist with a PhD in cellular and integrative physiology at St. Luke's Hospital in St. Louis, Missouri. Dr. Edwards explores not only diseases but also suggests techniques to optimize mental and physical health for a long and good life. Real people. Real advice. Real good. This is Doc Discussions, with Dr. Jason Edwards!
Doc Discussions with Dr. Jason Edwards
Why Lung Cancer Screening Matters More Than You Think
The quiet truth about lung cancer is that it often hides until it’s late. We break that pattern by showing exactly who qualifies for low‑dose CT screening, why it’s usually free under preventive benefits, and how a clear plan can turn fear into action. With pulmonologist Dr. Kristen Fisher and lung screening lead Lola Brand, we trace the path from a “spot on the scan” to a confident diagnosis, and we demystify the choices along the way.
We start with eligibility—ages 50 to 80 for most commercial plans (50 to 77 for Medicare), at least a 20 pack‑year history, and either current smoking or quitting within 15 years—then explain why symptoms like cough, breathlessness, or chest pain are often late arrivals. We dig into regional realities: histoplasma in the Mississippi and Ohio River Valleys and valley fever out West create benign nodules that mimic cancer. You’ll learn why careful follow‑up matters, how growth patterns guide decisions, and what risk factors beyond smoking—radon, asbestos, certain chemicals, age, and family history—should prompt extra vigilance.
When a nodule demands answers, we compare the three biopsy paths. Bronchoscopy uses navigation and endobronchial ultrasound to sample from the inside with a low pneumothorax risk. CT‑guided needle biopsy offers high diagnostic yield through the chest wall, while surgery becomes the right move when suspicion and resectability align. We also get real about AI: great as a copilot to guide tools and documentation, not ready to replace human judgment in the procedure suite. Most importantly, we share practical ways to manage the hardest stretch—the waiting—by setting information boundaries, asking focused questions, staying active, and focusing on what you can control today.
Early detection changes outcomes, options, and peace of mind. If you or someone you love qualifies, take the first step now. Subscribe for future episodes, share this with a friend who should be screened, and leave a review to help others find life‑saving information.
Welcome to Doc Discussions. I'm Dr. Jason Edwards and I'm here with Lola Brand and Dr. Kristen Fisher. Welcome.
SPEAKER_00:Welcome. Thank you.
SPEAKER_01:Yeah. So Lola is the head of our lung cancer screening program, and Kristen is a pulmonologist here. Um Kristen, can you tell us a little bit about yourself, where you're from, how you got here?
SPEAKER_02:So I grew up in Alton, Illinois, and did my medical school at SIU in Springfield, Illinois, and residency in Indiana, and then came back for fellowship at Washington University and then took the job here in 2018 after I finished, or 2017 actually, after I finished fellowship. And so I've been a pulmonologist here now for over eight years.
SPEAKER_01:Yeah, very good. And you went to medical school with Ryan Reedy and John Holtz.
SPEAKER_02:I did. I sure did. We were all three of us were in the same class, as well as Ryan's wife.
SPEAKER_01:Very good. That's a strong class. I mean, those are those are some great doctors. Are all of the uh SIU uh physicians um as highly touted as you guys are?
SPEAKER_02:I I thought I I hope so. I think so. Um obviously they're the ones who are around here, but yeah, it was quite ironic. I feel like when uh I had been in practice for about a year when Dr. Reedy came and um I was like, oh wow, we were in the same class, and then now with him doing thoracic surgery, we work pretty closely together.
SPEAKER_01:Yeah, great guy, great surgeon, as is John Holson for sure.
SPEAKER_02:Yes, John's great as well.
SPEAKER_01:And and Lola, where are you from originally?
SPEAKER_00:Waterloo, Illinois.
SPEAKER_01:Okay.
SPEAKER_00:Grew up on a farm, went to nursing school at Barnes Hospital School of Nursing, came here in '87 and have been here since then in multiple um positions. Yeah. Nursing on the floor, case management, and now for the last several years and the lung screening program.
SPEAKER_01:Okay. Now, what kind of farm was it that you grew up on?
SPEAKER_00:Um, we had pigs, cows, sheep, yeah, farm, uh grain farm, yeah, trucking business.
SPEAKER_01:Hampshire pigs.
SPEAKER_00:Oh, they had all kinds of pigs. Yeah.
SPEAKER_01:Yeah. They pigs get big, they're like 800 pounds. And so yeah, very good. Um, okay. And so Lola, can you tell us a little bit about the lung cancer screening program we have here?
SPEAKER_00:Okay, so the lung screening program has certain guidelines that has been set down by the United States Preventative Service Task Force. You have to be between the ages of 50 and 77 if you're a Medicare or a Medicare Advantage plan, 50 to 80 if you have a commercial plan. You have to have a current cigarette smoking history or quit smoking cigarettes within the past 15 years and have a 20-pack year history. Been seen by a physician who has documented that you are asymptomatic of any kind of lung cancer symptoms. And then we just set you up for the CAT scan. It's a very simple test. Um, and the result letter is sent out by myself. The doctor should be calling with the test results, and we just do that on an annual basis.
SPEAKER_01:Very good. And um, you you always have a great interaction with our mutual patients, and we very much appreciate you. You're a detail-oriented um uh nurse navigator, and and I think it makes a huge difference. So thanks for everything you do.
SPEAKER_00:Thank you.
SPEAKER_01:Um, Kristen, what are some of the early warning signs um that somebody may have a lung cancer? What do people present with?
SPEAKER_02:Um so typically, unfortunately, once which is why the lung cancer screening program is so important that a lot of times, unfortunately, by the time somebody has symptoms, it is a little bit more advanced than what we would like to capture. But some early symptoms, and sometimes you can find it early if it's something that's maybe obstructing an airway, which the patient may be short of breath or coughing up blood. Um, sometimes there's chest wall pain. Um, not coughing. Sometimes I've found it before with patients coming in with a cough, which is why I'm pretty careful about making sure that we get in mean that I get imaging on appropriate patients.
SPEAKER_01:Yeah, you're right. And most of these are caught at stage three or four, and so that's why you've got a screen, even if you have no symptoms. Correct. Sometimes you get lucky and a small lung cancer is next to a windpipe, and there's a little bit of bleeding, and you catch it before it takes off. But um it's it's a sneaky cancer that can really grow um without symptoms. Um you know, smoking's the most common cause um for lung cancer, and it's the vast majority of patients. What are some other things um, if you're not a smoker, um, that could lead to a lung cancer?
SPEAKER_02:So exposures, um, a lot of patients with uh prior asbestos exposure, radon exposure, other chemical exposures and things like that can place patients exposure to carcinogens, uh, can place patients at risk for cancer. Age in itself is a risk factor. So, you know, always following pulmonary nodules that are sometimes incidentally found, even in in um patients who are non-smokers are important in following appropriate guidelines for follow-up. Uh, there is an increased risk after the age of 65 specifically, family history for lung cancer.
SPEAKER_01:Do you think that's genetic or do you think it's secondhand smoke or a little bit of both?
SPEAKER_02:Probably a little bit of both. I definitely think there are a subset of patients that probably have some genetic predisposition because some of those patients I've seen in, and I'm sure you've seen them as well, that have had kind of multiple adenocarcinomas, in which case, you know, and and not maybe not even be, you know, that advanced in age or, you know, you can't really identify it. Although it's sometimes hard to pin down exposures. I find that it's really difficult sometimes because people don't always remember, you know, certain exposures that they've had in their lifetime.
SPEAKER_01:Yeah, yeah, for sure. Um, and radon gas is a, I think, a bigger deal in Missouri than it is in most places because of the limestone. Is that right?
SPEAKER_02:I believe so, yes.
SPEAKER_01:Yeah. Um, and so that you can buy a radon gas um kit and test your house. It's relatively cheap or have an expert do it. But it's uh I think usually when you buy a house, it's mandatory.
SPEAKER_02:It is. They'll give you a measurement when you buy a house and especially if it's a basement, right? Exactly. And it has to be below a certain level, otherwise, I think there's issues with selling it.
SPEAKER_01:Yeah, which is uh very good. Um you you mentioned lung nodules. Why do so many people in St. Louis have lung nodules?
SPEAKER_02:It has to do with where we live geographically. There's a fungus in the soil here called histoplasma, and it tends to cause a lot of pulmonary nodules because people will breathe it in, your body kills it, leaves behind, you know, evidence of it being there previously. But the problem is, is although it's very common to find, you can't tell a difference as a physician when you look at a scan between one of those nodules typically and one that could be an early lung cancer. So although the vast majority of nodules that we find incidentally end up being benign, you have to appropriately follow them in order to ensure that this is not an early lung cancer, because obviously, as we've discussed earlier, by the time somebody's symptomatic, it may be more advanced, and therefore finding it at an early stage in which it can be potentially cured is very important.
SPEAKER_01:Yeah, yeah, for sure. Um, I used to live in Kentucky and it's on the Ohio River Valley, and they have the same thing on the Mississippi and Ohio River Valley and the Missouri. And so um, so there's a lot of lung nodules out there. So, you know, most of the time when you have a lung nodule, it's not cancer, but you need the tincture of time to kind of discriminate uh histoplasmosis nodule won't grow, you know, uh over time typically, whereas the lung cancer will.
SPEAKER_02:Yeah, and you know, it depends, you know, valley fever for people that live out west, you know, um, there's other endemic fungi throughout the US, but there's specific areas such as here where it tends to be a little bit more concentrated.
SPEAKER_01:Now, uh uh valley fever I'm totally unaware of. What is that?
SPEAKER_02:So that is coccidiomycosis, which is another type of endemic of fungus, and it's typically in Arizona, California. And so sometimes when I have patients that may live part of the year in Arizona and part of the year here will find them, it tends to make people a little sicker. So some people actually have, you know, a fever and cough with it, but it will leave behind these nodules or even sometimes even bigger than a nodule that you makes when you first see their CT scans, you're you know, you might think that somebody has lung cancer, but it ends up just being a prior fungal infection.
SPEAKER_01:Huh. And usually from the histoplasma, people don't really feel sick.
SPEAKER_02:No, it rarely. Occasionally, somebody can have active infection. That's usually in somebody who has um something wrong with their immune system, that they're compromised in some way. Sometimes it can still happen in healthy individuals, but most of the time it doesn't need to be treated, even in those cases. Most people don't even know they have it.
SPEAKER_01:Um, yeah, that that's been my experience as well. Um, and um so there's so we talk about these nodules and um the low-dose um screening for the high-risk individuals. Um the um what's the difference between catching one of these nodules early versus you know, catching the tumor when you have a clinical symptom?
SPEAKER_02:There's a big difference in terms of prognosis, and you would be able to answer this better than I would. But if a cancer can be found in an early stage, such as a stage one, it can either be removed or radiated, um, depending on what is the best choice for that particular patient. And the patients tend to do great versus if it's more advanced, then it's gonna involve, you know, potentially chemotherapy or immunotherapy. And um, and it's a little bit, it's a lot more for the patient, and you know, it's it's a lot more involved and a greater chance of recurrence afterwards than if it's caught early and dealt with whenever it's a small nodule.
SPEAKER_01:Yeah. I it I think, you know, out of all the cancers we screen for, which is breast, prostate, colon, and lung, um, and cervical cancer, um, you know, you have one of the biggest deltas between, you know, catching it early versus late, just because patients um have such a rough time um when it's caught in stage three or four. But the new immunotherapies and the targeted therapies that the medical oncologists use, cure rates have improved for stage three and four patients, but it's improved from like, you know, if if if you look at the whole lot of them from like 20% to 30%. And so it's still not great odds. Um so you see patients before I do typically.
SPEAKER_02:I typically do.
SPEAKER_01:And you know, you're the one a lot of times that um will even diagnose um the cancer. How do you diagnose the cancer? Like what procedures do you do?
SPEAKER_02:Yeah, so I t I do a procedure called a bronchoscopy, which is a scope of the lungs. And there's different ways of doing um biopsies in order to um using different tools while I'm doing that in order to try to find the nodule. But there's multiple ways of doing a biopsy. I typically think of when I explain this to patients, there's really three different ways you can get at trying to determine what exactly a spot is. So this would be a spot that may be growing and maybe a spot that's large enough that I'm concerned about it to begin with. Um, and you can, I always tell people you can biopsy it from the inside out or outside in. And I do it from the inside out, which means that the patient is put under anesthesia and I put a scope into their lungs, similar to how somebody would get like a colonoscopy if they were only it's, you know, or an endoscopy, but it's in the lungs, not into the GI tract. And then using different technology, sometimes there is something that we do called navigational broncoscopy, where you can create a 3D map. There's robots now, which we may be getting soon here, um, where you can try to get at the spot and um and get a diagnosis that way.
SPEAKER_01:So you kind of like go through all the windpipes.
SPEAKER_02:You create it's like a map. So it's kind of like a video game, sort of where you, you know, follow that it will, you know, show a target on a screen that looks like, you know, I always say the green ball, and you can navigate out to it and try to get to it. And then if there's any concern for lymph node involvement, there's ultrasounds that we can use through a scope or basically taking very tiny biopsies. The other way is that what I mentioned, which was from the outside end, which is the radiologist will do this called a CT guided biopsy where a patient will be in a CT scanner. And this one they don't have to be put under anesthesia for, and they can stick a very tiny numb up the patient and stick a very tiny needle in through the chest wall and get and get a diagnosis that way. And then the third way is obviously surgically. So just depending on the situation depends on which way we may go about offering a biopsy. So typically that is what happens. Typically, I'll I'll be referred a patient at the time in which a nodule, you know, either I find the nodule whenever I'm doing screening or working them up for someone something else, or the primary care doctor um will send it. Loa's very good about identifying patients on and you know, if somebody has an incidental scan in the emergency room and making sure those patients get in to see somebody, you know, with the to do the appropriate workup. And then um after I figure out what the diagnosis is, then I refer them to the next step.
SPEAKER_01:Yeah. Um, so a couple technical questions. Um so the the lung is in a way kind of like a balloon, and you know, when you stick a needle in it, sometimes that balloon can deflate. And we call that a pneumothorax. Um, correct? Is that the right term? That is the correct term, yes. And um, and so is the rate of a pneumothorax um lower with a bronchoscopy than it is to with a CT guided biopsy? Yes. Okay, yeah, that's that's because that's pretty rare to have it from a bronchoscopy.
SPEAKER_02:It is pretty rare. I think it's said in the literature at somewhere one to two percent. Um the the the way I think about it, the differences between the two, is that a CT guided biopsy though has a little bit higher yield, meaning that there's a little, but it just depends on the nodule too. It really depends on where it's at. But the, you know, the the chance of getting the diagnosis, like say it's cancer and getting back that it is cancer, is a little bit higher yield with that versus a broncoscopy. So all of this has to be taken with the lens of the person doing it if you think you really got adequate sampling or not when you did it. Um, but broncoscopy technology is improving, and that's why I had mentioned there's some newer tech techniques out there and and um and so we all adapt with the times and and try to constantly try to seek the latest technology in order to try to um get a better biopsy.
SPEAKER_01:Okay, so now I'm gonna ask you a question that's that's a little bit of a curveball. Okay.
SPEAKER_02:Yeah.
SPEAKER_01:Um, so they're talking about um these AI robots doing surgery and it's kind of all the rave. Um, do you think that will come to reality? I mean, it's kind of it's you know, it's kind of hard to bet against Elon Musk, right? You kind of feel like a fool, but they're you know, they're talking about um these these robots being able to perform surgeries potentially better than humans. What do you what do you think about that?
SPEAKER_02:I don't know.
SPEAKER_01:That's a great honest answer.
SPEAKER_02:I don't know. I think that I think that it has a way to go before we would ever get to that point. I think that there's great ways of using that type of technology to assist the human and being able to do what needs to be done. So I think that I think that the reality of what would probably happen, let's say for a bronchoscopy and trying to help me better get a get a better sample, get to the get it better, would be using AI to help direct things, but still being controlled by ultimately a human having to make real life decisions at the time. Because I think we all know AI gets a little wonky. And I just have to say, from my experience using it for I use it for documentation purposes, it does some strange things sometimes. So I do not think that it is at the point of which that we're anywhere close to that. But I do see where I do see AI coming into effect is assisting us to be able to do our jobs better, not replacing us doing it.
SPEAKER_01:So so like the co-pilot, right? Yeah, the co-pilot.
SPEAKER_02:Like like it can say, come up with a plan and I can look at it and be like, okay, yeah, that makes sense.
SPEAKER_01:Yeah.
SPEAKER_02:And use it to help me get there. But at the end of the day, you still have to have somebody that's able to make make sure it's not gonna go into crazy computer land and do something strange.
SPEAKER_01:Because they can hallucinate, I think is the term they use, where they just kind of go off res and start doing some work.
SPEAKER_02:Well, yeah, occasionally I'll have some stuff show up in notes that I'm like, what's this talking about?
SPEAKER_01:Yeah. Well, thanks for kind of giving your input into this. And so a last question. When patients are diagnosed with a cancer, what advice do you give them about how to psychologically deal with it? Because I think in many ways, the first two weeks are kind of the worst.
SPEAKER_02:It is. It I think the uncertainty is really hard. And I think that it's a little bit different on the level in which, you know, those of us like Lowell and I on kind of the front end and dealing with this kind of stuff, what what they're experiencing, by the time they get to the oncologist, they kind of have most of the time they've had the chance to kind of wrap their head around the fact that they, you know, that, you know, the patient has cancer and kind of really looking forward to like getting the answer, like what's gonna happen next. But I have at the stage where somebody comes in and they're, you know, I'm like, well, I see this spot and I'm worried about it, but we don't know what it is. And that that part is very difficult to handle. Um, I think psychologically. Some people do really well with it and some people it's very nerve-wracking. And the whole process of sometimes us following nodules and saying, like, well, we don't, you know, it looks okay right now. We're gonna wait a few more months. Like, sometimes that waiting that few months is really hard. And so what I always tell people is like, let's just take this step by step. Like there's only so much we can control. I try to gauge when I'm talking to somebody how much information they want to know. Some people want to know the minute that that spot's found, like, what's the worst case scenario? And if they want me to take them down the rabbit hole, I'll go down that way and I'll say, well, you know, worst case scenario, this is probably, you know, as long as we get, you know, this back and it doesn't look like it's spread anywhere, you know, this is probably a stage one. And this is kind of what that looks like. We might be talking about surgery, or if it's a patient that I don't think is a surgical candidate, we might, you know, or maybe they don't want to have surgery, we'll be talking about radiation. And I don't give them a ton of information about that because I feel like, you know, you do a great job, for example, of going through radiation with the patients, but I give them an idea of what that looks like. And so for some people, they want to know that information, some people don't want to know that information. So I think as a as a, you just have to try to gauge like how much they want to know. But I'll answer as many questions as somebody has if that helps them kind of process a situation. Sometimes knowing, like, well, what are we gonna do if it is this? And I'll be like, look, we're not gonna go down this way. We don't even know if this is this might be something that's gonna go away on the next scan. But if it does, this is what you're looking at. And I think that sometimes helps people be able to know like what they're facing.
SPEAKER_01:And I think that's a sign of a great doctor that knows their patients and kind of knows like, I know them, I know their personality, I know this is kind of how much they can take right now, and it's not gonna be healthy for them to kind of go down this road. And, you know, I I I think the serenity prayer is really great for a lot of things in life. And it's that a lot of things are out of your control, and you've got to somehow find peace in life knowing that you can kind of only control a couple things, and you you're better off focusing on that. The mind, it most of the time works against you, and it'll just take off, and you gotta try to keep it reined in. And I I think that's great advice um to try to stay busy, to maybe go for a walk, kind of wear your body out so your mind's not working so hard against you. But it's it's for people out there who just get a cancer diagnosis. I mean, it's the first couple weeks are just the toughest, and you've got to not let your mind break you down. But it's tough. I mean, even knowing that it's it's still not easy.
SPEAKER_02:It's tough. And I, you know, it's it's hard because although we see people go through this, I don't think anybody really understands what it's like unless they've been through it. And so I as as empathetic as I try to be, I I do recognize that it's it's tough. It's tough for people.
SPEAKER_01:And um, it makes it all the more important to have people on the front end of it that are so kind and empathetic, like you two. And so I I thank you both, uh Lola Brand and Dr. Kristen Fisher for all the uh great work you do for our patients.
SPEAKER_00:I would just like to add that the lung screenings are a free exam under most patients, insurance the in that it's a preventive exam. So there's no cost to patients to get that for the every on an annual basis. If they have to come back for a CAT scan because they did find a nodule, those costs will go under their diagnostic benefits. But I think people need to be aware that this is something their insurance companies do cover fully, and hopefully that will lure more people into coming in and getting the lung screenings.
SPEAKER_01:Lola, is there a way that they could contact you or your office or the lung cancer screening program?
SPEAKER_00:Yep. My phone number is 314-205-6550. Please call, leave me a message. I will work out on getting orders from your physicians, explaining the procedure and getting you set up.
SPEAKER_01:Oh, well, thanks so much for being an advocate for so many of our patients, Lola.
SPEAKER_00:Thank you.
SPEAKER_02:Yeah, thank you, Lola. Lola, we'll always make sure we're on our toes. I appreciate that. She does a great job.
SPEAKER_00:She do a good job, too.
SPEAKER_01:Yeah, yeah, I think we got a great team from top to bottom, and I'm thankful for everybody. All right. Well, that's it for Doc Discussions. Thanks for listening.