What you didn't know about lung cancer.
Trying to stop its deadly path!
Abbie Begnaud, MD, is an Associate Professor of Medicine in the Division of Pulmonary, Allergy, Critical Care and Sleep Medicine at the University of Minnesota. In this interview Abbie helps us learn more about lung cancer: causes, myths, disparities and prevention.
Could you tell us a bit about yourself?
I grew up in south Louisiana in a large family. I was the first person in my family to finish college. I did training all over the place–studied in Miami and Louisiana. did postgraduate training in Kansas where I met my husband. I went back to northern Florida to do my specialty training in Pulmonary critical care medicine, and then I moved here. I’ve been in Minnesota since 2013. I have 1 daughter, who is 2 years old.
About you - from your biography page:
Can you tell us a bit why you decided to enter the medical field?
It’s a calling I felt with no background or knowledge when I was in high school. It was an uneducated decision–no one in my family was in the medical profession. My mom wanted me to be a lawyer. I was taking a debate class in 10th grade in high school, and it made me sick. I didn’t like it at all. When that class was taking place, there was a molecular genetics class–I switched to it and loved it. Then I told my mom I wanted to be a doctor, and she said 'okay I can live with that', and that was that. Then I did premed studies in undergrad.
You’re a pulmonologist. What is that, and why are you interested in the respiratory system?
What kind of doctor I thought I would be changed over time–I sort of stumbled into it. I considered being a lot of different types of doctors, and ultimately when I was in medical school and did an internal medicine rotation, that was the last thing I was thinking of, since an internal medicine doctor is a doctor for adults, and organs. Then when I did the internal medicine rotation, it was intellectually challenging and fascinating. I also did an oncology rotation and critical care rotation and liked it and then decided to do pulmonary medicine. One almost couldn’t do critical care training without pulmonary care training–it’s a natural synergy. I liked intensive care though I loved oncology and taking care of people with cancer. During my pulmonary medicine training, a mentor taught me about lung cancer and how to diagnose and treat people with it, and it felt like finally the right combo for me.
What other areas do you work on?
I work in clinics and hospitals and operating rooms. I see patients in the clinic with general lung problems: asthma, COPD. Most of my work focuses on people who might have lung cancer–I see people who have suspicious findings for possible lung cancer. Then I work with them on the diagnosis to figure out what it is. But I couldn't treat the lung cancer–I would refer them to someone who could do chemotherapy or radiation.
Talking about lung cancer
We don’t know much about lung cancer, can you speak about it?
It’s the deadliest cancer; it kills more people than breast, colon, and prostate cancers combined. It has traditionally been a depressing diagnosis, but there are new and promising treatments. Because of the association with cigarette smoking, there is a stigma. People talk about feeling guilt and being treated differently because of that diagnosis. Now there's more info on other causes: pollution/poor air quality, radon–now known to be the 2nd leading cause. Radon is a colorless, odorless radioactive gas that seeps into a home through cracks in the foundation and through walls and the ground, and over a number of years it can cause lung cancer. It’s important to recognize that not everyone who has lung cancer has smoked. It’s important for healthcare providers and the public to recognize that if you have respiratory symptoms such as a cough that doesn't go away, you should seek care. Sometimes if someone is not a smoker they don’t receive the screening they need because they don’t have the best-known risk factor.
How would someone know that they have lung cancer?
Early on you wouldn’t know at all–it starts as a small spot in the lung. The lung doesn’t have pain receptor fibers like you have on your fingertips or other places.You might not know about it until it becomes large enough to cause a problem when it gets to your main bronchial tube and causes a cough or trouble breathing. Usually lung cancer is at a pretty advanced stage before it causes problems people would experience and then seek medical treatment for. There’s a long early “subclinical” stage when the person has no idea–and that’s why screening is so important.
Before we continue, could you explain what screening is?
Screening is the process of looking for a disease, a problem before it becomes obvious, just like you might get your car checked before the “check engine” light comes on. When you find problems early before they cause symptoms or become noticeable to the person, there’s a better chance of treating them. There are different types of screening–BP, sugar, other conditions. Many people have heard of other types of cancer screening that are available such as mammograms and colon cancer screening.
Tell us about lung cancer screening, who is at risk for lung cancer, and who can get screened:
Lung cancer screening is newer and less-known and is mainly for older people who have risk factors. We currently screen people ages 50-80 who have smoked cigarettes for a long time because they’re more likely to get lung cancer. Specifically, it’s for people who have smoked a packet of cigarettes per day for 20 years (“20 pack-years”--but someone could get to 20 pack-years by smoking different amounts for different #s of years). People who have quit smoking for more than 15 years are usually not eligible. However, anyone can get lung cancer. There are other risk factors people aren’t aware of, like radon and family history. Lung cancer screening is a CT scan with a low dose of radiation. It’s easy; there’s no prep like for a colonoscopy, and it only takes about a minute. You just lie there on the table and go through the scan quickly.
Is lung cancer screening free?
Sort of. Health screenings are governed by an organization that makes preventive recommendations about ways to protect health, and there are some things that have to be paid for by health insurance and Medicare/Medicaid. Lung cancer screening is covered if you meet the eligibility criteria, but if you are uninsured or under-insured, it may not be covered by a state program, unlike screenings for some types of cancer.
Where can people get screened?
There are a few websites that can tell you where. Most places with a CT scanner can do it. But you need your clinic–if you have a regular provider–to make a referral.
Why do you think people don’t get screening for lung cancer?
There are a variety of barriers. As I said, lung cancer screening is still relatively new, especially compared to breast cancer screening. A lot of people are very afraid of any diagnosis of cancer but especially lung cancer, especially if they know someone diagnosed with lung cancer who is no longer alive. Lung cancer screening hasn’t risen to the level of being automatic or common knowledge. There have been some regulatory requirements that aren’t helpful. For example, you have to have a conversation with a healthcare professional and they have to order the exam, unlike a mammogram. And then there’s the eligibility piece I described before. You have to work hard to push through your own inertia and overcome those system barriers.
How can we protect ourselves from lung cancer?
The most important thing is to avoid smoking cigarettes, or if you smoke now, seek support for quitting. Testing your home for radon is something everyone should do. In Minnesota about 2 out of 5 homes have high levels of radon. Testing your home for radon is easy, and 10KFS makes it really easy by providing test-kits to people. If the levels are high, there are ways to mitigate it. Some people think something about the location or type of home they have will determine the level of radon, like if it’s a big new house built last year or a little old house built a long time ago, but that’s not true. Some people think only the basement is where there’s a problem, but if you have an HVAC system, the radon from the basement can circulate around the home. There’s also increasing recognition about pollution. Living somewhere where there is less pollution is good, but many people don’t have control over where they live. In turn, controlling pollution is difficult for an individual person.
About your research:
What do you do research on?
Lung cancer and disparities in lung cancer. I didn’t know that disparities existed when I started working in lung cancer. Now I know that there are groups that experience a disproportionate burden of lung cancer. The majority of my work focuses on screening–how to improve screening rates, but I do some work in other areas of lung cancer.
What health disparities related to lung cancer are you aware of? And what can be done about that?
The main groups with disproportionate levels of lung cancer are indigenous and Black Americans.There are over 500 diverse tribes around the country, and among some tribes and in some areas there are high rates of commercial tobacco use, which is the case in Minnesota. The disparities for Black Americans are similar in some ways, whether it has to do with predatory marketing by tobacco companies or living in marginalized areas, due to redlining, where there is poor air-quality. Some of these higher lung cancer rates have to do with control over where you live: for example, if you don’t own your own home, you have less control over radon mitigation. For Black Americans, it’s social determinants in terms of systemic racism. For indigenous Americans, it has more to do with colonialism and replacing traditional tobacco plants with commercial tobacco use.
Work with diverse communities
Can you tell us about your work with diverse communities, including Minnesota tribal and urban Native Americans? What has this work taught you, and how has your work benefited those communities?
It’s taught me a lot, and I could talk about it for hours. Everything I just told you I didn't know a few years ago until I started working with a tribe in central Minnesota and with indigenous organizations in the Twin Cities. In Minnesota we have a larger population than many parts of the US, but in many places where indigenous Americans are a small part of the population, other communities think of indigenous people as from an earlier part of this country's history and no longer in existence. I’ve seen that indigenous people are motivated to take care of themselves in order to be around for future generations and pass on their wisdom–which actually is probably universal. When people receive knowledge from a source they trust, like an older family or community member, they take it very seriously.
Why is it important for you to partner with communities, especially around cancer and lung health?
If your research is trying to be about the larger population but only represents a small part of the population, that's not very good research. Partnerships help researchers engage communities that may not have “bought into research.” Partnerships have done a lot to help me understand what patients bring to me when we meet in the clinic room–what they have faced and overcome to come see me that day or to get to the next appointment with me or to a referral. Many physicians have no idea about what their patients are facing and what they need from us.
I’m happy to work with anyone who is interested in working with different communities! There aren’t great numbers about lung cancer rates in some groups, such as Somali; and there’s a lot to figure-out there, and I’m open to doing that!.
Can you tell us about your efforts to make free lung cancer screening available to communities?
Through a grant from A Breath of Hope Foundation to the University of Minnesota, I am organizing events to provide free lung cancer screening for people who don't have insurance.
Radon
At the 10,000 Families Study (10KFS) we are researching radon. Why do you think it is important to do research about radon?
It’s still important to do research on radon because most research that has been done on it is quite old and was done as part of a lot of other things that were being researched. Most of the radon research done is still pretty rudimentary compared to other causes of lung cancers. Most people don’t know about radon or why it’s important. Radon is not a problem in Louisiana, and then I moved here to Minnesota and heard about it and was like “why is everyone not talking about this all the time? You have to put on your boots and coat and pick-up your snow shovel, and why isn’t radon part of the handbook?
What do you think about the 10,000 Families Study and the research we’re doing on radon?
The first time I heard about 10,000 Families was years ago, and I thought it was incredibly important to study families’ health across all communities. I would love to work with 10,000 Families on a future lung cancer research study!
With radon-testing, the participants are getting a benefit with a free radon test-kit: what do you have to lose? It’s a pretty easy thing to do. But if you’re living in an arrangement where you don’t have control over your house, what can you do to mitigate it? I am not a housing expert but I have heard from others that though limited, there are some avenues to get this fixed if you’re living in a rental dwelling (there are some umbrella protections for renters, for example). Knowledge is power, so if you are given a free test you should definitely use it.
For volunteers
Do you have opportunities for people and organizations who want to volunteer to help people get screened for lung cancer?
I am open to sharing my expertise with anyone. If someone is interested, I can help them find a place. Community events are open to people in the community where I’m having them, but if someone is involved with a community that they think might benefit, I’d be happy to talk with them about how to get that set-up.
How can they get in contact with you?
You can share my email! - [email protected]
Last thoughts
Do you have any last things you want our audience to know?
The important thing to know is that anyone with lungs can get lung cancer, and the future is bright with improved options for screening and treatment.
If you are interested in joining the 10,000 Families Study and get your free radon kit please find out if your family qualifies taking this survey - Join now
