>> From WXXI News.

This is Connections.

I'm Evan Dawson.

Our connection this hour was made in Rochester with a man named Obed Clinton.

As Obed told WXXI Racquel Stephen, he had been a smoker for most of his life.

When his doctor suggested he get screened for lung cancer, Obed pushed back as he told Raquel, being raised in a Latino household, he said the culture didn't lend to vulnerability.

But despite his hesitation, he did go in for the scan and fortunately his results were good.

Obed said after the scan, he felt relieved.

He's one of many people that local doctors hope will agree to a lung cancer screening.

They say lung cancer is the most prevalent cancer in our Rochester and Finger Lakes region, and they hope more screenings will lead to more lives saved.

According to Raquel's reporting, a comprehensive lung cancer screening program at the University of Rochester Medical Center has led to double the rate of people screened screened over the past three years.

The results, experts say, have made an impact throughout the course of the new program.

More than 60 people received lung cancer diagnoses, and nearly 80% of those patients were diagnosed at early stages, leading to better prognoses.

This hour, we're talking about the screening program and the goals.

And one issue, experts say, is that the stigma of lung cancer keeps people from going to get tested.

Our guest this hour talk about how to change that.

And we're going to hear about what Urmc is calling a soup to nuts approach to addressing this disease.

So let me welcome our guests here.

And Racquel Stephen is going to spend a few minutes taking us through her reporting.

Great to see you back here.

>> Thank you.

I know it's been it's been a while.

It has been.

>> It's been like a couple of.

>> Weeks a couple of weeks.

It's been a couple.

>> Of weeks.

Welcome in studio to Dr.

Charles Kamen who is associate director of community outreach and engagement at the Wilmot Cancer Institute at the University of Rochester Medical Center.

Welcome back to the program.

>> Great to be back.

>> Next to doctor came in and let me welcome Joyce Lucas, who is a patient who's going to be telling her story.

Thank you for being here.

Thank you.

And Dr.

M. Patricia Rivera is with us.

The C. Jane Davis and C. Robert Davis Distinguished Professor in Pulmonary Medicine and chief of Pulmonary and Critical Care Medicine Division at the University of Rochester Medical Center.

Dr.

Rivera, thanks for being with us.

>> Thank you.

>> So let's start.

Yeah, let's start with Raquel here.

And I'm thinking about Obed story and this idea that, you know, listen, I'm not going to go get screened here.

and, and I think people in a lot of ways can relate to the fear of getting screened.

There's all kinds of data that men aren't great at getting screened in general.

what did you learn in the course of this reporting about the challenge of getting people just to get screened at all?

>> Yeah.

So yeah, his name is Obed Cintron.

Oh, sorry about that.

Yeah.

And he, he said he started smoking at a very, very young age.

Everything.

Right?

Tobacco products?

marijuana.

and, you know, in that Latin culture, it's more of a, he said machismo, right?

You don't get checked, right?

You solve your own problems.

but he he has a great relationship with Dr.

Robert Fortuna.

and he said, you know, I'll trust him with my life.

And I think that's a big part of it, having that rapport with your your medical provider.

so he, he did go get screened.

he said that was the longest he said the anticipation was killing him.

so he got screened and the relief he felt was was something he couldn't describe.

And he would give advice to his, his men.

And other Latinos to, to get past that, that pride and that ego and to get screened because it can save your life.

>> So as we got ready for this program over the weekend, looking up some data we're going to I'm going to talk more about this with Joyce in a moment.

I grew up with my mother smoking for decades, tried to quit a number of times.

I remember the fifth time she she tried to quit smoking.

My stepfather had said, you know, honey, I love you.

I don't want you to get lung cancer.

I don't want you to be struggling.

And, she was like three days in.

And he said to her, you're doing great.

And she said, you're just trying to remind me that I want a cigarette.

You're trying to get me to fail.

And I remember thinking, I kind of just want her to smoke again.

I mean, it was such a grind.

I was, like, 14 years old, and I'm going like, wow.

Yeah.

But she worked really hard.

And when she had grandchildren, she did quit.

And she's 80 years old today, and I'm glad she did.

And we're going to talk coming up about what that means to health long term.

Because, look, I'm not a doctor.

You're the reporter here.

But one of the messages has to be like, you know, there is time for you to get yourself at least in a better position than you are today.

If you've been.

And this isn't all about smoking, as we're going to talk about, but just with smoking, there's still time to make some change, right?

>> Yes.

Yes, definitely.

And you know, the criteria to actually be screened is very narrow, very narrow.

so it's hard for people to even fit into this criteria.

but if you are part of it, I think Obed would say, yeah.

do it right.

Do it.

Yeah.

Get it done.

I mean it's better to I always I feel like it's always better to know than to not know.

You know, we went through this with the genetic screening, right?

That whole that theme where you would want to know.

And I feel like it's better to know that to not know, because you can get it resolved quickly, right away before it gets severe.

and that's always my, my philosophy.

>> Yeah, I, I absolutely understand that.

And, and again for listeners, we're going to be talking about lung cancer and a lot of different forms here.

And the nonsmoking lung cancer.

I can tell you from experience, having a friend, it feels unfair.

It can feel tragic, but it is obviously just as important to understand and deal with for the for the kind of the assumption that people have about lung cancer.

So 40% of Americans used to American adults used to smoke.

Raquel.

I mean.

40% 40.

>> Isn't that I've never I I'm not a smoker.

I know I think you're either a smoker or a drinker.

Right.

And I so I'll let you figure it out.

But but I've never been a smoker, so.

>> I.

>> Can't relate to it.

>> I watched my mom do it, and, you know, like, that kind of convinced me not to.

But we're down to 11%, so a lot of people will think like, what is Racquel Stephen reporting on lung cancer?

Before we used to have four times the smokers in this country obviously still a huge problem, right?

>> Yeah.

Especially overseas.

If you go to I heard in England, you know, in London it's everyone is smoking there.

I think for me it was just the, the number, the significance of how high how significant the increase, the, the screening increase was for UMC.

Right.

We know everyone at UMC are overachievers.

we know that much.

But just how they brought this program in and got so many people screened and how they caught things so early like this is a significant percentage, almost 80% of cases were at the beginning stages where they were able to, to, to do something.

So that was what got my attention.

>> Yeah.

So let's go over some of those stats and then I'll let Raquel go.

And we're going to kind of dig into these stories here.

So Raquel story reporting, as you just said, almost 80% of the cases were diagnosed at an early stage.

Phenomenal news.

63 new cases of lung cancer detected here.

And this is a program focused on primary care patients stretched across 42 different sites.

They're tracking individuals 50 to 80 who smoked at least one pack of cigarettes per day for 20 years and proposed they get screened.

So you say it's kind of narrow here, but but the results.

>> You still have some time.

>> I thank you a little bit of time.

I've never been a smoker, and I'm happy to say that.

But I also know people I love who have struggled with this.

And when you talk about early detection, that's pretty remarkable.

Those stats, did they pop to you when you learned that story?

>> Raquel.

Yeah, yeah.

I mean, I'm not you know, I'm not a smoker.

And but I think a lot of people can relate to this.

A lot of people were not probably two degrees separated from someone who is so we're all we're all affected by this in some way.

And when I do cover a story, my first thought is, how relatable is this?

and I feel for our listeners definitely is something that they would, they would appreciate.

>> Last thing before we let Raquel go here, we mentioned around 11% of Americans smoke.

It's not uniform.

That's not true.

Exactly.

In every place.

It doesn't.

That's not true in every neighborhood, in every ZIP code.

And there are parts in the city of Rochester, communities in the city of Rochester, where it's almost 1 in 3.

So you know, I just really appreciate your reporting on this.

It's great stuff here.

Anything else you want to add before we cut you loose here?

>> I my my only thing is now, you know, with, with millennials and Generation Z's, they're not smoking cigarettes per se.

They're doing a lot of hookah.

Right.

And and how and how does this relate to what we're what we're seeing?

yeah.

Who could be a problem in the future?

We don't know.

>> I don't know.

And I also don't know if Gen Z vapes the way that.

>> In vape.

Vaping.

>> I think vaping might be a millennial.

This is where I'm in trouble.

I'm speculating, but we're going to go through all of this.

Thank you for bringing this reporting to us for Kelsey.

She's going to get back to work here.

Racquel Stephen health equity and community reporter and producer for WXXI News.

Doing great work there.

So let me let me start with the experts here.

Dr.

Carmen.

Dr.

Rivera, I'll start with you.

Dr.

Carmen, I mentioned that when I looked at that data and said, okay, four and four out of ten Americans used to adults used to smoke, and now it's just over one out of ten.

It's still a huge problem.

I mean, we have not eradicated this problem.

>> No.

And you pointed out a really good issue, which is that in the city of Rochester, some ZIP codes have 30% smoking rates.

That's.

Yeah.

As you said, almost one out of three people are smoking here in Rochester.

So across the country the rates are lower.

But here in our region the rates are still relatively high.

>> And I'm going to ask Dr.

Rivera to tell us a little bit about screening in general and maybe, maybe both of you can talk about why this is happening in this way and maybe what sparked this initiative.

Dr.

Rivera, you want to take it from there?

>> Absolutely.

so lung cancer screening was first approved in the United States in 2013.

So it's been around for at least 12 years.

the, U.S.

Preventive Services Task Force gave it a letter B recommendation, which means it's covered by insurance, Medicaid, Medicare, then approved it in 2014.

Lung cancer screening is designed to detect lung cancer.

If it's going to develop in individuals who are at risk for developing lung cancer or at high risk.

And right now, that is, individuals between the ages of 50 and 80 who have smoked at least 20 pack years or a pack a day for 20 years, or two packs for ten years.

And if quit, have quit within 15 years.

So it's been around for for 12 years.

The data from two large randomized trials shows that it detects cancer at an early stage.

That's what it's supposed to do.

And most of the trials, 77 to 80% of the cancers detected were stage one cancers.

And it results in a decrease in risk of dying from lung cancer.

Because you're detecting lung cancer at an early stage when you can do the most for and that is surgical resection, the ability to cure early stage lung cancer is much higher than the ability to cure when it's at stage two, 3 or 4.

So it works.

It's been shown in two large trials and multiple smaller trials.

That it is an effective means of early detection of lung cancer.

I will say that the most important intervention to prevent lung cancer is smoking cessation.

Smoking prevention and smoking cessation combined the ability to be smoke free or staying smoke free for seven years and getting screened actually doubles the benefit from lung cancer screening.

So this is early detection, but it's also important because it's an opportunity to really prevent and that is by smoking cessation.

And it's incredibly difficult for individuals to quit smoking.

Tobacco ism is a disease.

It is an addiction.

It's not that people don't have willpower or they don't have, you know, they're not strong enough.

That is nonsense.

It is very difficult to quit smoking.

I want to go back to a comment you made about stigma, and that is very important.

Lung cancer is a cancer that is stigmatized.

people feel guilty.

Society has made people who smoke feel guilty.

We have never approached smoking cessation in a way that we do other diseases.

It is a disease.

Tobacco ism is an addiction and should be treated as such.

And one of the things that we advocate for through the American Cancer Society and the National Lung Cancer Roundtable and the Association of Tobacco Cessation, is to eliminate certain words from our language like smoker we shouldn't label individuals as smokers because that in itself is stigmatizing.

We should refer to people who smoke, people who used to smoke, people who don't smoke.

and that is a way to try to, you know, eliminate some of the stigma that is associated with this disease.

>> On that note, Dr.

Rivera, one follow up before I turn to Dr.

Carmen here.

what do you make of the argument that pushes back on that idea that that what will work will be sort of the bluntness of and the directness of the argument against it.

Some people talk about the probably the 80s and 90s ads where they showed you a smoker's lung.

I still remember that myself.

And the notion of the risk that people are are in if they choose to smoke.

What do you what do you make of the idea that we need to be more blunt, not you know, not a softer touch.

>> I don't think that that kind of approach has worked.

we know from from really important studies that have been led in, in states that have very high tobacco consumption, like Kentucky, that individuals who smoke don't want to see those images.

They don't want to see people in with oxygen or black lungs or people with tracheostomies.

I think we it backfired.

I think people understand the risks.

I think no one is smoking because they don't they don't care about their health.

It is a really, really significant addiction.

Nicotine is a very addictive drug.

And the cigarette is a very is a brilliant, man made device to deliver a very addictive drug.

And for every cigarette that you smoke, a smoking individual gets a milligram of nicotine in their bloodstream and nicotine elevates your mood, it curbs hunger, it curbs, you know, it affects depression.

It people feel better.

So I think, you know, I, I believe that we should approach tobacco ism as a disease and provide people with the ability to get counseling and pharmacotherapy because there are multiple drugs that work.

It's very and not give up on people when they're unable to quit.

>> Absolutely.

>> Because it is a very difficult addiction to to quit.

>> no.

As I said, I saw it firsthand with my mother, and I'm so glad that she was able to get to that point.

and as much as, you know, we laugh about how hard it was, that's that was sort of between us and the family.

And she laughs about it now.

But it's not because she wasn't trying.

It's not because she didn't want it.

So.

So what is it, Dr.

Rivera, that you think has worked to reduce the national rate of smoking from around 4 in 10 adults to just over 1 in 10 adults?

>> I do think it's been policies.

It's been the work of great organizations that have advocated for for better tobacco control, for minimizing the for increasing taxes on cigarettes.

Of course, it's very state dependent.

You know, New York has very high tax rate for cigarettes.

But if you go to other states like North Carolina, where I lived for many, many years, the the tax on cigarettes is very low.

so it's it's very state dependent.

But I think all the effort that has been put into advertisement and policies and, you know, through the FDA has, has made a difference.

>> should we be doing better?

Absolutely.

Could we ever achieve what, you know Australia has achieved where they have really, really strong anti-tobacco policies that are supported by the federal government?

I don't know, I just don't know if we'll ever get there.

But I think it has been the work over the last, you know, since the first Surgeon General report in the 1960s to really eliminate tobacco products.

but it's it's very challenging.

I don't think we'll ever be without zero tobacco, you know, will never be tobacco free.

>> Well.

>> Potentially make it worse.

a lot of people are vaping and using e-cigarettes.

That's a lot of nicotine per cartridge of electronic cigarettes.

So we potentially may have a population of younger individuals who are getting very addicted to nicotine.

And in the future may turn to cigarettes.

>> Well, and it's interesting, Dr.

Carmen, as your colleague notes, country to country, there's a pretty wide variation of of success in dealing with tobacco addiction and lung cancer rates that are often pretty closely allied with that.

So what's your big picture overview.

How are we doing?

>> Well, just to comment on the global perspective.

>> Yeah.

>> It is crazy going to a country like Spain, which has one of the highest smoking rates in the world, and on every box of cigarettes they have smoking kills printed on it.

So that kind of fear messaging is, as Dr.

Rivera is saying, doesn't necessarily work.

That said, I mean, our office does community outreach and engagement, and when we go to community events, one thing we do is we bring pig lungs, one of which is a healthy pig lung, one of which is a lung that replicates a human exposed to tobacco.

And it's blackened and charred and doesn't really inflate when you hit this foot pedal to make the lungs inflate and deflate.

And it's a great talking point, especially for kids.

They bring their families over and they're like, look at the pig lung.

And I think educating with that kind of message can maybe prevent people from smoking, even if it's not going to be resonant with someone who's actively smoking right now.

So big picture.

Why does it matter to think about lung cancer?

You know, last month was lung Cancer Awareness Month.

But we should think about lung cancer all year round.

Even in December.

And our region that we serve is 27 counties.

I think last time I was on, I asked you what the state was with the highest cancer incidence rate in the country, and it's Kentucky.

>> Kentucky.

>> Yep, yep.

But if our 27 counties were their own state, we'd have the second highest rate of cancer.

>> Yeah.

That's remarkable.

>> Yes, remarkable.

And one of the main reasons why is because our lung cancer rate is so high.

It's the third highest prevalence of cancer.

Prostate and breast are higher, but it's definitely the highest mortality rate.

So it's the deadliest cancer.

And when you look at all of the cancer centers across the whole country, we have the fifth highest lung cancer rate of any cancer center in our region.

But to Raquel's story earlier, we have the second highest rate of lung cancer in Latino populations.

So it doesn't even lung cancer doesn't affect every community equally.

And so we should be really thinking about how to push these messages out, you know, broadly across the whole region, but specifically to places like the city of Rochester and Latino communities, and make sure that people know, like there's no stigma.

I mean, there shouldn't be stigma, right?

You should go get yourself checked so you can act on that information appropriately.

>> And so now, as you continue with this effort how what do you want the public to know how they might be able to get screened in the future?

>> Yeah, I mean, I can have Patricia talk about the screening piece.

I do want to put in a plug for our tobacco cessation program that we have at Wellmont, which maybe we mentioned last time, but it's free.

It's text message based.

You can go to the Wilmot Community Outreach and Engagement website, and you can self enroll and you can get free nicotine replacement therapy as well as text message support to stop smoking.

So we have resources available that are free and available to the public to help them quit.

>> And Dr.

Rivera, do you want to talk about screening, how people can get involved?

>> Yep.

Two processes at UMC screening through the primary care physicians or the primary care network.

and we also have a centralized lung cancer screening clinic that we started in 2021. that people can be referred to.

We see patients five days a week.

Most of the appointments are by telehealth.

and we have about seven or eight imaging facilities where people can get their low dose CT.

We have a comprehensive team of physicians, pulmonologists, surgeons, radiologists who review all of the positive scans to make sure that we make a decision as a team about the next best step, so that we're following nodules detected on screening in a way that it's concordant with what the guidelines recommend.

and offer, of course, smoking cessation in parallel with screening, screening has to be every year.

I think sometimes people think it's a one time thing.

It isn't.

This works when people come back every year for their annual screening, and we screen until people reach the age of 80 or right now, if they've, they reach a they've been 15 years quit or longer.

Although in the screening program we also evaluate patients for other risks for lung cancer because smoking and age are only two risks.

We ask about asbestos exposure, family history, prior history of cancer so that we can make the best decision with the patient about lung cancer screening.

But it's important for people to remember that once you have a screening test, if it's negative, you have to come back every year.

And if it's positive, you have to come back for a follow up to make sure that that nodule isn't anything concerning.

Nodules are very common, but the majority are not cancer.

So it's important for people to come back.

>> Can I make a comment on the whole environmental exposure thing?

Yeah.

So we were talking earlier about how at this point, 20% of lung cancers are due not to smoking to other factors.

Asbestos is a common one, but another is radon.

And radon is actually very common in this region.

Only certain kinds of bedrock have radon in them, which is a radioactive gas.

It's colorless, odorless.

It seeps through the foundation of your house.

And if you're exposed to it over a long time, it can cause lung cancer.

It's actually the second most common cause of lung cancer after smoking.

So especially people in the Southern Tier, Steuben County, Livingston County can be exposed to radon, and that can be a predictor of lung cancer as well.

Unfortunately, you can't get screened for lung cancer based on the current guidelines.

If you're exposed to radon or asbestos.

But as Patricia said, you'll be evaluated for those risk factors if you do go into the program.

>> when we come back from our break, we're going to talk to Joyce Lucas about her own journey.

And I think it's going to be really instructive and powerful to hear Joyce's story.

I also want to encourage listeners, if you want to share your own story, do you.

Are you someone who used to smoke?

Has that changed?

What was it?

Maybe that did change?

Have you ever thought about screening?

What do you think about screening?

We're talking about this program to try to get more people screened in our region where lung cancer is a big problem.

Lung cancer is the most deadly form of cancer, and it is still that way, even though rates have declined.

And as we go to break, let me just read some stats for you because I want to follow up on the point that Dr.

Carmen was making.

Yeah.

So in Spain, 26% of the population of adults smokes.

That's more than double the United States.

So the United States is at 11%.

Spain's up at 26%, highest rate in the world.

Burma at 42%.

And Indonesia is almost 40%.

That's a huge country.

Australia down to 7 or 8%.

And the lowest rates for smoking in the world.

Nigeria and Panama.

Only 2.5% of the adult population in those countries smoke regularly.

So it's a wide, wide range and it is not the same story everywhere.

It is not the same story in Rochester as it is with the country at large.

We've got a higher smoking rate in the city here.

Certain ZIP codes, certain communities have higher rates of smoking, and they want to address all of that.

So we're going to come right back and we're going to talk to Joyce about her story on the other side of this break.

Coming up in our second hour, a new film called Walkable USA examines what it would take to change downtowns like Rochester, like Oklahoma City, like Hammond, Indiana, which is a lot like Rochester, which has seen a hollowed out downtown core that used to be thriving.

And there's not just one simple solution here.

It is complicated.

There are powerful forces against it.

The film, I think, is a pretty good one, and we're going to talk about it next hour.

>> Support for your public radio station comes from our members and from Mary Cariola, center, proud supporter of Connections with Evan Dawson.

Believing an informed and engaged community is a connected one.

Mary Cariola and Excellus BlueCross BlueShield, working with members to find health coverage for every stage of life.

Helping to make care and coverage more accessible in more ways for more people across the Rochester community.

Details online at USBC.

>> All right.

Before we get Joyce's story, I've got an all caps email that we've got to get to.

Jim says Evan, please, all caps have one of your guests explain what screening actually entails.

Statistics, history.

personal stories.

That's all well and good, but we need to know what screening entails.

Jim.

Fair point.

Dr.

Rivera mentioned it is not a one time thing.

You got to do it annually.

What does it entail, doctor Rivera?

>> Absolutely.

right now, the there is a mandate for individuals who are eligible for screening or at risk for screening to talk to a clinician, either a nurse practitioner or physician, and do what's called shared decision making.

That is, talk about what it entails, what are the benefits, early detection, what are the potential risks?

Finding nodules that need to be followed.

and and once that decision is made to proceed with screening, the Cat scan is ordered.

It takes all of maybe 5 to 8 minutes.

It's a Cat scan is done with individual lying down.

There's sort of a cone that comes over your chest, but it's not.

It's not at all confining or restricting.

You hold your breath and the scan is done.

There is no intravenous contrast that's necessary.

It's actually a pretty pretty fast exam.

And it's very low dose of radiation.

that is delivered during the screening CT the once the scan is done, it is then interpreted by radiologists and then the interpretation is sent to the physician or the nurse practitioner that ordered the Cat scan.

So for example, for my patients I get the results of the Cat scan.

If the Cat scan is negative, nothing concerning.

I send a message through patients through my chart, or I call them if they don't use my chart.

Hey, your Cat scan is fine.

I'll see you back in a year.

I've placed the order for you to have your next scan in a year, and if there's a nodule that needs to be followed, then I call patients and say, this is what we found and this is what we're going to do.

The other thing that the lung cancer screening CT can show you, because it is a Cat scan that goes from the neck to the top of the abdomen.

So it includes the thyroid, the coronary arteries, the liver.

Sometimes you see part of the kidneys.

There are what we call incidental findings or additional findings.

And sometimes they're very important.

Like we see a lot of calcium in your coronary arteries.

Let's make sure that your cholesterol is okay, that your lipids are okay, that your blood pressure is well controlled, that your diabetes is controlled.

and that's been shown to be important in terms of detecting other conditions like emphysema and getting pulmonary function testing or coronary artery calcification, and making sure that you're being cared for so that your risk of having a major cardiac event is reduced.

So that's really the process.

It's pretty streamlined.

and then again, the important thing is to come back annually and to come back if something is found.

>> So there you go, Jim.

I hope that helps there.

And it was a very good question on on screening, what that entails.

Joyce Lucas story as I'm going to I'm going to frame this as a good news story, the kind of the, the the tale that tells you what can change because you're someone who smoked for almost 30 years, right?

Starting around 1980.

Yep.

Okay.

>> Late 70s, 1978, about 2008.

>> Okay.

So about 30 years of smoking.

How much did you smoke when you were when you were smoking.

>> Minimum a pack a day, a pack of 20 to 25 cigarettes a day.

>> You told me a story on the phone this morning that I thought would be also helpful.

You said in this climate, we get these cold winters and you'd get these 15 minute breaks at work.

And what were you doing on those breaks?

>> So in a 15 minute span that you're on the clock, you had to go out in frigid temperatures, sometimes windchills less than zero.

Yeah.

To smoke.

>> And your goal is to get at least a couple down.

>> Two cigarettes really quick.

Yeah.

Along with the crisp, fresh air which caused bronchitis and respiratory infections every single year.

>> So you'd get bronchitis every year.

>> Every single year.

>> And did you in your mind, connect it to the smoking?

>> No.

I mean, of course I didn't connect the smoking and the frigid temperatures, both you're inhaling, you know, not just the cigarettes but also the cold air.

>> So you're thinking, well, it's Rochester, it's cold.

Everybody gets.

>> Clean, fresh air.

I can go in smelling fresh.

>> Everybody's everybody's got breathing problems.

in 1978, when you started smoking, what convinced you to start?

>> So in my community, smoking.

There's no shame.

There's no guilt.

I mean, everybody does it.

at that time in life, here in the city of Rochester, I would go to the bus stop to go to school or to work, and they were at the corner passing out cigarettes.

>> Everyone's smoking.

>> Philip Morris literally passed out Newports.

Anybody can attest to this in the city.

Oh, yeah.

And you know, they free cigarettes.

Who wouldn't take them, you know.

Oh, no.

Everybody was doing it.

We 18 years old, young adults.

It was cool.

>> The culture was very different.

>> Very different.

>> I tried to explain this to my son now, who's 13, and it's like, I'm glad it's not around you like it was when I was your age.

I grew up in Cleveland, and when the Cleveland Browns would play at the stadium, the biggest sign almost as big as the scoreboard itself, you'd see it in highlights.

It says Marlboro Country.

Now you're in Marlboro.

>> And then cigarettes back in those days were on the counter right next to the candy.

The candy bars.

>> Right there.

Yeah.

So easy to get.

And and vis a vis today's dollars, a lot cheaper than.

>> Oh, yeah, I think it was like $1.50 less than $2 when we started.

>> So about 30 years of smoking.

Why did you stop in 2008?

>> So after losing my husband, I had young kids and I, you know, I quit several, several times prior to that.

>> So you did try.

>> So in 2008, I don't think it was quitting.

I call it surrendering because as the doctor said, it is addiction.

That's con, more powerful than yourself.

Your will sometimes.

So instead of quitting, I associated it with surrendering, which made me accountable for, you know, my fears when I go get these screenings is like, you know, I smoked.

I did this to myself.

So now.

>> Wow.

In a moment, I'm.

>> Gonna accountability.

>> I'm going to ask both the the professionals on the panel to kind of describe what stands out from this story.

But let's let's put a happier bow on this.

So you get to that point in 2008, do you remember your last cigarette?

>> I do, I literally sat on my deck.

I had a new house, and I wrote a letter to Newport that you're killing me.

My kids need me.

>> Wow.

>> I can no longer afford you.

I don't like the way you smell.

And just this nice long letter.

And I set it on fire, and I surrendered.

>> Okay, so you wrote the letter, and then you lit it on fire?

Yep.

>> Yeah.

Give it to the universe.

>> Gave it and and it, you know, despite the previous efforts trying to stop.

That was your last cigarette.

>> That was my last cigarette.

>> That was it.

And did you notice a change in your health in a year?

In five years?

>> no.

I mean, the desire is always there, but you people have association with gaining weight.

Is that your taste buds are back and everything tastes good now, and you can exercise and you just feel better.

Okay.

And then a couple years after that, when I started doing the screenings, that was it was scary emotion.

It's sort of like a double edged sword, I would say.

You go in with serious anxieties, oh, what have I done to myself?

You know, you know, there's a possibility of something going on because smoking isn't something natural.

But at the same time, you come out with a relief that, you know, it's not as bad as you thought.

I did have nodules in my earlier screenings.

at the end of my screenings in 2023, those nodules have seemed to shrink.

>> So the screenings for you, you can relate to the people who are feeling like either I don't want to do this, or I have a ton of anxiety.

>> There is tons of anxieties.

I don't think people don't want to know.

I think they're afraid of what they will find out.

Yeah, but I mean, as a cessation coach, I encourage people to get screenings because cancer isn't necessarily I mean, smoking doesn't necessarily cause cancers.

It could.

But if early detection would give you a better chance of getting treatment.

>>, and so in 2023, 15 years after you stopped smoking the screening of your lungs told you, what about your lungs.?

>> That they now function like a nonsmoker?

>> Amazing.

>> And, you know, I heard one of the doctors earlier said that they don't like to scare the scare tactics, but I don't think they're scare tactics.

I think they are realizations of what's possible.

What could happen to you.

So some of those commercials did encourage me.

I mean, you know, to see somebody at a gravesite at at 42 saying, I never thought 21 would be half my life, you know, makes you think.

>> Yeah.

And to be clear on some of the numbers here, it's still unusual for people in their 40s to even smokers to have lung cancer.

It is not unusual for people in their 70s 80s who have smoked their whole lives to to develop lung cancer.

I'm not saying it can't happen, I'm just saying I'm looking at the data.

But you're saying those ads, you still remember them.

>> I.

>> Do, they affected.

>> You, certainly.

>> And the conversation you told me you had conversations with your.

You have three sons.

>> Yep.

I had three sons growing up as a smoker.

And they would trash them.

They would break them up.

They would get grounded.

But they didn't care.

They did not want me to smoke.

And fortunately none of them they would.

>> They would grab your cigarettes and tear them up.

>> They would.

I found my cigarettes in the trash can.

I found them in the toilet.

I found him in the back of a Hess truck.

I mean.

>> What did you what did you.

What did you say when you had these confrontations?

>> Yeah, unfortunately, at that time, my state of mind was a little different than it is now.

And they would get grounded because it wasn't their possessions or.

Yeah, you know, you don't really.

I must say I'm guilty that I wasn't so concerned with what they thought at the time.

>> No, I mean, I think it's like we've talked about you have an addiction.

>> It's an addiction.

>> You had an addiction.

But you look back now.

And what do you think about their actions?

>> Yeah, it was valid.

Absolutely.

>> They loved you.

>> And I thank God that none of them smoked.

>> So yeah, that that's my story.

Joyce, I got to say, I, I'm one of three brothers and we grew up watching my mother smoke and my stepfather and I had zero desire.

It was just I didn't like the way it smelled.

I, you know, I wanted to feel good physically, but it's, you know, again, culture changes, norms change.

It is not easy to move that.

>> Grew up with no smokers.

None of my parents smoked.

I had a couple of uncles, but nobody in my environment smoked.

I quit each time I got pregnant after nursing.

First thing I did was grab a cigarette.

>> So how you feeling these days?

>> I feel amazing.

I just walked down three flights in the parking garage and I could breathe.

>> Breathe deep, feel pretty good.

>> I do.

>> and you get screened every year?

>> Well, not any, not since 2023.

Okay.

>> 15 years of screening.

since you stopped smoking.

Okay.

>> So because my lungs have reversed, I am no longer required to have screenings.

>> Okay.

But it was worth it to do it every year.

>> Absolutely.

>> Yeah.

So let me ask the doctor, Carmen and Dr.

Rivera what they hear.

So, Dr.

Carmen, you hear this story, what stands out to you?

>> I knew about half that story.

That's really actually very moving.

Joyce.

I love the burning the letter piece.

Yeah, very, very notable.

I think, you know, my best friend growing up, his mom was a smoker, and he always said, this is gross.

I'm never going to do it.

He grew up and he ended up becoming a smoker, which I'm glad when people avoid that.

But the the context can really influence people to, to smoke.

And I think that shows the importance of quitting.

If you have kids, if you have a family.

>> So with me, when I first started, we were having cigarettes and I was like 17 or 18 and I just literally puff and blow it out.

I wasn't really a smoker, and I had three other sisters that we all smoked around the same time, and they were like, you're not smoking.

So at 21, when we started having kids, they quit cold turkey and I was the only one left smoking for the years.

>> I think the other thing that stands out like yeah, the trends back then it was so common.

Right.

Cigarettes were everywhere, advertising was everywhere.

And there was a long period where you didn't see smoking in media, movies, TV.

And I feel like that's starting to change.

This could be just my perception, but I feel like I'm seeing in more movies and TV people smoking cigarettes again and looking very cool doing it, which gives me some concern.

>> Yeah, yeah, I, I don't know if there's I'm somebody got data to back that up, but there was definitely a period I think a generation where you didn't see that like you used to with Cary Grant.

Cary Grant was probably smoking in most.

>> Of his.

Davis was the.

>> Betty Davis, you know, the hepburns.

I mean, everybody was smoking in old America.

So old.

It's amazing what we think is old Dr.

Rivera.

When you hear Joyce's story, what stands out to you?

>> I just think you are so brave.

Quitting smoking is the hardest thing that any individual has to do.

And I commend you and congratulate you.

I always ask patients, how did you do it?

I always want to be inspired by methods people took.

Or, you know, I did it through this method, or I had this friend or this family member so that I can share that with my patients.

so and again, the most important intervention to prevent lung cancer is smoking prevention or cessation.

But it isn't just about lung cancer.

It's the many other cancers that are linked to smoking, bladder cancer and breast cancer, and head and neck cancer and esophageal cancer.

It's coronary artery disease is osteoporosis and osteopenia.

Smoking, has multiple effects, not the lungs are, you know, one organ, but many organs can be affected.

So I think I always tell people it's, you know, and it's never too late.

We have studies that show that for every ten years that you are smoke free, the benefits just continue to increase.

And people say, well, I've been smoking, I'm 60 or 70.

It's just it's never too late.

so I just I'm inspired by you.

I think people need to always be congratulated for doing such a hard thing.

>> Absolutely.

>> Thank you.

So when I did the screenings, they did find that I had fatty liver or something, or kidneys or something that we've been watching and that has resolved as well.

So the screenings, did, you know, gave me a little hope and explored other things.

when I go out and talk to folks about smoking, I don't to quit.

You have to be ready.

Body, mind and soul.

I did the patches, I did the gum, I did it all.

But until you're ready, totally ready.

Nothing's going to work.

>> Go ahead.

>> I will say.

Yeah.

I mean, if people are thinking about quitting.

I mentioned the tobacco cessation program.

I can give the number if that be helpful.

People can call to talk to tobacco cessation specialists.

So it's five, eight, 55049461.

So you can call talk to a specialist if you feel like you're ready to quit smoking.

>> Let me read an email from Annalee who says, I smoked for 40 years.

I quit smoking 11 years ago.

I had a brother who his entire life said that he was going to smoke till the day he died, and he did.

He died from emphysema five years ago.

It's a horrible way to go.

And what he said just days before he died was how mistaken he had been about smoking.

that is a I'm sorry to hear that on Elaine.

I'm sorry for your loss there, but I also wish you good health.

11 years smoke free for you.

And I hope that you're on a path just like Joyce.

you know, it's certainly possible, right, Joyce?

>> It is.

Absolutely.

I talk to people all the time.

I spoke to one lady that's 88 years old.

That was spoken since she was eight years old.

And never did a screening.

Don't want to do a screening, you know, have no clue.

Which is unfortunate.

>> and I thank you for that email.

Let me read Dallas who says radon is pretty much all over Western New York.

I don't know that it's actually proven that it causes lung cancer.

Maybe Dr.

Rivera can can weigh in on that.

Dr.. >> Yeah, either of us could.

>> Go ahead.

Dr.

Carmen, do you want to start?

>> Yeah, yeah, it is linked over the long term.

Right.

So it's not like you walk into a pocket of radon, and that increases your risk.

But inhaling air with radon over the long term does increase lung cancer risk.

It's most pronounced if you are smoking and exposed to radon at the same time.

That's the highest risk level.

>> Okay.

And then you want to add there Dr.

Rivera.

>> No it is one of the occupational exposures.

you know, like asbestos and silicosis.

That has definitely been linked to lung cancer risk.

>> Pat wants to know if vaping is equally dangerous as cigarettes.

>> The million dollar question, right?

>> Because it.

>> It's so common.

Yeah, yeah.

So.

And Patricia can chime in on this too.

The data.

We don't have enough data yet to really see over the long term whether it's going to stack up.

What we know is it's not healthy.

You still get nicotine, as you heard earlier.

the the additives from a vape are not the same as from a cigarette.

So it does look slightly different.

But there is certainly risk there.

Whether it compares to smoking cigarettes in terms of carcinogenesis, we don't know yet.

>> Okay.

Dr.

Rivera.

>> More linked to inflammation in small airways or small air tubes in your lung.

I mean, we had of course, the very serious acute lung injury that occurred a few years ago from vaping.

But, clearly damage to the air tubes has been well reported.

We don't have enough data as as Charlie said, about whether or not there is a link.

But anytime that you're inhaling and putting foreign substances into your lungs, it's just not good.

one of the things that I worry about vaping again, is the amount of nicotine that people are being exposed to when they vape and getting addicted to nicotine, and whether or not, you know, years from now, if e-cigarettes or vaping devices are going to be much more expensive than they are now, and cigarettes become a lot more affordable, people will have to resort to smoking cigarettes in order to get their nicotine fix.

so it's it's it's the data is not out yet, but it is concerning.

And the same is true for, you know, cannabis.

And anytime you're burning something and inhaling it into your lung, it is not good.

>> All right.

Let me try to get as much listener feedback in the next five minutes, because we've got a lot here.

Gloria in Canandaigua on the phone next.

Hi, Gloria.

Got it.

To keep it tight.

Go ahead.

>> Okay.

I'm 80 years old.

I started smoking when I was 13 years old because I wanted to look older.

And I smoked until I was 25 when I, you know, there were announcements on the radio saying that if you get pregnant, it can affect the development of the baby.

And I it really hit me.

And so I threw away the pack that I had.

And did not start smoking again.

But wanted to kept feeling like I needed a cigarette for two years after that.

And, did get pregnant, but it was luckily I wasn't smoking.

>> Yeah.

So, Gloria, first of all, I'm.

I hope you're in good health and feeling good these days.

And I. And that story that you have is pretty common.

People moved by different reasons.

but also the feeling, I think, Joyce, you said even after you stopped smoking, you still wanted cigarettes.

>> The craving never goes away.

If I walk past somebody with a cigarette, it smells awful.

It's repulsive.

But yet there's times where I wish I had a cigarette.

But because of where I came from, I would never go back.

>> Yeah.

So, Gloria, I think a lot of people can relate.

And.

And Dr.

Carmen that just says, you know, that is probably pretty common.

That's the addiction.

>> That is it.

>> Don't give up.

Right?

>> Right.

Exactly.

It's, as Patricia said, one of the hardest substances to quit, actually, because our brains love nicotine.

>> question about any screening for nonsmokers.

So I don't think that's what this particular program is for.

But go ahead, Dr.

Carmen.

>> So Patricia can say more about this, but you can pay into a screening if you are concerned about your risk.

But there's not a program of screening unless you meet the eligibility criteria, which are, as you heard, pretty restrictive.

>> Okay, doctor Avera, anything to add there?

>> right now we have no guidelines on how to approach screening.

And individuals who have never smoked or individuals who have don't have 20 pack years of smoking.

they're are some I, I do a lot of risk assessment when I see patients in clinic, I take into account other risk factors like family history or personal history of cancer, but there is no data currently in the United States or in Europe about screening individuals who have never smoked.

>> Okay.

And you may think that's crazy, but because we've heard there is still a risk, but the risk and benefit have to get weighed out for something like screening.

Right?

>> Okay.

>> And if I could chime in really quick, as soon as you quit smoking, your body immediately reacts.

I mean, you can feel the difference each minute.

There's a there's a statistic where after 20 minutes your body changes and which each stage is the longer you quit, the more your body is healing.

>> real quick here, she said.

If you've ever ridden your bicycle in rush hour traffic or behind a bus or other large vehicles, putting out amounts of hydrocarbon, perhaps you've wondered, like me, if the exercise you're getting is neutralized by the pollution you're getting.

Dr.

Carmen.

>> Yeah.

Really, it's it's over the long term.

So in that moment, you're probably not getting too much.

negative effect in the bike riding is still good for you, so keep doing that.

But yes, air pollution is another risk factor for lung cancer for sure.

>> Okay.

So I mean obviously see why you got to go where you got to go, the routes you got to take.

But if you can avoid routes that have that kind of exposure over the long term, you know better to do that if you can.

So many great questions and comments.

Joyce Lucas your story is going to affect so many people.

Thank you for telling your story.

Thank you for your continued good health to you.

Thank you.

And Dr.

Carmen, thank you for the expertise.

We appreciate your time.

>> Thank you so.

>> Much, Dr.

Rivera.

Great having you.

Thank you for being with us this hour.

Thank you.

>> Thank you very much.

>> If you want to call Urmc about this screening, 1-877-728-4543 and we'll have the website information in our show notes as well.

If you want to learn more about this screening opportunity, more Connections coming up in a moment.

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