Virtua Health Dr. Matthew Puc
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00:00Hi, I'm Nicole from 92.5 XTU.
00:03And hi, I'm Marissa from The Pressin and Steve Show on 93.3 WMMR.
00:08And so excited today to introduce thoracic surgeon and medical director of the Penn Medicine
00:14Virtual Health Cancer Program located in South Jersey, Dr. Matthew Coots.
00:21Thank you so much for being here today.
00:23Well, thank you for having me.
00:25It's a pleasure.
00:26All right, so as a thoracic surgeon, you specialize in the lungs, especially lung cancer.
00:33We know that smoking is the number one cause of lung cancer, but what about vaping?
00:39Yeah, great question.
00:41In short order, we don't have that information yet just because vaping has not been around
00:48long enough.
00:49It's relatively new, so we just don't have the data.
00:53However, we do know that the vaping fluid that people use to vape does contain some of
01:03the same chemicals that we know will or can cause lung cancer.
01:09So I think, you know, in short order, there's a concern that could potentially be carcinogenic
01:16to the lungs and lead to lung cancer.
01:20It just, we just don't have enough data and vaping is, just has not been around long enough
01:27to have that information yet compared to tobacco products such as cigarettes, which have been
01:34around for decades and decades.
01:35So we have plenty of data about that product and to know that it's, you know, a direct cause of lung cancer.
01:46Just, I just want to add, since we are on the topic of lung cancer, I always feel it's important
01:51that, you know, we know that tobacco is the number one cause.
01:54The second cause is radon.
01:56And I always mention that because people usually don't hear about that.
02:00And I think this is a great opportunity for that, that radon exposure over time, over decades,
02:07is the second common cause of lung cancer.
02:10So it's important to be aware of that.
02:12I always let people know we live kind of in a high radon area.
02:16So it's important to kind of test your basements and your living space for that exposure.
02:22That's what I was going to say.
02:23Where would one be exposed to radon?
02:25Yeah, so radon comes from the ground.
02:28So it actually comes up from people's basements into their living space.
02:34So it's kind of important to kind of test your basements.
02:38And if you have high levels, then you need to mitigate what we call mitigation products
02:44are out there to kind of get that radon out of your basement and into the atmosphere
02:50or to the outside environment so you're not breathing it in.
02:54So we kind of forget about that.
02:57We're always so hooked on tobacco, which is important, but radon is the second leading
03:03cause of lung cancer.
03:05Really quick, before we move on to Marissa's question, I think it's important for people
03:10to know you're talking about vaping.
03:14We're talking about tobacco usage.
03:18Most chemicals in both are the same.
03:20The difference is, is that what doesn't vaping have that cigarettes do or tobacco does, I
03:26should say.
03:26For people that are confused, like what the difference is from one to the other.
03:30Yeah.
03:31So, you know, it's interesting when you look at when vaping first came out and was advertised,
03:38it was really advertised as a way to get people off cigarettes.
03:44It was, you know, to help.
03:46And so when you look, and the other thing that was kind of a misnomer about vaping, a lot of
03:53people said it was just water vapor.
03:55And that's a, that's a huge misconception.
03:58I just want to kind of make sure people realize that because there are differences between
04:04vaping and, and tobacco.
04:06And some of, some of the differences, there's less kind of chemicals, there's less carcinogens
04:13in vaping than there is in a, in a tobacco product, such as cigarettes.
04:18Um, however, vaping still contains, uh, a certain number of carcinogens that we know are cancer
04:26causing, um, you know, when you vape, you're heating a metal element, such as tin, aluminum,
04:34nickel, that can all end up being deposited, uh, in your lungs, um, which, you know, sitting
04:41there is not good for your lungs.
04:43Um, and vaping also is an irritant just to your throat and lungs themselves, which causes
04:49significant inflammation on daily or chronic use, which can ultimately lead to like chronic
04:55bronchitis, uh, and even like irreversible lung damage.
04:59So, you know, besides the carcinogen, um, risk, um, there's also just a risk of, you know,
05:06respiratory illnesses, um, uh, that you don't want to have and potential long-term lung damage.
05:13That's important.
05:13Yeah, so there's none of those safe vaping, even though whatever that they advertise, um,
05:19I have to jump in.
05:19You said that there's not a lot of research with vaping.
05:22I mean, there's a ton of research, but not long-term research.
05:25Um, what about natural substances, those non-tobacco substances that have been around for a while?
05:32What sort of effects do those have with cancer and lung treatment?
05:35Yeah, great question.
05:37So all those, you know, non-tobacco products, um, they are, you know, anything that is
05:42smoked and inhaled into the lungs, um, is going to create number one inflammation to the airways.
05:49Um, you know, like I say, anything besides oxygen shouldn't be going into your lungs.
05:55So everything else is pretty much an irritant.
05:58Um, and again, those irritants can cause inflammation, chronic inflammation needs, uh, leads to, you
06:04know, chronic bronchitis, mucus production, chronic cough, um, you know, asthma exacerbation,
06:12things like that, just from a respiratory illness standpoint.
06:15So, so, so all those issues still exist.
06:19In addition to that, um, you know, these non-tobacco products, um, can also contain carcinogens.
06:27Um, and again, the link to lung cancer, um, is not as well developed as we know with tobacco
06:37products such as cigarettes.
06:39Um, but these non-tobacco products also have that potential risk.
06:45The data just, the long-term data just is not there yet.
06:49Um, a lot of these, uh, products are illegal.
06:53So we have not been able to do the research that we really need to, uh, in this field until
07:00more recently.
07:01So I think with time, we'll get more of that data, but that risk still is the, that concern,
07:07you know, and that risk for lung cancer is there.
07:11We just need to prove it.
07:12Oh, wow.
07:13That's really interesting that, um, the research is newer, um, based on the laws that have passed
07:19just over the past few years.
07:22Correct.
07:22Correct.
07:23And that will change, you know, historically, um, a lot of these non-tobacco products have
07:28been there for a long time, but, you know, when a product is illegal, people are not going
07:33to admit to, to using it or, or won't admit to using it on a regular basis.
07:37So it's really hard to do, you know, the clinical trials that you need to, to get that data.
07:43Um, so I think now with the laws changing, yeah, I think now that opens the availability
07:50to do those trials that we, that need to be done, um, to prove that link.
07:56Um, and some of the difficulty also is, you know, people who use non-tobacco products also
08:01use tobacco products.
08:03So there's going to be that cross reaction, you know, so you really, you're going to be,
08:08you know, you're going to need to do well-controlled trials to kind of separate those two influencers.
08:14So, you know, you have a separation there, but I think, I think now the, the environment
08:18is there to, to get that done.
08:21Yeah.
08:21So fascinating.
08:22All right.
08:23So, um, someone you love, uh, lifelong smoker used to be a heavy smoker.
08:31What advice would you give them for obviously making sure that their lungs are healthy?
08:37Yeah, that's a great question.
08:39And we have, there's two points I want to touch on with that.
08:43Um, number one, um, heavy smokers, um, I would encourage them to quit smoking.
08:49Number one.
08:50Um, I think that is step number one and, and we've kind of listed some of all the reasons
08:56above, um, why that's important.
08:57Um, uh, the sooner the better.
09:00Um, virtual offers a host of smoking cessation programs, um, that have been well-developed over
09:08the years, uh, which include both group sessions and also individual one-on-one counseling,
09:14um, that can happen.
09:15So I think, um, I highly recommend that.
09:19Um, I mean, I see a lot of patients who just go cold turkey and do it on their own.
09:23Um, and, and a lot of times that's, that can be effective.
09:28Um, but again, it's, it's a difficult journey.
09:31Anyone who's, who's tried to go down that road of, uh, of quitting tobacco, um, usually
09:39it takes multiple attempts and we have plenty of programs here to help folks through that
09:43process.
09:44Um, because I encourage folks that, you know, failure is not a reason to stop trying, you
09:51know, because it's just the kind of a natural process of, of trying to get off nicotine.
09:56Nicotine is very addictive.
09:57Um, and that's the, that's, that's the problem.
10:01Um, nicotine is probably more addictive than even heroin and, and, um, cocaine and products
10:08like that.
10:09Um, and so it is not easy, uh, and we don't want people to go it alone.
10:13So we do have a lot of smoking cessation programs here to help.
10:17The other thing, and now we have very good clinical data to show, um, lung cancer screening.
10:23Lung cancer screening is done with a CT scan of the dose, uh, and what we call a, a low
10:30dose CT scan.
10:31So you get really minimal radiation exposure.
10:35Um, and that data has been around since 2011, um, to show the benefits and the survival benefits
10:42of screening high risk individuals, such as heavy smokers, as you alluded to.
10:48Um, and we have very clear guidelines.
10:51So the guidelines now for people who should be screened, um, are folks who are 50 years
10:56of age or older, um, and who have what we call a 20 pack year history or, or more.
11:03And the way we define a pack history is we basically multiply the number of packs a day you smoke,
11:10uh, by the number of years that you've been smoking.
11:13So if you smoke one pack a day or have been smoking one pack a day for 20 years, one times
11:2020 is 20.
11:22If you're doing it for 30 years, one pack for 30 years is one times 30 is 30 years.
11:27So that's how you kind of come up with that pack years.
11:30Um, and that's kind of the set guidelines now for lung cancer screening.
11:36Um, and the issue with screening and lung cancer is we're trying to find it early.
11:42We're trying to find it at earlier stages because that's when it's curable.
11:46And that's when people do not have symptoms yet.
11:49And that's the issue.
11:50Um, I always kind of jokingly, jokingly say the lung tissue does not have pain fibers.
11:57So if you have a lung nodule, your body's not going to feel it.
12:01Um, and most lung nodules when they were lung cancers, when they start out, they're pretty
12:05small.
12:06So they're really not going to be irritating to the, to the patients, to the airways.
12:12Um, so you're not going to know about it.
12:13Usually you don't know about it until it's too late.
12:16And by the time you have symptoms with a lung cancer, that's usually when it's well advanced.
12:23And so lung cancer screening catches these early when they're very treatable.
12:28Um, that's really, really important for people to know that.
12:32Mm-hmm.
12:33And I read that, um, it is covered by insurance.
12:36Correct.
12:37So, so the United States Preventative Task Force, that's a mouth load, is the agency that
12:45recommends, you know, screening, um, for the population health.
12:50Um, and whatever they recommend, um, private insurers have to cover that service.
12:57Um, and CMS or Medicare usually follows the same guidelines.
13:02So correct.
13:03In short order, yes, lung cancer screening is covered by insurance.
13:08Um, and I also want to plug Virtua's lung screening program.
13:12Um, we do have a website, uh, virtua.org slash lung screening, um, where you can basically
13:21go online and request an appointment, um, through our website, um, to help people kind
13:28of navigate that process.
13:30Wow.
13:31And Virtua is there through the whole process.
13:33Um, we talked about screening.
13:34Now let's talk about treatment.
13:36Virtua and Penn Medicine just opened a proton therapy center, uh, over there in Voorhees,
13:42New Jersey, um, explain to us what proton therapy is and why this is so significant in the lung
13:49screening and treatment process.
13:51Yeah.
13:51So proton therapy or protons, um, or is a newer type of radiation therapy for the treatment
13:59of, uh, various, um, malignancies or cancers in the, in the body.
14:04Um, previous to proton or besides proton, it's what we call photons has been kind of the, what
14:12people are more familiar with and has been around much longer.
14:15Um, and that's photons with an H this is protons with an R protons.
14:21Um, sometimes the two words get a little bit, uh, mixed up, but proton therapy is a way of
14:29delivering radiation to the body with less collateral damage to the surrounding tissue or the surrounding
14:37normal tissue or the non-cancerous tissue.
14:40Um, there's a lot of physics involved, but the way protons are delivered, once it hits the
14:46target or the target tumor, the energy from it just drops off.
14:52So you have very limited, you know, um, damage to the normal tissue surrounding it as opposed to
14:58photons, which generally travel somewhat past the tumor and then kind of drop off.
15:04So you're going to get some collateral damage.
15:08So, you know, in, in, in high rent districts, like I say, um, and really critical tissue or
15:14critical organs, such as the brain, the spine, um, you know, where you don't have much room for error,
15:21that, that dose of radiation comes in, hits the, hits the target and then just drops off.
15:27And so there's a lot less collateral damage.
15:30So, so when we talk about brain and spine, protons can be very helpful.
15:35Uh, it can be very helpful in lung tissue, uh, and also prostates.
15:39Prostates are, um, you know, a popular area to use protons or use targeted therapy like proton
15:47radiation.
15:49So interesting.
15:50So who's the candidate for proton therapy?
15:53Yeah.
15:54So not all cancer types are, uh, are, are candidates.
15:58Um, and the best way to figure that out is we have, you know, our proton therapy center.
16:05Um, we have, uh, very well-trained, uh, radiation oncologists who basically manage those folks.
16:12Um, and basically a consultation with one of them will help determine, you know, for each individual
16:20patient, what's really appropriate, you know, is it a standard photon therapy and, uh,
16:26the best way to go, or would protons add benefit in their particular situation?
16:32So, you know, each, you know, in essence, really any tumor site could benefit from protons,
16:38but it really comes down to the individual patient situation, uh, and the tumor site and
16:45the location.
16:46And the only way to best know that is to have our radiation oncologists evaluate these folks.
16:52Um, and again, our proton therapy center, um, and, and Voorhees, as you mentioned, is connected
17:00with the Penn medicine virtual health cancer program.
17:04Um, and, and this was kind of a, a partnership with them to bring protons to, you know, the
17:11community of South Jersey.
17:13So we do have, you know, uh, when you think about what we can offer here, we do offer the latest and
17:20greatest advancements in cancer treatments that you can really get anywhere else, uh, in, in the,
17:26in the country.
17:28Before we wrap up, one of my really close friends, her mom, uh, just got cleared.
17:33She went to, she had lung cancer, went to Voorhees and yeah, she's in remission now.
17:38So yeah, she was diagnosed in the summer of 2021 and I just saw her last week and now she only has
17:45to, you know, get scanned like every six months, but yeah, she went to, she went to virtual and Voorhees.
17:50That's fabulous.
17:51Yeah.
17:51Glad to hear it.
17:54Well, Dr. Poots, thank you so much for joining us today.
17:56Um, Nicole and myself always learn so much from these sessions and we are honored to be
18:03able to share it with our audience because there's so much important information out there.
18:06And if you don't think that this affects you in some way, it does, it's whether it's yourself
18:10or somebody out there, um, share this with a family member or a friend who needs to hear it.
18:15Um, and if you would like to learn more about lung screening or proton therapy at Penn Medicine
18:20Virtua Cancer Program in South Jersey, all you have to do is go to Virtua.org.
18:26That's Virtua.org for all the information.
18:29Thank you guys so much.
18:30It's so important.