The Lung Cancer Screening Program at NewYork-Presbyterian/Weill Cornell Medical Center provides state-of-the-art, low-dose computed tomography (LDCT) imaging for high risk individuals under the guidance of a coordinated, multidisciplinary team of experts.

Based on evidence from the National Lung Screening Trial (NLST) and several other studies, the U.S. Preventive Services Task Force (USPSTF) has recommended annual screening with low-dose CT in persons at high risk for lung cancer. In fact, the most critical finding of the NLST is that annual screening with low-dose CT for 3 years reduced lung cancer specific mortality by 20% in this high risk population, as opposed to chest x-ray screening.

If you are interested in more information or would like to schedule an appointment, please call us at 646-697-LUNG (5864).

 

Introduction                                                       Frequently asked questions

Why this program                                              Resources

Is lung screening right for you                        Contact information

Program overview                                             Hospital map  

 

Why choose NewYork-Presbyterian/Weill Cornell Medical Center for lung screening?

When a participant joins our comprehensive program, we provide the highest level of service in coordinating the initial visit and follow-up. Our experts will be available to guide you throughout the process.

Our program draws on the expertise of a multidisciplinary team of pulmonologists, thoracic surgeons, oncologists, and radiologists, who collaborate on recommendations and are available for specialized care should further testing or treatment be necessary.

Recognizing that smoking is the strongest risk factor for developing lung cancer, we offer and encourage discussion with our dedicated smoking cessation counselor.  We know that it is difficult to quit smoking, and because smoking cessation is the best way to reduce your risk, we offer individualized support.

We also offer a range of support groups, providing compassionate counseling, education and support for participants and their family members.

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Is lung screening right for you?

The U.S. Preventive Services Task Force (USPSTF) recommends annual screening for lung cancer with low-dose CT in adults ages 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. A pack-year equals the number of packs smoked per day times the number of years the patient smoked. For example, 1 pack per day for 30 years equals 30 pack-years.

Based upon a review of existing data, this high risk population may also include individuals outside these guidelines. Our program can provide an individualized assessment of your risk to help guide your decision about whether to undergo a low-dose screening CT.

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Program Overview

  • Potential participants referred to the program will be contacted by our coordinator, who will schedule a consultation to discuss the risks and benefits of participation.                                               
  • Low-dose CT screening can be performed on the same day as the consultation.                                  
  • Participants undergo a low-dose CT that will be reviewed by a selected group of board certified radiologists within 24 hours.                                                                                                                           
  • Findings are reported to both the participant and referring physician with recommendations for follow-up. These recommendations are based upon continued review of current literature and monthly quality care meetings by the Lung Cancer Screening Program Steering Committee staffed by a multidisciplinary team of pulmonologists, thoracic surgeons, oncologists and radiologists.          
  • Participants may schedule a visit to discuss results in person. Should a participant require additional testing or treatment, the program coordinator serves as the point person for streamlined communication and comprehensive care with our multidisciplinary team.                                               
  • Our dedicated counselor is available to provide support and smoking cessation counseling.

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Frequently Asked Questions

What is a low-dose CT scan? How much radiation exposure is involved?                           

Who interprets the CT? What happens if there are abnormalities?

Who should consider screening?

Is a prescription required?

What is the cost?

Where do the consult and CT scan take place?

What factors increase the risk of developing lung cancer?

What are the risks associated with lung cancer screening?

What are the benefits of lung cancer screening? What supporting evidence exists?

What do my results mean?

What is a lung nodule and how can you tell if it is cancerous?

Why does the program offer smoking cessation?

How does lung cancer screening compare to screening for colon and breast cancer?

What other types of screening exists for lung cancer?

Why is a multidisciplinary approach to lung cancer screening so important?

What does this program do to ensure quality care? Does this program participate in research?

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What is a low-dose CT scan? How much radiation exposure is involved?

CT scanning refers to obtaining cross-sectional x-ray pictures through the body and has been found to be more sensitive than x-ray for detection of lung cancer. Low-dose CT scans utilize less than 20% of radiation used for standard CTs.  The quality of the CT images and interpretation are extremely important; screening is best performed in a structured program.

The amount of radiation exposure from a low-dose CT is less than 1.5 mSv, which compares to the naturally occurring background radiation one receives over 6 months at sea level.

For the scan, you will be taken to an exam room and asked to lie down on a table, which slides through the scanner. You will then be asked to hold your breath for less than 5 seconds while the machine scans your chest. This process takes under 5 minutes and is completely painless.

Lung cancer screening is a process, rather than the completion of a single low-dose CT. In order to receive the greatest benefits from screening, you must be scanned annually and follow up on any abnormalities that are found. Our program coordinator will help you navigate throughout this process and facilitate all follow-up.

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Who interprets the CT? What happens if there are abnormalities?

CT examinations are read by a selected group of board certified radiologists within 24 hours.

It is not uncommon for abnormalities to be found on screening CTs. Nodules are found in approximately 25% of individuals screened; the majority (95%) of these findings are NOT cancer. While we are primarily screening for lung cancer, other abnormalities such as past or present pneumonia, tuberculosis, and emphysema may be detected.

Our multidisciplinary team of pulmonologists, thoracic surgeons, oncologists and radiologists will make follow-up recommendations based on individual results. This team will be available to guide lung cancer screening participants through further diagnostic testing and any needed treatment.

In many cases, follow-up will include subsequent low-dose CTs in order to monitor findings for changes over time. Other abnormalities may require another type of CT scan called Positron Emission Tomography (PET)-CT and/or a biopsy.

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Who should consider screening?

Only individuals at increased risk for lung cancer should be screened with low-dose CTs, which are highly sensitive tests yielding many false positives requiring follow-up.

Benefits have been clearly proven for adults ages 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. A pack-year equals the number of packs smoked per day times the number of years the patient smoked. For example, 1 pack per day for 30 years equals 30 pack-years.

Screening may be appropriate for individuals not meeting the above criteria but are otherwise at high risk for lung cancer.  For example, individuals with a first degree relative (parent, sibling, or child) who was diagnosed with lung cancer at an early age may be at increased risk. Our program can provide an individualized assessment of your risk to help guide your decision about whether to undergo a low-dose screening CT.

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Is a prescription required?

A doctor’s order is required for any imaging test, including a low-dose CT. If you do not have a referring physician, our physicians can meet with you when you arrive for consultation to discuss the risks and benefits of screening and assess your eligibility.

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What is the cost?

While many insurance companies will cover the cost of a low-dose CT for lung cancer screening, some still do not.  If insurance coverage is not available, the fee for screening is $350. This cost includes volumetric analysis, a diagnostic tool that assists radiologists in distinguishing benign (non-cancerous) from malignant (cancerous) nodules. If an initial scan yields positive findings requiring follow-up, the participant’s insurance should cover additional exams.

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Where do the consult and CT scan take place?

Initial consultations are held at Weill Cornell Imaging at NewYork-Presbyterian, 520 East 70th Street (between York Ave and the East River), Starr Pavilion Ground Floor, New York, NY 10021. Low-dose CT screening can be performed on the same day as the consult. Scans are conducted in an outpatient setting at one of our Weill Cornell Imaging offices, including the Starr Pavilion. Hospital Map 

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What factors increase the risk of developing lung cancer? What role does family history play?

Factors associated with an increased risk of lung cancer include history of smoking tobacco, age, exposure to secondhand smoke and environmental exposure to carcinogens such as asbestos and radon. Individuals have an elevated risk if a parent or sibling has been diagnosed with lung cancer, particularly if that individual was diagnosed before age 50.

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What are the risks associated with lung cancer screening?

False positives: The greatest risk associated with lung cancer screening is discovering misleading findings. Abnormal findings are common in low-dose CTs; the majority are NOT cancer. In some cases, further testing including follow up scans and biopsies may be indicated to determine whether a finding is benign or cancerous. Our multidisciplinary team takes great care to order additional tests only in the appropriate settings and thereby minimize risks to participants.

Exposure to radiation: Low-dose CT scans utilize less than 20% of radiation used for standard CTs. Radiation exposure from annual screening does add up however the risk from this minimal level of radiation is not believed to be significant. Our radiologists ensure that the lowest dose of radiation is used while maintaining high-quality images.

Anxiety: The screening process and follow-up testing may cause anxiety for some individuals. Our expert clinicians are available to discuss findings, give reassurance about benign nodules, clarify surveillance of suspicious nodules, and explain treatment plans with participants when needed. Our program coordinator serves as the go-to person to help guide participants through the screening and follow-up process. Participants may also meet with the program counselor for additional support.

For those at high risk for lung cancer, the benefits of screening are expected to outweigh the risks of false positives, radiation exposure, and anxiety.

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What are the benefits of lung cancer screening and what supporting evidence exists?

Lung cancer screening aims to detect cancer before an individual experiences symptoms and to reduce the risk of dying from lung cancer. It has been shown to prevent 1 in 5 deaths from lung cancer.

The National Lung Screening Trial found that annual screening with LDCT for 3 years reduced lung cancer specific mortality by 20% in a high risk population, as opposed to chest x-ray screening. Additionally, IELCAP studies have shown that annual CT screening helps detect 85% of lung cancer in its earliest stages, when treatment is most effective. When treated with surgery, the cure rate of these early lung cancers can be as high as 92%.

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What do my results mean?

CT examinations are read by a selected group of board certified radiologists within 24 hours. Imaging results usually fall into one of two categories: negative or positive. Our program additionally provides recommendations for follow-up to both the referring physician and participant. Whether a screen is negative or positive, our physicians are available to review results and recommendations should participants choose.

A negative screen indicates that no nodules were identified, or that nodules were very small or consistent with prior scans, indicating that findings are benign. If your screen is negative, we recommend that your return in one year for annual screening.

A positive screen indicates that nodules were identified and may require additional CTs or other testing. Abnormal findings are common in low-dose CTs; the majority (95%) are NOT cancer. Our multidisciplinary team will review all lung screens that are positive for nodules to distinguish between benign (non-cancerous) and malignant (cancerous) abnormalities. This team will work with participants to monitor, evaluate, and treat nodules.

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What is a lung nodule and how can you tell if it is cancerous?

A nodule is a small spot or abnormality found on a CT scan. Nodules may be caused by cancer, infections, scar tissue, or other conditions. It is common to discover nodules through low-dose CT scans, and most (95%) are benign (non-cancerous).  Our clinical experts assess all nodules for specific traits that may indicate they are cancerous. These traits include rough edges, odd shape, large size, fast growth rate, lack of calcium buildup, and high density.

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Why does the program offer smoking cessation?

As indicated by the USPSTF recommendation, smoking cessation is an integral component of any lung screening program because it is the most effective way to reduce the morbidity and mortality of lung cancer. We know that it is difficult to quit smoking and encourage discussion with our dedicated smoking cessation counselor, who offers individualized support based on best practices evidence. Low-dose CT screening for lung cancer is not a substitute for smoking cessation.

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How does lung cancer screening compare to screening for colon and breast cancer?

While colonoscopies and mammograms have been used for many years to screen for colon and breast cancer, low-dose CTs for lung cancer screening are in the early stages of implementation, with quality standards still being developed.  We offer screening through a comprehensive and evidence-based program to ensure that participants receive the highest quality care even while national guidelines are being developed.

The National Lung Screening Trial reports that 320 high risk individuals must be screened in order to save one life from lung cancer. In comparison, approximately 817 individuals must be screened by sigmoidoscopy to save one life from colon cancer, and 351 women aged 50-59 must be screened by mammography to save one life from breast cancer. 

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What other types of screening exists for lung cancer?

Chest x-rays and sputum cytologic evaluation have been used for lung cancer screening, but low-dose chest CTs have greater sensitivity, or ability of the test to correctly identify a positive result. Low-dose CT is the only test recommended by the U.S. Preventive Services Task Force (USPSTF) for lung cancer screening.

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Why is a multidisciplinary approach to lung cancer screening so important?

Lung cancer screening can be a complex process involving risk assessment, follow-up evaluation, and treatment when appropriate. This requires a coordinated team of specialists including pulmonologists, thoracic surgeons, oncologists, and radiologists. Our team holds regular meetings to discuss the individualized plan for each screening participant. The program coordinator serves as the point person for streamlined communication between each participant and this multidisciplinary team.

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What does this program do to ensure quality care? Does this program participate in research?

The Lung Cancer Screening Program Steering Committee is staffed by a multidisciplinary team of pulmonologists, thoracic surgeons, oncologists and radiologists. This Steering Committee convenes monthly for quality care meetings and performs continuing reviews of current literature to ensure that program recommendations are appropriate.

The program offers participants enrollment in a research registry aimed at advancing efforts in lung cancer screening. Our program is dedicated to improving the prevention, diagnosis, and treatment of lung cancer. 

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For more information or to schedule an appointment, please call 646-697-LUNG.

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References:

Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, Fagerstrom RM, et al., National Lung Screening Trial Research Team. (2011) Reduced lung-cancer mortality with low-dose computed tomographic screening. New Engl J Med 365(5):395-409.

The International Early Lung Cancer Action Program Investigators. (2006) Survival of Patients with Stage I Lung Cancer Detected on CT Screening; N Engl J Med 355:1763-1771. DOI: 10.1056/NEJMoa060476

Schoen RE, Pinsky PF, Weissfeld JL, Yokochi LA, Church T, Laiyemo AO, et al, PLCO Project Team. (2012) Colorectal-cancer incidence and mortality with screening flexible sigmoidoscopy. N Engl J Med 366:2345-57.

Nelson HD, Tyne K, Naik A, Bougatsos C, Chan B, Nygren P, Humphrey L. (2009) Screening for Breast Cancer: Systematic Evidence Review Update for the U.S. Preventive Services Task Force. Evidence Review Update No. 74. AHRQ Publication No. 10-05142-EF-1. Rockville, MD: Agency for Healthcare Research and Quality.

Humphrey LL, Deffebach M, Pappas M, Baumann C, Artis K, Priest Mitchell JP, et al. (2013) Screening for lung cancer with low-dose computed tomography: a systematic review to update the U.S. Preventive Services Task Force recommendation. Ann Intern Med 159:411-20.

Hendrick RE, Helvie MA. (2012) Mammography screening: a new estimate of number needed to screen to prevent one breast cancer death; Am J Roentgenol 198(3):723-8. DOI: 10.2214/AJR.11.7146.

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Resources

U.S. Preventive Services Task Force (USPSTF) recommendations on screening for lung cancer

http://www.uspreventiveservicestaskforce.org/uspstf/uspslung.htm

 

USPSTF Fact Sheet for Patients

http://www.uspreventiveservicestaskforce.org/uspstf13/lungcan/lungcanfact.pdf

 

NCCN Guidelines: Lung Cancer Screening for Patients

http://www.nccn.org/patients/guidelines/lung_screening/index.html

 

NCI PDQ Lung Cancer Screening

https://www.healthwise.net/weillcornell/Content/StdDocument.aspx?DOCHWID=ncicdr0000258019

 

American Cancer Society Lung Cancer Prevention and Early Detection

http://www.cancer.org/acs/groups/cid/documents/webcontent/acspc-039558-pdf.pdf

 

National Cancer Institute Lung Cancer

http://www.cancer.gov/cancertopics/types/lung

 

NLST Study Guide for Patients and Physicians

http://www.cancer.gov/newscenter/qa/2002/NLSTstudyGuidePatientsPhysicians

 

USPSTF Fact Sheet for Referring Physicians http://www.uspreventiveservicestaskforce.org/uspstf13/lungcan/lungcanguide.pdf

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Contact Information

If you are interested in more information or would like to schedule an appointment, please call us at 646-697-LUNG.

 

Bradley B. Pua, M.D.                                                                           Brooke Crawford, R.N.

Program Director                                                                                 Program Coordinator

 

ADDRESS: 520 East 70th Street, Starr Pavilion Ground Floor, New York, NY 10021

TEL: 646-697-LUNG (5864)

Hospital Map

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