Lung Screening Program
The Mount Sinai Health System team has over 25 years of pioneering research leadership in detecting early lung cancers. Mount Sinai's Lung Disease and Lung Cancer Treatment Programs ensure patients a seamless transition to the best possible care should it become necessary. At Mount Sinai, we offer comprehensive consultations by internationally recognized experts and ensure rapid access to needed tests and the most advanced technologies, including:
- Computed tomography (CT) scan
- Fine-needle aspiration (FNA)
- Endobronchial ultrasound
- Molecular testing
- Positron emission tomography (PET) scan
Tobacco use is the leading cause of lung cancer, the top cancer killer in the United States for both men and women. It is responsible for approximately 87 percent of lung cancer cases (American Lung Association 2011). Even if you were once a smoker and quit, you have an increased chance of developing lung cancer.
The lung cells of smokers go through changes that can lead to lung cancer. The longer a person has been smoking, and the more cigarettes she or he smoked, the greater the risk is of developing lung cancer.
Current CT screening for lung cancer recommendations from the United States Preventive Services Task Force (USPSTF) include those who are asymptomatic smokers and former smokers between 55 and 80 years old who have smoked 30 pack-years and have quit within the last 15 years. Medicare currently reimburses this group but only up to age 77.
In addition, other societies such as the National Comprehensive Cancer Network include smokers and former smokers starting at age 50 with 20 pack-years and at least one other risk factor (environmental exposure, first degree relative with lung cancer, other lung diseases, history of other smoking related cancer).
Other countries have different eligibility criteria that also include screening never smokers as well as lower ages for starting screening.
For those people with Medicare, they will need to undergo a shared decision making counseling session. This can be conducted either by their own physician or at the screening site by a trained nurse practitioner. Here the risks and benefits of screening will be discussed to assist you in making your decision about whether to be screened. In addition you will also be provided with information about smoking cessation.
Other Risk Factors
Even if you’re not a smoker, the following are associated with an increased risk for lung cancer:
- Have been exposed to radon, a colorless, odorless radioactive gas emitted by rocks and soil in some areas that can get trapped in houses and buildings.
- Work or have worked with asbestos. This also puts you at risk for mesothelioma (another form of cancer that affects the lining of the lungs and stomach) and if you are smoker, your risk is greatly increased. Other carcinogenic substances found in the workplace like arsenic and some forms of silica and chromium also increase lung cancer risk.
- Have had significant exposure to secondhand smoke. Have either been exposed to cancer-causing agents in the environment, or have lung scarring from certain types of pneumonia.
- Have a first-degree relative, such as a parent or sibling, who has had lung cancer, especially if the relative contracted it while young. Smokers with close relatives with lung cancer are at even higher risk for lung cancer.
- Are an African American who has a family member diagnosed with of lung cancer
- Veterans who had active duty on submarines, in Vietnam or the Gulf War, and had exposure to asbestos, nuclear propulsion, herbicides, battlefield emissions or other carcinogens.
- Employees, past and current, of munitions plants (who may be eligible for free screening under the Department of Energy’s Worker Health Protection Program).
- People exposed regularly to secondhand smoke, such as tobacco smoke, airline personnel or hospitality industry workers.
Mount Sinai Research in Lung Cancer Screening
In addition to our clinical program for lung cancer screening, Mount Sinai also has an ongoing research program for people over the age of 40 that includes smokers and never smokers who are interested in screening.
Other Groups Who Are Heavily Exposed to Toxins Associated with Lung Cancer
Some people have never smoked, never worked with asbestos and have never been exposed to any known cancer-causing agents; yet, they still get lung cancer, and we don’t know why. Right now there is no sure way to prevent lung cancer. However, if you are a smoker, the single most important action you can take to reduce your risk for developing lung cancer is to quit smoking.
If you think you are at risk for lung cancer you should discuss with your doctor the option of being screening.
Following a CT (Computed Tomography) scan, additional testing may be required. The compassionate professionals of our Lung Screening Program assist patients who require additional testing. All diagnostic tests can be performed here at Mount Sinai, and making you feel comfortable is one of our top priorities.
Should you receive a diagnosis of lung cancer, our team of renowned surgeons, radiation oncologists, oncologists, psychologists, and other professionals will be with you every step of the way to offer you the most advanced surgical and clinical care in a supportive and caring environment.
Types of Additional Testing:
Follow-up CT Scans
In most cases, the only additional test necessary is another low-dose CT scan, taken one to three months after the first scan. In some cases, when an infection is considered to be the cause of a lung abnormality, we may suggest that your physician prescribe antibiotics, as they are helpful in clearing them up.
If your follow-up CT shows no growth of the abnormality, or if it shows a decrease in the finding, we will ask you to return one year from the time of your original scan when the abnormality was first found to confirm the stability of the lesion.
Fine-Needle Aspiration (FNA)
If your lesion is growing, our staff will perform an FNA biopsy to determine the diagnosis. This procedure is performed under local anesthesia while you are lying in a CT scanner. Using the CT images as a guide, our radiologist locates the lesion and inserts a long, thin needle into it to obtain a sample of the cells, which are then examined by a pathologist. Most people can return home the same day after this procedure.
In some cases, we may perform a bronchoscopy. We do this by inserting a thin tube with a miniature camera at the end through your mouth and into your lungs, which permits our physicians to look directly into your lungs for signs of malignancy. Sometimes we insert a needle through the tube to extract samples of the lesion or fluid.
Endobronchial Ultrasound (EBUS)
A minimally invasive procedure, EBUS is typically performed in combination with a bronchoscopy. It involves using an ultrasound probe to search for abnormal lung tissue, and then using a tiny needle to take a sample of the tissue.
This highly-detailed test of the cancerous tissue's make-up (including DNA mutations and protein levels) may be conducted, depending on your medical history and stage of the disease. This analysis can detect gene mutations, such as epidermal growth factor receptor (EGFR), which signals pathways associated with cell growth. The objective of molecular testing is to better target treatment therapies for patients with genetic alterations in their tumor.
Positron Emission Tomography (PET)
PET scans, along with the tests already listed, can assist our physicians in diagnosing lung cancer. PET scans are nuclear medicine tests which take 3-D pictures of the entire body using a tracer made from sugar that emits a small amount of radiation that you ingest. A PET scan can help to determine whether an abnormality seen on a CT scan is cancer and also if the cancer has spread to other areas of the body.
Who decides they want to become a lung cancer advocate? "In most cases that doesn’t just happen – it’s personal," former NFL star Chris Draft began, while raising awareness about lung cancer at Mount Sinai. "Unfortunately, what was personal for me was that my wife Keasha was diagnosed with lung cancer. I was just finishing up playing in the NFL with the Washington Redskins, and I remember coming home to my wife challenging me to P90X and to run a 10K race with her. This was an amazing, fit woman with all types of energy. She was an incredible dancer and athlete, but in December of 2010, she started to have shortness of breath between workouts. So right before Christmas, she spoke to her primary care doctor and had a chest X-ray, which revealed a mass on her left lung."
Never Smokers Like Keasha Can Get Lung Cancer
"The most important fact we discovered was that anyone can get lung cancer. She was a never smoker. She was a healthy woman with a great relationship with her primary care doctor, but the diagnosis was at stage 4. With lung cancer, all of a sudden you become well versed in all these things you never want to know about – like a PET scan, radiation oncology, and medical oncology. My wife did a great job of fighting and finding a way to smile each day, but unfortunately, treatment doesn’t always work. My wife passed from lung cancer December of 2011, but not before we were able to be married and to launch Team Draft, a foundation dedicated to raising lung cancer awareness, increasing research funding, and shattering the misconception that it is a ‘smoker’s disease.’"
Launching Team Draft to Change the Face of Lung Cancer
Before their wedding, Keasha asked Chris, "What do you think of asking our family and friends to support the fight against lung cancer instead of bringing presents?" His answer: "Absolutely, yes." "It shows her commitment, not just to herself but to how it would affect everyone else," Chris remarked. "So we continue that battle since her passing and believe that if we do not educate people about lung cancer, people may not care. Our mission is to change the face of lung cancer. And doing that allows individuals to relate to the people and not just fight lung cancer, but also fight for the people and know there is hope."
Team Draft Visits Mount Sinai to Promote Lung Cancer Awareness
"We came to Mount Sinai because there is hope and change here," Chris explained. "If you look at the five-year survival rate [16.6 percent, according to the American Lung Association], it doesn’t tell the whole story and it is not the only marker of lung cancer. Mount Sinai is leading the way with early detection and treatments. So it was natural to bring our cause to New York."
A key factor to a better outcome is self-awareness. "When my wife felt like something was wrong, she went and had it looked at. The most important thing is to know your body and listen to it and do something about it. Getting a CT scan will be your best chance to find it as early as possible."
"At Mount Sinai, it’s a team approach. Sometimes you hear that and it’s almost a cliché. Playing in the NFL it’s absolutely necessary. With lung cancer, it’s becoming increasingly clear how important it is for the thoracic surgeon, the medical oncologist, radiation oncologist, radiologist and pulmonologist to all work together – and that your primary care physician (PCP) is your quarterback of your team and the conduit to get you into the cancer space [if necessary]."
Reflections of the Past Give Way to Hope for the Future
"People ask me what I am most proud of and I say being able to be by my wife throughout her experience. For caregivers, I want to encourage the positive, the hope, and doing the little things for your loved one." Chris also reminds caregivers to take time for themselves, so as to stay as energetic as possible.
"The cancer playbook in layman’s terms cannot be changed up. If you can prevent it, that is the best thing. But we know it can’t all be prevented. So the next phase is early detection; after that is treatment, and then research and survivorship. For those who can find it early, that is ideal – that is the best chance at the best quality of life and the best outcomes that both Team Draft and Mount Sinai are trying to improve."