Javier Zulueta, MD, right, is joined by, from left, Rahul Agarwal, MD, and Fernando Carnavali, MD.
Lung cancer is by far the leading cause of cancer deaths in the United States accounting for about one in five cancer deaths. It is difficult to detect because there are often no symptoms in its earliest stages—only 16 percent of lung cancers in the United States are detected at a localized stage.
Lung cancer screening for smokers and former smokers, like the Early Action Lung Cancer Action Program (I-ELCAP), has been found effective in detecting lung cancer at earlier stages. However, as more lung cancers are being detected in non-smokers and many are ineligible for screening under the I-ELCAP guidelines, additional tools are needed to detect lung cancers early and save lives.
The newly launched Incidental Lung Nodule Program (ILNP) at Mount Sinai Morningside opens a new path for early detection guided by methodically identifying the patients with lung nodules at most risk for lung cancer and ensuring they receive timely interventions.
How the Incidental Lung Nodule Program Works
CT scans ordered for other illnesses and injuries are methodically scanned by computerized search—a more equitable and inclusive tool for detecting lung cancer early. All of those scans with a reported and documented incidental lung nodule are reviewed by a team led by a pulmonologist with special expertise in lung nodules.
Research has shown that about 25 percent of individuals who have a CT scan of the chest will have an incidental lung nodule detected, most of which need follow-up. Approximately five percent of the individuals with lung nodules may have lung cancer. With an early diagnosis, lung cancer can be successfully treated in the majority of patients.
All scans with findings are entered into a database for tracking and follow-up. The ILNP team notifies the ordering physician and the patient’s primary care provider, if available, via Epic, phone call, or letter, with a specific follow-up recommendation. If the ordering physician was in the Emergency Department and there is no primary care provider available, the ILNP team will reach out to the patient directly.
How Do Patients Seek Evaluation and Treatment
Javier Zulueta, MD, a lung nodule expert and pulmonologist at Mount Sinai Morningside, leads a multidisciplinary clinic that accepts referrals from physicians and is available directly to patients. Patients who need evaluation by the nodule clinic will be offered an appointment within one week of notification. They will be evaluated by a pulmonary specialist, and a plan will be established according to guidelines, including a wide variety of diagnostic and treatment options depending on the characteristics of the nodule:
- Blood test for cancer biomarkers
- PET scan
- Pulmonary function tests
- Biopsy by robotic bronchoscopy or CT guidance
- Evaluation by Thoracic Surgery
Smoking cessation will be offered to anyone who is a current smoker. All patients will be given a plan for CT scan follow-up within a predetermined period of time—anywhere between three and 12 months.
Patients may require exam and follow-up or diagnostic interventions like image-guided bronchoscopy or percutaneous biopsy. If cancer is diagnosed, the patient will be presented at Mount Sinai Morningside’s weekly multidisciplinary lung cancer and nodule conference. After review of all diagnostic and staging tests, a decision regarding treatment will be made. This can vary depending on the stage but includes thoracic surgery for early stages and oncologic assessment for all.
Patient Follow-Up
Patient not requiring immediate care will be prompted to repeat their CT scan on a recommended schedule and will continue to receive evaluation through the ILNP. The ILNP program navigators will contact the primary care physician, other provider, or the patient directly if patient is not getting the recommended diagnostics.
For more information or to refer a patient to the Lung Nodule Clinic, please call 212-523-3589.