Who Should Be Screened for Lung Cancer

NYU Langone’s Lung Cancer Screening Program follows the screening guidelines agreed upon by the U.S. Preventive Services Task Force and the Centers for Medicare and Medicaid Services. You may be a candidate for screening if you:

  • are age 55 to 77. Note that some insurance providers may provide coverage for screening up to age 80.
  • have at least a 30 pack-year smoking history—equivalent to smoking one pack a day for 30 years or 2 packs a day for 15 years
  • are a current smoker or have quit smoking within the last 15 years

If a doctor recommends screening, you may get a low-dose CT scan to look for signs of early-stage lung cancer.

Not everyone should be screened, however. CT scans are very sensitive and can pick up many “false positives”—abnormalities in the lungs, including small scars or tiny lymph nodes, that are not cancer and are unlikely to ever cause a problem.

If one of these abnormalities is detected, you may need a follow-up CT scan or, less often, a biopsy or other procedure. This can make you unnecessarily anxious. Most often no cancer is found. For that reason, it’s important to only screen individuals who have an increased risk for lung cancer.

What Increases Risk for Lung Cancer

The single most important risk factor for lung cancer is cigarette smoking. Tobacco use accounts for almost 90 percent of all lung cancers. So if you have ever smoked, you have an increased chance of developing lung cancer. The longer you smoke and the more packs of cigarettes you smoke, the greater your risk for developing cancer.

Other risk factors that may put you at increased risk for lung cancer include: 

  • exposure to radon, a radioactive gas that can exist in homes
  • exposure to asbestos, especially if exposure occurred in the workplace
  • significant exposure to second-hand smoke, either at home or at work
  • exposure to cancer-causing agents in the environment, especially occupational exposures
  • lung scarring from certain types of pneumonia or a diagnosis of chronic obstructive pulmonary disease (COPD) or emphysema
  • a first-degree relative, such as a parent or sibling, who has had lung cancer

For those who require help to quit smoking, we offer tobacco cessation programs.

Additional Considerations When Considering Screening 

The National Lung Cancer Screening Trial, a research study sponsored by the National Cancer Institute and published in 2011, showed that CT screening for lung cancer can save lives. Doctors and patients must weigh risks and benefits. Often, people with a lower risk for developing lung cancer, such as nonsmokers, should not be screened, because the risks of the screening outweigh the benefits.

Some people undergo invasive diagnostic procedures as a result of lung cancer screening. While sometimes these tests lead to a diagnosis of cancer, in others, there is no cancer. But the invasive diagnostic procedures themselves come with the risk of injury or even death. Those risks must be considered before deciding to undergo lung cancer screening.

False-positive results of a low-dose CT screen may cause anxiety and concern even if the result is proven not to be cancer. Then again, you can get a false sense of security if you receive a false-negative result, which is when there is cancer, but it isn’t detected. These issues have not yet been adequately studied.