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O33-1 Screening with low-dose computed tomography (ldct) of asbestos exposed subjects is associated with reduced lung cancer mortality
  1. Fabiano Barbiero1,2,3,
  2. Fabio Barbone1,4,5,
  3. Valentina Rosolen1,
  4. Manuela Giangreco1,
  5. Federica Edith Pisa1,4,
  6. Tina Zanin6,
  7. Stefano Meduri7,
  8. Paolo Cassetti8,
  9. Alessandro Follador9,
  10. Ornella Belvedere9,10,
  11. Francesco Grossi11,
  12. Gianpiero Fasola9
  1. 1Department of Medical and Biological Sciences, University of Udine, Udine, Italy
  2. 2University of Parma, Department of Clinical and Experimental Medicine, Parma, Italy
  3. 3Health and Safety at Work Department (SPISAL), Local Health Authority No 12, Region of Veneto, Mestre, Italy
  4. 4Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy
  5. 5Department of Medical Sciences, University of Trieste, Trieste, Italy
  6. 6Health and Safety at Work Department. Local Health Authority No 2 (ASS2), Region of Friuli Venezia Giulia, Gorizia, Italy
  7. 7Unit of Radiology, Hospital of Latisana – Palmanova, Latisana-Palmanova, Italy
  8. 8Unit of Radiology, Hospital of Monfalcone, Gorizia, Italy
  9. 9Department of Oncology, University Hospital of Udine, Udine, Italy
  10. 10Department of Oncology, York Teaching Hospital, York, UK
  11. 11Lung Cancer Unit, IRCCS AOU San Martino-IST National Cancer Research Institute, Genoa, Italy

Abstract

Purpose In 2002 subjects already enrolled in a surveillance program for asbestos-exposed workers were recruited in a Low Dose CT scan screening (LDCT) (ATOM002 Study). During the 2-year program LDCT identified 11 lung cancer (LC) cases versus none detected by chest radiographs (CXR). The objective of this study is to evaluate whether, after a 10-year follow-up, this program was effective in reducing mortality for LC as compared with conventional health surveillance.

Methods Within a cohort of 2,433 occupationally asbestos-exposed men, enrolled in a public health surveillance program, we compared mortality and survival between participants in a screening program based on LDCT (ATOM002-P, n = 926) and non-participants (ATOM002-NP, n = 1,507). For external comparison, we estimated the standardised mortality rate ratio (SMR_ITA) using italian standard rates. For internal comparisons we performed Cox proportional hazard models to assess survival for all causes, all cancers, LC and malignant neoplasm of the pleura. Final models were adjusted for smoking habits, age at start of follow-up, level of exposure to asbestos and Charlson-Quan comorbidity index.

Results LC crude mortality was 99.4 per 100,000 person-year in ATOM002-P (Obs = 8) compared to 430.4 per 100,000 person-year in ATOM002-NP (Obs = 50). Compared with italian mortality rates, a trend towards reduced mortality for lung cancer was found among ATOM002-P (SMR_ITA = 0.51 95% CI: 0.22–1.01), in contrast to a statistically significant increase in the ATOM002-NP (SMR_ITA = 1.98; 95% CI: 1.47–2.61). Internal comparisons show a significant 59% reduction in mortality for lung cancer in ATOM002 participants (HR = 0.41,95% CI: 0.17–0.96). Mortality was also reduced for all causes (HR = 0.61, 95% CI: 0.44–0.84), but not for all cancers (HR = 0.97, 95% CI: 0.62–1.50) and malignant neoplasm of the pleura (HR = 0.86, 95% CI: 0.31–2.41).

Conclusions In our cohort, a 2-year LDCT-based screening protocol was more effective in reducing mortality for LC than conventional public health surveillance. Surveillance program for asbestos-exposed workers should include LDCT screening.

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