Article Text
Abstract
Objective The US National Comprehensive Cancer Network (NCCN) recommends two pathways for eligibility for Early Lung Cancer Detection (ELCD) programmes. Option 2 includes individuals with occupational exposures to lung carcinogens, in combination with a lesser requirement on smoking. Our objective was to determine if this algorithm resulted in a similar prevalence of lung cancer as has been found using smoking risk alone, and if so to present an approach for lung cancer screening in high-risk worker populations.
Methods We enrolled 1260 former workers meeting NCCN criteria, with modifications to account for occupational exposures in an ELCD programme.
Results At baseline, 1.6% had a lung cancer diagnosed, a rate similar to the National Lung Cancer Screening Trial (NLST). Among NLST participants, 59% were current smokers at the time of baseline scan or had quit smoking fewer than 15 years prior to baseline; all had a minimum of 30 pack-years of smoking. Among our population, only 24.5% were current smokers and 40.1% of our participants had smoked fewer than 30 pack-years; only 43.5% would meet entry criteria for the NLST. The most likely explanation for the high prevalence of screen-detected lung cancers in the face of a reduced risk from smoking is the addition of occupational risk factors for lung cancer.
Conclusion Occupational exposures to lung carcinogens should be incorporated into criteria used for ELCD programmes, using the algorithm developed by NCCN or with an individualised risk assessment; current risk assessment tools can be modified to incorporate occupational risk.
- methodology
- speciality
- construction
- materials
- exposures and occupational groups
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Footnotes
Contributors LSW was involved in designing the study, supervising data collection, participating in the data analysis and writing the manuscript. JMD was involved in designing the study, performed the data analysis and assisted in writing the manuscript. KC collected the study data. JS collected the study data. PSQ provided overall study coordination and assisted in writing the manuscript. DKM facilitated and/or conducted the follow-up medical evaluations and assisted in writing the manuscript. KR was involved in designing the study participated in the data analysis and assisted in writing the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests LSW occasionally testifies as an expert witness for workers with asbestos-related diseases.
Patient consent Not required.
Ethics approval All study procedures and materials were reviewed and approved by the Central DOE Institutional Review Board and the CPWR Institutional Review Board.
Provenance and peer review Not commissioned; externally peer reviewed.