Article Text

other Versions

Download PDFPDF
Original research
Lung cancer mortality among construction workers: implications for early detection
  1. John M Dement1,
  2. Knut Ringen2,
  3. Stella Hines3,
  4. Kim Cranford4,
  5. Patricia Quinn2
  1. 1Division of Occupational and Environmental Medicine, Duke University Medical Center, Durham, North Carolina, USA
  2. 2The Center for Construction Research and Training (CPWR), Silver Spring, Maryland, USA
  3. 3Division of Occupational and Environmental Medicine, School of Medicine, University of Maryland Baltimore, Baltimore, Maryland, USA
  4. 4Zenith American Solutions, Oak Ridge, Tennessee, USA
  1. Correspondence to Dr John M Dement, Division of Occupational and Environmental Medicine, Duke University Medical Center, Durham, NC 27705, USA; john.dement{at}


Objectives This study examined predictors of lung cancer mortality, beyond age and smoking, among construction workers employed at US Department of Energy (DOE) sites to better define eligibility for low-dose CT (LDCT) lung cancer screening.

Methods Predictive models were based on 17 069 workers and 352 lung cancer deaths. Risk factors included age, gender, race/ethnicity, cigarette smoking, years of trade or DOE work, body mass index (BMI), chest X-ray results, spirometry results, respiratory symptoms, beryllium sensitisation and personal history of cancer. Competing risk Cox models were used to obtain HRs and to predict 5-year risks.

Results Factors beyond age and smoking included in the final predictive model were chest X-ray changes, abnormal lung function, chronic obstructive pulmonary disease (COPD), respiratory symptoms, BMI, personal history of cancer and having worked 5 or more years at a DOE site or in construction. Risk-based LDCT eligibility demonstrated improved sensitivity, specificity and positive predictive value compared with current US Preventive Services Task Force guidelines. The risk of lung cancer death from 5 years of work in the construction industry or at a DOE site was comparable with the risk from a personal cancer history, a family history of cancer or a diagnosis of COPD. LDCT eligibility criteria used for DOE construction workers, which includes factors beyond age and smoking, identified 86% of participants who eventually would die from lung cancer compared with 51% based on age and smoking alone.

Conclusions Results support inclusion of risk from occupational exposures and non-malignant respiratory clinical findings in LDCT clinical guidelines.

  • lung cancer
  • pulmonary function
  • chest radiography
  • LDCT

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors All authors participated in the collection and quality control of all data used for this study. JMD, SH and KR cogenerated study hypothesis and study analytical design. JMD conducted the statistical analyses. JMD, KR, SH and PQ developed and edited the manuscript.

  • Funding Funding for this work is provided by the US DOE through cooperative agreement number DE-FC01-06EH06004.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The Central DOE Institutional Review Board approved this project (approval numbers DOE000409 and DOE000286).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available. Data are not available for sharing per IRB requirements.