TY - JOUR T1 - Lung cancer mortality among construction workers: implications for early detection JF - Occupational and Environmental Medicine JO - Occup Environ Med SP - 207 LP - 213 DO - 10.1136/oemed-2019-106196 VL - 77 IS - 4 AU - John M Dement AU - Knut Ringen AU - Stella Hines AU - Kim Cranford AU - Patricia Quinn Y1 - 2020/04/01 UR - http://oem.bmj.com/content/77/4/207.abstract N2 - 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. ER -