Lung cancer and mesothelioma screening with low-dose spiral computed tomography (LDCT) in 1,000 asbestos-exposed workers: An Alpe-Adria Thoracic Oncology Multidisciplinary group study (ATOM 002)

Abstract

7048 Background: LDCT is more sensitive than chest radiography (CXR) for detection of early stage lung cancer in heavy smokers. However, little is known about LDCT screening in asbestos-exposed subjects. To address this issue, we have designed a prospective, nonrandomized trial to evaluate baseline and annual repeat screening with LDCT in 1,000 asymptomatic asbestos-exposed workers. Here, we report the results of the baseline screening. Methods: Eligibility criteria include: exposure to asbestos, age 40 to 75 yrs, no prior cancer or severe concomitant conditions, no chest CT scan in the last 2 yrs. After written informed consent, eligible subjects undergo a structured interview, CXR and LDCT. Subjects with negative baseline exams undergo annual repeat LDCT. Subjects with positive baseline exams undergo high resolution CT (HRCT) and additional diagnostic workup. Results: Between February 2002 and October 2003, 1007 volunteers have been enrolled. Subject characteristics: median age, 59 yrs; males, 97%; smoking history, 66%; former or current shipyard workers, 78%; median asbestos exposure time, 30 yrs. The following data refer to 943 participants. On LDCT, 619 non calcified nodules (NCN) have been identified in 41% of participants. CXR detected 43 nodules. Pleural abnormalities have been detected in 42% and 69% of participants by CXR and LDCT, respectively. So far, six cases of stage I lung cancer have been diagnosed and treated with radical surgery: 3 bronchioloalveolar carcinomas, 1 carcinosarcoma, 2 adenocarcinomas. In addition, one malignant pleural mesothelioma and one thymic carcinoid have been identified. Conclusions: LDCT seems to be useful for the early detection of lung cancer also in asbestos-exposed subjects. Annual repeat LDCT screening may provide information on the natural history and evolution of asbestos-related pleural abnormalities. Study supported by Compagnia di San Paolo, Torino, and Provincia di Gorizia. No significant financial relationships to disclose.