Abstract
Asbestos exposure is the most important cause of occupational lung cancer mortality. Two large randomized clinical trials in the U.S. and Europe conclusively demonstrate that annual low-dose chest CT (LDCT) scan screening reduces lung cancer mortality. Age and smoking are the chief risk factors tested in LDCT studies, but numerous risk prediction models that incorporate additional lung cancer risk factors have shown excellent performance. The studies of LDCT in asbestos-exposed populations shows favorable results but are variable in design and limited in size and generalizability. Outstanding questions include how to: (1) identify workers appropriate for screening, (2) organize screening programs, (3) inform and motivate people to screen, and (4) incorporate asbestos exposure into LDCT decision-making in clinical practice. Conclusion: Screening workers aged ≥50 years with a history of ≥5 years asbestos exposure (or fewer years given intense exposure) in combination with either (a) a history of smoking at least 10 pack-years with no limit on time since quitting, or (b) a history of asbestos-related fibrosis, chronic lung disease, family history of lung cancer, personal history of cancer, or exposure to multiple workplace lung carcinogens is a reasonable approach to LDCT eligibility, given current knowledge. The promotion of LDCT-based screening among asbestos-exposed workers is an urgent priority.
Highlights
Eligibility criteria and the LLPv2 model to assess relative performance in the screened population. The use of these alternative selection criteria failed to detect 26% (LLPv2, ≥5% risk threshold), 18% (NLST), and 7% (LLPv2 ≥ 2.5% risk threshold) of the lung cancers that had been detected by the use of PLCOm2012 .The authors found that the PLCOm2012 model very likely underestimated lung cancer incidence in the study population, which had a high rate of co-morbidities
This reasonably straightforward information could be collected as part of the Electronic health record (EHR), and simple algorithms that combine age, smoking history, and occupation could be used to indicate to the clinician whether the patient is a candidate for lowdose chest CT (LDCT)-based lung cancer screening
Over 70 years of research has demonstrated that occupational asbestos exposure is an important cause of lung cancer mortality
Summary
Critical elements of the rationale in support of lung cancer screening among asbestosexposed populations have been demonstrated and include:. Establishing a consensus about the characteristics of asbestos exposure in association with other lung cancer risk factors that determine likely benefit from and suitability for lung cancer screening; Developing and testing methods to identify and enroll at risk AEPs in LDCT screening; Modifying health care information systems and health provider practice to facilitate identification and inclusion of asbestos-exposed populations in LDCT screening; and Educating and motivating asbestos-exposed populations to participate in annual These challenges exist for other occupational lung carcinogens, such as silica, diesel exhaust, welding, selected metal exposures, and others, so that overcoming such obstacles for AEPs will permit the generalization of lessons learned on AEPs to other workers at risk for occupational lung cancer [1]
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