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Occup Environ Med. 2018 Nov 10. pii: oemed-2018-105431. doi: 10.1136/oemed-2018-105431. [Epub ahead of print]

Early detection of lung cancer in a population at high risk due to occupation and smoking.

Author information

Center for Construction Research and Training, Silver Spring, Maryland, USA.
Division of Occupational and Environmental Medicine, Department of Community and Family Medicine, Duke University, Durham, North Carolina, USA.
Zenith American Solutions, Inc, Oak Ridge, Tennessee, USA.
Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington, USA.
Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Washington, District of Columbia, USA.



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.


We enrolled 1260 former workers meeting NCCN criteria, with modifications to account for occupational exposures in an ELCD programme.


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.


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.


construction; exposures and occupational groups; materials; methodology; speciality


Conflict of interest statement

Competing interests: LSW occasionally testifies as an expert witness for workers with asbestos-related diseases.

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