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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

1
Center for Construction Research and Training, Silver Spring, Maryland, USA.
2
Division of Occupational and Environmental Medicine, Department of Community and Family Medicine, Duke University, Durham, North Carolina, USA.
3
Zenith American Solutions, Inc, Oak Ridge, Tennessee, USA.
4
Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington, USA.
5
Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Washington, District of Columbia, USA.

Abstract

OBJECTIVE:

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.

METHODS:

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

RESULTS:

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.

CONCLUSION:

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.

KEYWORDS:

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

PMID:
30415231
DOI:
10.1136/oemed-2018-105431

Conflict of interest statement

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

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