Lung cancer screening an asbestos exposed population: Existing lung cancer risk criteria are not sufficient

Author:

Brims Fraser J. H.123ORCID,Harris Edward J. A.12,Murray Conor4,Kumarasamy Chellan2,Ho Alice1,Adler Brendan5,Franklin Peter6,de Klerk Nick H.6

Affiliation:

1. Department of Respiratory Medicine Sir Charles Gairdner Hospital Perth Western Australia Australia

2. Curtin Medical School Curtin University Perth Western Australia Australia

3. National Centre for Asbestos Related Diseases Institute for Respiratory Health Perth Western Australia Australia

4. ChestRad Medical Imaging Perth Western Australia Australia

5. Envision Medical Imaging Perth Western Australia Australia

6. School of Global and Population Health University of Western Australia Perth Western Australia Australia

Abstract

AbstractBackground and ObjectiveAsbestos is a major risk factor for lung cancer, with or without tobacco smoke exposure. Low dose computed tomography (LDCT) screening for early lung cancer is effective but only when targeting high risk populations. This study aimed to analyse the effectiveness of LDCT screening in an asbestos exposed population and to compare lung cancer screening program (LCSP) eligibility criteria.MethodsParticipants in an asbestos health surveillance program, the Western Australia Asbestos Review Program, underwent at least one LDCT scan and lung function assessment as part of annual review between 2012 and 2017. Lung cancer cases were confirmed through linkage to the WA cancer registry. Theoretical eligibility for different screening programs was calculated.ResultsFive thousand seven hundred and two LDCT scans were performed on 1743 individuals. The median age was 69.8 years, 1481 (85.0%) were male and 1147 (65.8%) were ever‐smokers (median pack‐year exposure of 20.0). Overall, 26 lung cancers were detected (1.5% of the population; 3.5 cases per 1000 person‐years of observation). Lung cancer was early stage in 86.4% and four (15.4%) cases were never smokers. Based on current lung screening program criteria, 1299 (74.5%) of this population, including the majority (17, 65.4%) of lung cancer cases, would not have been eligible for any LCSP.ConclusionThis population is at raised risk despite modest tobacco exposure. LDCT screening is effective at identifying early‐stage lung cancer in this population and existing lung cancer risk criteria do not capture this population adequately.

Funder

Department of Health, Government of Western Australia

National Health and Medical Research Council

Publisher

Wiley

Subject

Pulmonary and Respiratory Medicine

Reference38 articles.

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5. Welding fumes and lung cancer: a meta-analysis of case-control and cohort studies

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