Fabio Barbone1,2, Fabiano Barbiero1,3, Ornella Belvedere4, Valentina Rosolen1, Manuela Giangreco1, Tina Zanin5, Federica E Pisa2,6, Stefano Meduri7, Alessandro Follador8, Francesco Grossi9, Gianpiero Fasola8. 1. Dipartimento di Area Medica, University of Udine, Udine, Italy. 2. Institute of Hygiene and Clinical Epidemiology, Azienda Sanitaria Universitaria Integrata, Udine, Italy. 3. Occupational Health and Safety Department, Local Health Authority No 3 'SERENISSIMA', Veneto Region, Mestre, Italy. 4. Department of Oncology, York Teaching Hospitals NHS Foundation Trust, York, UK. 5. Occupational Health and Safety Department, Local Health Authority No 2 (ASS2), Friuli Venezia Giulia Region, Gorizia, Italy. 6. Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology BIPS, Bremen, Germany. 7. Department of Radiology, Latisana Hospital, Latisana, Italy. 8. Dipartimento ad Attività Integrata di Oncologia, Azienda Sanitaria Universitaria Integrata, Udine, Italy. 9. Division of Medical Oncology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Abstract
Background: We previously showed that low-dose computed tomography (LDCT) screening in asbestos-exposed workers is effective in detecting lung cancer (LC) at an early stage. Here, we evaluate whether LDCT screening could reduce mortality from LC in such a high-risk population. Methods: Within a cohort of 2433 asbestos-exposed men enrolled in an Occupational Health surveillance programme, we compared mortality between the participants in the ATOM002 study (LDCT-P, N = 926) and contemporary non-participants (LDCT-NP, N = 1507). We estimated standardized mortality ratios for the LDCT-P and LDCT-NP populations using regional and national rates (SMR_FVG and SMR_ITA, respectively). We compared survival for all causes, all neoplasms, LC and malignant neoplasm of pleura (MNP) between LDCT-P and LDCT-NP using Cox proportional hazard models adjusted for age, smoking history, asbestos exposure level and comorbidities. Results: A reduction in mortality from LC was observed in the LDCT-P group compared with regional and national figures (SMR_FVG = 0.55, 95% confidence interval (CI) 0.24-1.09; SMR_ITA = 0.51, 95% CI 0.22-1.01); this was not the case for the LDCT-NP group (SMR_FVG = 2.07, 95% CI 1.53-2.73; SMR_ITA = 1.98, 95% CI 1.47-2.61). A strong reduction in LC mortality was observed for the LDCT-P compared with the LDCT-NP [hazard ratio (HR) = 0.41, 95% CI 0.17-0.96]. Mortality was also reduced for all causes (HR = 0.61, 95% CI 0.44-0.84), but not for all neoplasms (HR = 0.97, 95% CI 0.62-1.50) and MNP (HR = 0.86, 95% CI 0.31-2.41) within the LDCT-P population. Conclusions: In our cohort, participation in the LDCT screening study was associated with reduced mortality from LC. This finding supports the use of LDCT in surveillance programmes for asbestos-exposed workers.
Background: We previously showed that low-dose computed tomography (LDCT) screening in asbestos-exposed workers is effective in detecting lung cancer (LC) at an early stage. Here, we evaluate whether LDCT screening could reduce mortality from LC in such a high-risk population. Methods: Within a cohort of 2433 asbestos-exposed men enrolled in an Occupational Health surveillance programme, we compared mortality between the participants in the ATOM002 study (LDCT-P, N = 926) and contemporary non-participants (LDCT-NP, N = 1507). We estimated standardized mortality ratios for the LDCT-P and LDCT-NP populations using regional and national rates (SMR_FVG and SMR_ITA, respectively). We compared survival for all causes, all neoplasms, LC and malignant neoplasm of pleura (MNP) between LDCT-P and LDCT-NP using Cox proportional hazard models adjusted for age, smoking history, asbestos exposure level and comorbidities. Results: A reduction in mortality from LC was observed in the LDCT-P group compared with regional and national figures (SMR_FVG = 0.55, 95% confidence interval (CI) 0.24-1.09; SMR_ITA = 0.51, 95% CI 0.22-1.01); this was not the case for the LDCT-NP group (SMR_FVG = 2.07, 95% CI 1.53-2.73; SMR_ITA = 1.98, 95% CI 1.47-2.61). A strong reduction in LC mortality was observed for the LDCT-P compared with the LDCT-NP [hazard ratio (HR) = 0.41, 95% CI 0.17-0.96]. Mortality was also reduced for all causes (HR = 0.61, 95% CI 0.44-0.84), but not for all neoplasms (HR = 0.97, 95% CI 0.62-1.50) and MNP (HR = 0.86, 95% CI 0.31-2.41) within the LDCT-P population. Conclusions: In our cohort, participation in the LDCT screening study was associated with reduced mortality from LC. This finding supports the use of LDCT in surveillance programmes for asbestos-exposed workers.
Authors: Giulia Veronesi; David R Baldwin; Claudia I Henschke; Simone Ghislandi; Sergio Iavicoli; Matthijs Oudkerk; Harry J De Koning; Joseph Shemesh; John K Field; Javier J Zulueta; Denis Horgan; Lucia Fiestas Navarrete; Maurizio Valentino Infante; Pierluigi Novellis; Rachael L Murray; Nir Peled; Cristiano Rampinelli; Gaetano Rocco; Witold Rzyman; Giorgio Vittorio Scagliotti; Martin C Tammemagi; Luca Bertolaccini; Natthaya Triphuridet; Rowena Yip; Alexia Rossi; Suresh Senan; Giuseppe Ferrante; Kate Brain; Carlijn van der Aalst; Lorenzo Bonomo; Dario Consonni; Jan P Van Meerbeeck; Patrick Maisonneuve; Silvia Novello; Anand Devaraj; Zaigham Saghir; Giuseppe Pelosi Journal: Cancers (Basel) Date: 2020-06-24 Impact factor: 6.639