Patrick Maisonneuve1, Cristiano Rampinelli2, Raffaella Bertolotti3, Alessandro Misotti4, Filippo Lococo5, Monica Casiraghi6, Lorenzo Spaggiari7, Massimo Bellomi8, Pierluigi Novellis9, Michela Solinas9, Elisa Dieci9, Marco Alloisio10, Luca Fontana11, Benedetta Persechino11, Sergio Iavicoli11, Giulia Veronesi9. 1. Division of Epidemiology and Biostatistics, IEO, European Institute of Oncology IRCCS, Milan, Italy. Electronic address: patrick.maisonneuve@ieo.it. 2. Department of Medical Imaging and Radiation Sciences, IEO, European Institute of Oncology IRCSS, Milan, Italy. 3. Division of Thoracic Surgery, Data Management, IEO, European Institute of Oncology IRCSS, Milan, Italy. 4. Dietetics and Clinical Nutrition, Hospital of Melegnano, ASST Melegnano-Martesana, Milan, Italy. 5. Department of Thoracic Surgery, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy. 6. Division of Thoracic Surgery, European Institute of Oncology IRCSS, Milan, Italy. 7. Division of Thoracic Surgery, European Institute of Oncology IRCSS, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy. 8. Department of Medical Imaging and Radiation Sciences, IEO, European Institute of Oncology IRCSS, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy. 9. Division of Thoracic and General Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy. 10. Division of Thoracic and General Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy; Department of Biomedical Science, Humanitas University, Rozzano, Milan, Italy. 11. Italian National Insurance Institute for Workplace Injuries (INAIL), Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Rome, Italy.
Abstract
OBJECTIVES: Smoking is the main risk factor for lung cancer, but environmental and occupational exposure to carcinogens also increase lung cancer risk. We assessed whether extending low-dose computed tomography (LDCT) screening to persons with occupational exposure to asbestos may be an effective way reducing lung cancer mortality. MATERIALS AND METHODS: We conducted a nested case-control study within the COSMOS screening program, assessing past asbestos exposure with a questionnaire. LDCT scans of asbestos-exposed participants were reviewed to assess the presence of pulmonary, interstitial and pleural alterations in comparison to matched unexposed controls. We also performed an exhaustive review, with meta-analysis, of the literature on LDCT screening in asbestos-exposed persons. RESULTS: Exposure to asbestos, initially self-reported by 9.8% of COSMOS participants, was confirmed in 216 of 544 assessable cases, corresponding to 2.6% of the screened population. LDCT of asbestos-exposed persons had significantly more pleural plaques, diaphragmatic pleural thickening and pleural calcifications, but similar frequency of parenchymal and interstitial alterations to unexposed persons. From 16 papers, including this study, overall lung cancer detection rates at baseline were 0.81% (95% CI 0.50-1.19) in asbestos-exposed persons, 0.94% (95% CI 0.47-1.53) in asbestos-exposed smokers (12 studies), and 0.11% (95% CI 0.00-0.43) in asbestos-exposed non-smokers (9 studies). CONCLUSION: Persons occupationally exposed to asbestos should be monitored to gather more information about risks. Although LDCT screening is effective in the early detection lung cancer in asbestos-exposed smokers, our data suggest that screening of asbestos-exposed persons with no additional risk factors for cancer does is not viable due to the low detection rate.
OBJECTIVES: Smoking is the main risk factor for lung cancer, but environmental and occupational exposure to carcinogens also increase lung cancer risk. We assessed whether extending low-dose computed tomography (LDCT) screening to persons with occupational exposure to asbestos may be an effective way reducing lung cancermortality. MATERIALS AND METHODS: We conducted a nested case-control study within the COSMOS screening program, assessing past asbestos exposure with a questionnaire. LDCT scans of asbestos-exposed participants were reviewed to assess the presence of pulmonary, interstitial and pleural alterations in comparison to matched unexposed controls. We also performed an exhaustive review, with meta-analysis, of the literature on LDCT screening in asbestos-exposed persons. RESULTS: Exposure to asbestos, initially self-reported by 9.8% of COSMOS participants, was confirmed in 216 of 544 assessable cases, corresponding to 2.6% of the screened population. LDCT of asbestos-exposed persons had significantly more pleural plaques, diaphragmatic pleural thickening and pleural calcifications, but similar frequency of parenchymal and interstitial alterations to unexposed persons. From 16 papers, including this study, overall lung cancer detection rates at baseline were 0.81% (95% CI 0.50-1.19) in asbestos-exposed persons, 0.94% (95% CI 0.47-1.53) in asbestos-exposed smokers (12 studies), and 0.11% (95% CI 0.00-0.43) in asbestos-exposed non-smokers (9 studies). CONCLUSION:Persons occupationally exposed to asbestos should be monitored to gather more information about risks. Although LDCT screening is effective in the early detection lung cancer in asbestos-exposed smokers, our data suggest that screening of asbestos-exposed persons with no additional risk factors for cancer does is not viable due to the low detection rate.