Low-dose computed tomography screening for lung cancer and pleural mesothelioma in an asbestos-exposed population: Baseline results of a prospective, nonrandomized feasibility trial - An alpe-adria thoracic oncology multidisciplinary group study (ATOM 002)

Gianpiero Fasola, Ornella Belvedere, Marianna Aita, Tina Zanin, Alessandro Follador, Paolo Cassetti, Stefano Meduri, Vincenzo De Pangher, Giusto Pignata, Valentina Rosolen, Fabio Barbone, Francesco Grossi

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Abstract

Objective. To evaluate the feasibility of using low-dose computed tomography (LDCT) for the early diagnosis of lung cancer and malignant pleural mesothelioma in an asbestos-exposed population. Methods. Between February 2002 and October 2003, 1,045 volunteers already enrolled in a surveillance program for asbestos-exposed workers and former workers were recruited. The main eligibility criteria were: written informed consent, definite exposure to asbestos, age 40-75, no prior cancer or severe concomitant conditions, no chest CT scan in the past 2 years. A smoking history was not required. After a structured interview, chest X-ray (CXR) and LDCT were performed. Participants with negative examinations were assigned to annual LDCT. Participants with positive findings received high-resolution CT and additional diagnostic workup as appropriate. Results. Baseline characteristics of the screened population were: median asbestos exposure time, 30 years; median age, 58; median pack-years in smokers/former smokers, 18.5. Thirty-four percent had never smoked. On LDCT, 834 noncalcified nodules were identified in 44% of participants, versus 43 nodules in 4% on CXR. Pleural abnormalities were observed in 44% and 70% of participants by CXR and LDCT, respectively. Overall, LDCT identified nine cases of non-small cell lung cancer - eight stage I, one stage IIA - and one thymic carcinoid, corresponding to 1% of the enrolled population. All cases were radically treated. None had been detected by CXR. No pleural mesothelioma was diagnosed. There were 11 false-positive results. Conclusions. Our findings first suggest that LDCT may be at least as useful in asbestos workers as in heavy smokers for the early diagnosis of lung cancer; this benefit is evident even in a poor-risk population, with low rates of smoking prevalence and a previous history of radiological surveillance. The role of spiral tomography in screening for pleural mesothelioma remains uncertain.

Original languageEnglish
Pages (from-to)1215-1224
Number of pages10
JournalThe oncologist
Volume12
Issue number10
DOIs
Publication statusPublished - Oct 2007

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Asbestos
Mesothelioma
Lung Neoplasms
Thorax
Tomography
Population
X-Rays
Early Detection of Cancer
Smoking
Carcinoid Tumor
Population Characteristics
Informed Consent
Non-Small Cell Lung Carcinoma
Volunteers
History
Interviews

Keywords

  • Asbestos
  • Lung cancer
  • Malignant pleural mesothelioma
  • Occupational exposure
  • Screening
  • Spiral computed tomography

ASJC Scopus subject areas

  • Cancer Research
  • Hematology

Cite this

Low-dose computed tomography screening for lung cancer and pleural mesothelioma in an asbestos-exposed population : Baseline results of a prospective, nonrandomized feasibility trial - An alpe-adria thoracic oncology multidisciplinary group study (ATOM 002). / Fasola, Gianpiero; Belvedere, Ornella; Aita, Marianna; Zanin, Tina; Follador, Alessandro; Cassetti, Paolo; Meduri, Stefano; De Pangher, Vincenzo; Pignata, Giusto; Rosolen, Valentina; Barbone, Fabio; Grossi, Francesco.

In: The oncologist, Vol. 12, No. 10, 10.2007, p. 1215-1224.

Research output: Contribution to journalArticle

Fasola, Gianpiero ; Belvedere, Ornella ; Aita, Marianna ; Zanin, Tina ; Follador, Alessandro ; Cassetti, Paolo ; Meduri, Stefano ; De Pangher, Vincenzo ; Pignata, Giusto ; Rosolen, Valentina ; Barbone, Fabio ; Grossi, Francesco. / Low-dose computed tomography screening for lung cancer and pleural mesothelioma in an asbestos-exposed population : Baseline results of a prospective, nonrandomized feasibility trial - An alpe-adria thoracic oncology multidisciplinary group study (ATOM 002). In: The oncologist. 2007 ; Vol. 12, No. 10. pp. 1215-1224.
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abstract = "Objective. To evaluate the feasibility of using low-dose computed tomography (LDCT) for the early diagnosis of lung cancer and malignant pleural mesothelioma in an asbestos-exposed population. Methods. Between February 2002 and October 2003, 1,045 volunteers already enrolled in a surveillance program for asbestos-exposed workers and former workers were recruited. The main eligibility criteria were: written informed consent, definite exposure to asbestos, age 40-75, no prior cancer or severe concomitant conditions, no chest CT scan in the past 2 years. A smoking history was not required. After a structured interview, chest X-ray (CXR) and LDCT were performed. Participants with negative examinations were assigned to annual LDCT. Participants with positive findings received high-resolution CT and additional diagnostic workup as appropriate. Results. Baseline characteristics of the screened population were: median asbestos exposure time, 30 years; median age, 58; median pack-years in smokers/former smokers, 18.5. Thirty-four percent had never smoked. On LDCT, 834 noncalcified nodules were identified in 44{\%} of participants, versus 43 nodules in 4{\%} on CXR. Pleural abnormalities were observed in 44{\%} and 70{\%} of participants by CXR and LDCT, respectively. Overall, LDCT identified nine cases of non-small cell lung cancer - eight stage I, one stage IIA - and one thymic carcinoid, corresponding to 1{\%} of the enrolled population. All cases were radically treated. None had been detected by CXR. No pleural mesothelioma was diagnosed. There were 11 false-positive results. Conclusions. Our findings first suggest that LDCT may be at least as useful in asbestos workers as in heavy smokers for the early diagnosis of lung cancer; this benefit is evident even in a poor-risk population, with low rates of smoking prevalence and a previous history of radiological surveillance. The role of spiral tomography in screening for pleural mesothelioma remains uncertain.",
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T2 - Baseline results of a prospective, nonrandomized feasibility trial - An alpe-adria thoracic oncology multidisciplinary group study (ATOM 002)

AU - Fasola, Gianpiero

AU - Belvedere, Ornella

AU - Aita, Marianna

AU - Zanin, Tina

AU - Follador, Alessandro

AU - Cassetti, Paolo

AU - Meduri, Stefano

AU - De Pangher, Vincenzo

AU - Pignata, Giusto

AU - Rosolen, Valentina

AU - Barbone, Fabio

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N2 - Objective. To evaluate the feasibility of using low-dose computed tomography (LDCT) for the early diagnosis of lung cancer and malignant pleural mesothelioma in an asbestos-exposed population. Methods. Between February 2002 and October 2003, 1,045 volunteers already enrolled in a surveillance program for asbestos-exposed workers and former workers were recruited. The main eligibility criteria were: written informed consent, definite exposure to asbestos, age 40-75, no prior cancer or severe concomitant conditions, no chest CT scan in the past 2 years. A smoking history was not required. After a structured interview, chest X-ray (CXR) and LDCT were performed. Participants with negative examinations were assigned to annual LDCT. Participants with positive findings received high-resolution CT and additional diagnostic workup as appropriate. Results. Baseline characteristics of the screened population were: median asbestos exposure time, 30 years; median age, 58; median pack-years in smokers/former smokers, 18.5. Thirty-four percent had never smoked. On LDCT, 834 noncalcified nodules were identified in 44% of participants, versus 43 nodules in 4% on CXR. Pleural abnormalities were observed in 44% and 70% of participants by CXR and LDCT, respectively. Overall, LDCT identified nine cases of non-small cell lung cancer - eight stage I, one stage IIA - and one thymic carcinoid, corresponding to 1% of the enrolled population. All cases were radically treated. None had been detected by CXR. No pleural mesothelioma was diagnosed. There were 11 false-positive results. Conclusions. Our findings first suggest that LDCT may be at least as useful in asbestos workers as in heavy smokers for the early diagnosis of lung cancer; this benefit is evident even in a poor-risk population, with low rates of smoking prevalence and a previous history of radiological surveillance. The role of spiral tomography in screening for pleural mesothelioma remains uncertain.

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KW - Lung cancer

KW - Malignant pleural mesothelioma

KW - Occupational exposure

KW - Screening

KW - Spiral computed tomography

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