Low-dose computed tomography screening for lung cancer in people with workplace exposure to asbestos

Patrick Maisonneuve, Cristiano Rampinelli, Raffaella Bertolotti, Alessandro Misotti, Filippo Lococo, Monica Casiraghi, Lorenzo Spaggiari, Massimo Bellomi, Pierluigi Novellis, Michela Solinas, Elisa Dieci, Marco Alloisio, Luca Fontana, Benedetta Persechino, Sergio Iavicoli, Giulia Veronesi

Research output: Contribution to journalArticle

3 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)23-30
Number of pages8
JournalLung Cancer
Volume131
DOIs
Publication statusPublished - May 1 2019

Fingerprint

Asbestos
Workplace
Lung Neoplasms
Tomography
Occupational Exposure
Environmental Exposure
Early Detection of Cancer
Carcinogens
Meta-Analysis
Case-Control Studies
Smoking

Keywords

  • Asbestos-exposed
  • Low-dose chest CT
  • Lung cancer screening
  • Lung-neoplasms
  • Meta-analysis
  • Pleural plaques
  • Pleural thickening

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine
  • Cancer Research

Cite this

Low-dose computed tomography screening for lung cancer in people with workplace exposure to asbestos. / Maisonneuve, Patrick; Rampinelli, Cristiano; Bertolotti, Raffaella; Misotti, Alessandro; Lococo, Filippo; Casiraghi, Monica; Spaggiari, Lorenzo; Bellomi, Massimo; Novellis, Pierluigi; Solinas, Michela; Dieci, Elisa; Alloisio, Marco; Fontana, Luca; Persechino, Benedetta; Iavicoli, Sergio; Veronesi, Giulia.

In: Lung Cancer, Vol. 131, 01.05.2019, p. 23-30.

Research output: Contribution to journalArticle

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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.",
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T1 - Low-dose computed tomography screening for lung cancer in people with workplace exposure to asbestos

AU - Maisonneuve, Patrick

AU - Rampinelli, Cristiano

AU - Bertolotti, Raffaella

AU - Misotti, Alessandro

AU - Lococo, Filippo

AU - Casiraghi, Monica

AU - Spaggiari, Lorenzo

AU - Bellomi, Massimo

AU - Novellis, Pierluigi

AU - Solinas, Michela

AU - Dieci, Elisa

AU - Alloisio, Marco

AU - Fontana, Luca

AU - Persechino, Benedetta

AU - Iavicoli, Sergio

AU - Veronesi, Giulia

PY - 2019/5/1

Y1 - 2019/5/1

N2 - 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.

AB - 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.

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KW - Low-dose chest CT

KW - Lung cancer screening

KW - Lung-neoplasms

KW - Meta-analysis

KW - Pleural plaques

KW - Pleural thickening

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