Yield of Low-Dose Computerized Tomography Screening for Lung Cancer in High-Risk Workers: The Case of 7189 US Nuclear Weapons Workers

摘要

Objectives. To determine the lung cancer screening yield and stages in a union-sponsored low-dose computerized tomography scan program for nuclear weapons workers with diverse ages, smoking histories, and occupations. Methods. We implemented a low-dose computerized tomography program among 7189 nuclear weapons workers in 9 nonmetropolitan US communities during 2000 to 2013. Eligibility criteria included age, smoking, occupation, radiographic asbestos-related fibrosis, and a positive beryllium lymphocyte proliferation test. Results. The proportion with screen-detected lung cancer among smokers aged 50 years or older was 0.83% at baseline and 0.51% on annual scan. Of 80 lung cancers, 59% (n?=?47) were stage I, and 10% (n?=?8) were stage II. Screening yields of study subpopulations who met the National Lung Screening Trial or the National Comprehensive Cancer Network Group 2 eligibility criteria were similar to those found in the National Lung Screening Trial. Conclusions. Computerized tomography screening for lung cancer among high-risk workers leads to a favorable yield of early-stage lung cancers. Public Health Implications. Health equity and efficiency dictate that screening high-risk workers for lung cancer should be an important public health priority. An ongoing challenge is identifying optimal populations for low-dose chest computerized tomography (CT) scan for the early detection of lung cancer. 1–4 The National Lung Screening Trial (NLST) demonstrated that screening based on age and smoking reduces lung cancer mortality but does not address other lung cancer risk factors such as family history, chronic lung diseases, and occupational exposures, let alone a broader range of ages and smoking histories. 5 Published risk-prediction models, 2,3,6 online lung cancer–risk calculators, and professional organizations 7,8 address additional lung cancer risk factors, but empirical studies that support their use are limited. Exposures to occupational lung carcinogens such as asbestos, diesel exhaust, and silica are important, because they are common, may act synergistically with tobacco to raise lung cancer risk, and occur among blue-collar populations with the highest prevalence of cigarette smoking. 9–11 Uncertainties about the magnitude of occupation-related lung cancer risk, however, complicate decision-making about eligibility for screening. 6,12 Another unsettled question is whether the benefits of low-dose CT screening, heretofore demonstrated principally at large tertiary care medical centers, could be replicated in community-based screening. 5 We examined the feasibility and screening yield of low-dose CT scanning for the detection of early-stage lung cancers among a large population of former nuclear weapons production, testing, and research workers, principally in nonurban settings in 5 states in the United States. In doing so, we included screening participants with a broad range of age and smoking histories to compare lung cancer screening results among population subsets with different combinations of age, smoking, and occupational risk.