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

Our plain-English summary of Comment on: "Low-dose computed tomography screening for lung cancer in people with workplace exposure to asbestos", by E.J.A. Harris, A.W. Musk, N. DeKlerk, et al (Lung Cancer, 2019).

The study

• Authors: E.J.A. Harris, A.W. Musk, N. DeKlerk, F.J.H. Brims
• Journal: Lung Cancer
• Published: 2019;136:148-149
• Type of article: Letter
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This is a letter to the editor, not a full research article. The authors were commenting on an earlier case-control study by Maisonneuve et al. on low-dose CT screening for lung cancer in people exposed to asbestos at work. For comparison, they described their own Western Australian Asbestos Review Program, which included 1743 asbestos-exposed people. These were people with the equivalent of at least 3 months of full-time work exposure to asbestos, or pleural plaques on chest x-ray. Since 2012, 18 lung cancers were detected over more than 3958 person-years of observation up to mid-2017, a detection rate of 0.5 per 100 person-years. In this group, 61.1% had pleural plaques and 34.5% had interstitial changes consistent with asbestosis. The median estimated cumulative asbestos exposure was 0.7 fibre/ml.yrs. Four lung cancers were found in never smokers, out of 596 never smokers screened. Ten of the 18 cancers would not have been found under the NCCN or PLCOm2012 screening guidelines. The authors suggested caution about excluding asbestos-exposed never or light smokers from screening, and said further work is needed.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Letter to the editor commenting on another study (Maisonneuve et al.), reporting summary data from the authors' own asbestos screening and review program
• Who was studied: 1743 asbestos-exposed individuals in the Western Australian Asbestos Review Program (ARP), followed from 2012 to mid-2017. A third were never smokers. Ever-smokers had a median smoking history of 17 pack years (IQR 7.2 to 33).
• Exposure: Occupational asbestos exposure, defined as the equivalent of at least 3 months full-time exposure, or pleural plaques on chest x-ray. Estimated median cumulative exposure was 0.7 fibre/ml.yrs (IQR 0.09 to 3.0). Fiber types are not specified.
• Main results:
  • In the ARP cohort, 18 lung cancers were detected since 2012.
  • In the ARP cohort, the lung cancer detection rate was 0.5 per 100 person-years, over more than 3958 person-years of observation up to mid-2017.
  • In the ARP cohort, 61.1% had pleural plaques and 34.5% had interstitial changes consistent with asbestosis under the Helsinki criteria.
  • In the ARP cohort, four lung cancers were detected in never smokers: 4 of 596 never smokers screened, and 22% of all lung cancers detected.
  • In the ARP cohort, 10 of the 18 lung cancers would not have been detected if recruitment had been based on current screening guidelines (NCCN or PLCOm2012).
• The authors' conclusion: The authors suggested caution when excluding asbestos-exposed never or 'light' smokers from occupational lung cancer screening programs. They stated that further work is needed to stratify the risk profiles of never smokers so that screening can be clinically effective and cost-effective.

Topics

Medical terms in this study, explained in our Lexicon: Low-Dose CT Screening, Lung Cancer.

Related studies

• Comment on: "Low-dose computed tomography screening for lung cancer in people with workplace exposure to asbestos" — F. Barbone, F. Barbiero, et al. (2019)
• Response to comment on: "Low-dose computed tomography screening for lung cancer in people with workplace exposure to asbestos" — P. Maisonneuve, S. Iavicoli, et al. (2019)
• Recommendations for Implementing Lung Cancer Screening with Low-Dose Computed Tomography in Europe — G. Veronesi, D.R. Baldwin, et al. (2020)
• 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) — G. Fasola, O. Belvedere, et al. (2007)
• Low-dose chest computed tomography screening of subjects exposed to asbestos — K. Kato, K. Gemba, et al. (2018)
• Impact of low-dose computed tomography screening on lung cancer mortality among asbestos-exposed workers — F. Barbone, F. Barbiero, et al. (2018)

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