CT scan screening is associated with increased distress among subjects of the APExS

Our plain-English summary of CT scan screening is associated with increased distress among subjects of the APExS, by C. Paris, M. Maurel, A. Luc, et al (BMC Public Health, 2010).

The study

• Authors: C. Paris, M. Maurel, A. Luc, A. Stoufflet, J.C. Pairon, M. Letourneux
• Journal: BMC Public Health
• Published: 2010;10:647
• Cited by: 13 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: The aim of this study was to assess the psychological consequences of HRCT scan screening in retired asbestos-exposed workers.

Methods: A HRCT-scan screening program for asbestos-related diseases was carried out in four regions of France. At baseline (T1), subjects filled in self-administered occupational questionnaires. In two of the regions, subjects also received a validated psychological scale, namely the psychological consequences questionnaire (PCQ). The physician was required to provide the subject with the results of the HRCT scan at a final visit. A second assessment of psychological consequences was performed 6 months after the HRCT-scan examination (T2). PCQ scores were compared quantitatively (t-test, general linear model) and qualitatively (chi²-test, logistic regression) to screening results. Multivariate analyses were adjusted for gender, age, smoking, asbestos exposure and counseling.

Results: Among the 832 subjects included in this psychological impact study, HRCT-scan screening was associated with a significant increase of the psychological score 6 months after the examination relative to baseline values (8.31 to 10.08, p < 0.0001, t-test). This increase concerned patients with an abnormal HRCT-scan result, regardless of the abnormalities, but also patients with normal HRCT-scans after adjustment for age, gender, smoking status, asbestos exposure and counseling visit. The greatest increase was observed for pleural plaques (+3.60; 95%CI [+2.15;+5.06]), which are benign lesions. Detection of isolated pulmonary nodules was also associated with a less marked but nevertheless significant increase of distress (+1.88; 95%CI [+0.34;+3.42]). However, analyses based on logistic regressions only showed a close to significant increase of the proportion of subjects with abnormal PCQ scores at T2 for patients with asbestosis (OR = 1.92; 95%CI [0.97-3.81]) or with two or more diseases (OR = 2.04; 95%CI [0.95-4.37]).

Conclusion: This study suggests that HRCT-scan screening may be associated with increased distress in asbestos-exposed subjects. If confirmed, these results may have consequences for HRCT-scan screening recommendations.

In plain English

This French study asked whether chest CT screening for asbestos-related disease was linked to changes in distress among retired or unemployed asbestos-exposed workers. In two of the four regions of the Asbestos Post-Exposure Survey, 832 participants completed a 12-item distress questionnaire (the PCQ) before screening and again 6 months after their scan. The average score rose from 8.30 to 10.07. The share with an abnormal score rose from 20.5% to 32.6%. In analyses adjusted for gender, age, smoking, self-assessed exposure and counseling, scores rose most in people whose scans showed only pleural plaques (+3.60, 95% CI +2.15 to +5.06). Scores also rose in people with isolated lung nodules (+1.88, 95% CI +0.34 to +3.42) and in those with normal scans (+1.40, 95% CI +0.11 to +2.69). In a second analysis, links between an abnormal score and asbestosis, or two or more findings, were close to but not statistically significant. The authors concluded that screening was associated with increased distress. They noted there was no comparison group of exposed people without scans, and that the findings need confirmation.

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: Before-and-after questionnaire study (distress measured before screening and 6 months after the scan), carried out as an ancillary study within a national French CT screening program (the Asbestos Post-Exposure Survey, APExS)
• Who was studied: Unemployed or retired asbestos-exposed workers in two of the four French regions of the APExS, enrolled December 2004 to December 2005. 1184 were invited to repeat the questionnaire and 867 returned it. 832 completed all questionnaires: 92.3% male, mean age 62, 9.1% current smokers.
• Exposure: The exposure studied was HRCT scan screening and its results. Participants had occupational asbestos exposure judged reliable by industrial hygienists and no known occupational asbestos-related disease. Fiber types were not specified. Self-assessed intensity of asbestos exposure was also recorded.
• Main results:
  • Scan results were unknown for 160 of the 832 participants and normal in 213. The remaining 459 (68.3% of those with a known result) had at least one lesion. 113 had isolated pleural plaques.
  • Across all 832 participants, the mean global PCQ distress score rose significantly from baseline to 6 months: 8.30 to 10.07 in Table 2 (unadjusted).
  • An abnormal PCQ score (above the 95th percentile of non-exposed subjects) was found in 32.6% of participants at 6 months, compared with 20.5% before screening (unadjusted).
  • In adjusted analyses, the largest score increase was in participants with pleural plaques only: +3.60 (95% CI +2.15 to +5.06).
  • In adjusted analyses, the score rose by +1.88 (95% CI +0.34 to +3.42) in participants with isolated pulmonary nodules.
  • In adjusted analyses, the score rose by +1.40 (95% CI +0.11 to +2.69) in participants with normal scans.
  • At 6 months, compared with participants whose scans were normal, only those with pleural plaques had a higher PCQ score.
  • In logistic regression, the odds of developing an abnormal PCQ score were not statistically significant but close to it. The odds ratio was 1.92 (0.97 to 3.81) for participants with asbestosis and 2.04 (0.95 to 4.37) for those with two or more diseases, compared with normal scans.
  • 74 participants without an identified scan who repeated the questionnaire showed no significant score increase (8.31 to 9.20).
• The authors' conclusion: The authors concluded that HRCT scan screening was associated with a long-term increase in distress in asbestos-exposed subjects, with the largest increase for pleural plaques. They said the results must be confirmed because the clinical significance of the findings is hard to estimate.
• Limitations the authors state:
  • No control group of exposed subjects without HRCT was available, so the score increase may not be clinically relevant.
  • Participants were volunteers, which could cause selection bias.
  • The 6-month interval could allow changes in health status to affect the second questionnaire, independently of the scan result.
  • The diagnosis of asbestosis, which was based on radiology reports, was probably overestimated in these elderly subjects.
  • Statistical power was low for the logistic regression (abnormal versus normal score) analysis.

Topics

Medical terms in this study, explained in our Lexicon: CT Scan, High-Resolution CT (HRCT), Asbestos Exposure, Pleural Plaques.

Related studies

• Factors associated with cancer distress in the Asbestos Post-Exposure Survey (APEXS) — M. Maurel, A. Stoufflet, et al. (2009)
• Smoking, occupational risk factors, and bronchial tumor location: a possible impact for lung cancer computed tomography scan screening — M. Gonzalez, J.M. Vignaud, et al. (2012)
• Performance of chest radiograph and CT scan for lung cancer screening in asbestos-exposed workers — B. Clin, F. Morlais, et al. (2009)
• Pleural plaques and asbestosis: dose- and time-response relationships based on HRCT data — C. Paris, S. Thierry, et al. (2009)
• Factors determining early adherence to a lung cancer screening protocol — U. Montes, L.M. Seijo, et al. (2007)
• Current status of screening for malignant pleural mesothelioma — H.I. Pass, M. Carbone (2009)

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