Evaluation of lung cancer early detection offered by the German Social Accident Insurance for formerly asbestos-exposed employees using low-dose computed tomography - setting and study design

Our plain-English summary of Evaluation of lung cancer early detection offered by the German Social Accident Insurance for formerly asbestos-exposed employees using low-dose computed tomography - setting and study design, by F. Greiner, J. Heidrich, H. Keller, et al (Archives of Public Health = Archives Belges de Santé Publique, 2025).

The study

• Authors: F. Greiner, J. Heidrich, H. Keller, D. Taeger, T. Wiethege, V. Harth
• Journal: Archives of Public Health = Archives Belges de Santé Publique
• Published: 2025;83(1):198
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Clinical trials have shown the benefits of lung cancer screening (LCS) in certain high-risk groups using low-dose high-resolution computed tomography (LDCT). Risk groups are usually defined by age and tobacco use. Exposure to asbestos dust is an important occupational risk factor for lung cancer. Since 2014, the German Social Accident Insurance (DGUV) has introduced annual LCS for high-risk groups (EVA-LCS). In addition to occupational asbestos dust exposure, the population at risk is defined by age (≥ 55 years) and tobacco consumption (≥ 30 pack-years). The health services research project EVALUNG aims to evaluate the EVA-LCS using a combination of quantitative and qualitative methods.

Methods: The quantitative part will be based on a secondary data analysis of routine administrative and medical data from the EVA-LCS. The results of the individual screening rounds will be analysed in a cross-sectional design. Primary endpoints are participation patterns, the rate of findings requiring further diagnostic investigation, the detection of lung cancer including tumour stage and characteristics, and the notification and recognition of asbestos-related occupational diseases. Secondary endpoints include false-positive and false-negative findings, incidence of other cancers, and all-cause and cancer-related mortality. To avoid selection bias, a complete set of anonymised data (approximately 22,200 individuals as of 12/2021) from the EVA-LCS will be transmitted for use in EVALUNG. A sub-sample will be used to perform longitudinal analyses and explore a linkage with cancer registry data. Another component is the development and piloting of quality indicators. Qualitative interviews will be conducted to analyse the perceptions, satisfaction, and potential psychological effects of EVA-LCS participants. Interviews with participating physicians will focus on their attitudes and knowledge regarding LCS. A further aim is to develop an evidence-based decision aid.

Discussion: The EVALUNG concept is based on various complementary approaches, enabling a comprehensive evaluation of the EVA-LCS and the identification of optimization potentials. The quality of the data is crucial for the validity of the quantitative analyses. One way to address potential limitations is to link the data with cancer registry data. The results may contribute to the planning and development of a national LDCT lung cancer screening programme in Germany.

© 2025. The Author(s).

In plain English

This article is a study protocol. It reports no results from the planned evaluation, only some figures on the existing programme, such as participation of 30 to 40% per screening round. It describes the authors' plan (the EVALUNG project) to evaluate the yearly low-dose CT lung cancer screening offered since 2014 by the German Social Accident Insurance to people exposed to asbestos dust at work. Eligible people were at least 55 years old with at least 30 pack-years of smoking. They also needed at least 10 years of work asbestos exposure starting before 1985, or a recognised occupational disease no. 4103 (asbestosis or diseases of the pleura caused by asbestos dust). The plan was to analyse anonymised records on about 22,200 eligible people as of 12/2021, including non-participants. Outcomes included participation, lung cancer detection and tumour stage, and notification and recognition of asbestos-related occupational diseases. Interviews with screening participants and physicians were also planned. Data quality, the authors stated, would determine which analyses were possible. They concluded the results may help plan a national screening programme in Germany.

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: Study protocol for an observational evaluation. It combines secondary analysis of routine administrative and medical data (cross-sectional analyses, plus exploratory longitudinal analyses and cancer registry linkage) with qualitative interviews.
• Who was studied: All people eligible for the German Social Accident Insurance lung cancer screening programme (EVA-LCS), both participants and non-participants: approximately 22,200 individuals as of December 2021.
• Exposure: Occupational asbestos dust exposure. The main (GVS) cohort had at least 10 years of exposure beginning before 1985. The second (UVT) cohort had recognised occupational disease no. 4103 (asbestosis or diseases of the pleura caused by asbestos dust). Both cohorts also had to be aged 55 or older with a smoking history of at least 30 pack-years. No fiber types were specified.
• Main results:
  • This is a descriptive figure for the existing screening programme, not an evaluation result. Participation in the low-dose CT scan ranged between 30 and 40% per screening round, which the authors estimated gives 6,500 to 8,500 cases with a scan.
• The authors' conclusion: The authors concluded that the results may contribute to the planning and development of a national low-dose CT lung cancer screening programme in Germany.
• Limitations the authors state:
  • The quality of the routine data will determine whether the existing data sets can be used, so some planned analyses may be limited.
  • Data gaps and breaks in documentation may occur, for example when a person moves from one cohort to the other.
  • For older cases, only scanned documents rather than structured data may be stored.
  • Participants and non-participants may differ in health and social characteristics, which could cause confounding in comparisons.

Topics

Medical terms in this study, explained in our Lexicon: Lung Cancer, Low-Dose CT Screening, Clinical Trial, Occupational Disease, Selection Bias, Cancer Registry.

Related studies

• Who participates in LDCT screening for the early detection of lung cancer after long-term occupational exposure to asbestos dust? Results of the analysis of administrative and medical routine data from the German Social Accident Insurance — N. Oubaid, F. Greiner, et al. (2026)
• Is it useful to combine sputum cytology and low-dose spiral computed tomography for early detection of lung cancer in formerly asbestos-exposed power industry workers? — M.K. Felten, L. Knoll, et al. (2014)
• Diagnostic Performance of Ultra-Low-Dose Computed Tomography for Detecting Asbestos-Related Pleuropulmonary Diseases: Prospective Study in a Screening Setting — M. Schaal, F. Severac, et al. (2016)
• Computed tomography in the early detection of asbestosis — R. Bégin, G. Ostiguy, et al. (1993)
• Early detection of interstitial lung disease in asbestos exposed non-smoking workers by mid-expiratory flow rate and high resolution computed tomography — Z. Dujić, J. Tocilj, et al. (1991)
• Low-dose computed tomography (LDCT) in workers previously exposed to asbestos: detection of parenchymal lung disease — M.C. Carrillo, S. Alturkistany, et al. (2013)

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