Medical screening for lung cancer: perspective and strategy

Our plain-English summary of Medical screening for lung cancer: perspective and strategy, by K.H. Kilburn (Journal of Occupational Medicine., 1986).

The study

• Author: K.H. Kilburn
• Journal: Journal of Occupational Medicine.
• Published: 1986;28(8):714-8
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 001184).

Abstract

Strategies to prevent or reverse cancer promotion are described. One strategy, involving the screening and prompt treatment of small lung cancers, is proposed as a study to be tested in occupational groups with very high risk, specifically asbestos-exposed shipyard workers who smoke cigarettes. The relative risk can be assigned on the basis of (1) age, (2) years since first asbestos exposure, and (3) cigarette smoking amount, recency of cessation and age at onset. Proposed surveillance would be chest x-ray films at 4-month intervals and sputum cytology in current smokers and those within 10 years of cessation. Means of detection, such as monoclonal antibody tests for adenocarcinoma and other marker molecules, would be explored. Prompt conventional treatment would be assured. Other inquiries would be directed at new treatment, such as using targeted molecules directed at surface antigens.

In plain English

This 1986 article was a commentary without new data. The author proposed a lung cancer screening and treatment study in asbestos-exposed shipyard workers who smoke. Very high risk meant two or more risk factors, such as smoking plus asbestos, or both plus welding. The plan would follow 5,000 workers exposed to asbestos for 15 years or more, who were current or recent smokers and over 45. All would have chest x-ray films every 4 months, and current smokers and those within 10 years of quitting would also have sputum cytology. The author estimated screening would cost about $200 per person per year. Based on asbestos workers' mortality experience, the author expected about 65 lung cancers a year. That gave a rough $15,385 per cancer detected, counting screening costs alone. The author also suggested a factorial trial of preventive agents such as vitamin A or carotene. The author noted that sputum cytology may miss or misread cells. The author also said it was unclear whether finding small tumors improves survival, though evidence favored improved salvage. The author concluded that such a trial should be undertaken.

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: Commentary proposing a screening, surveillance and chemoprevention study (no new data collected)
• Who was studied: Proposed population (not yet studied): 5,000 very high risk shipyard workers and retired or ex-workers in major US shipbuilding areas, exposed to asbestos for 15 years or more, current or recent cigarette smokers, older than 45
• Exposure: Asbestos exposure combined with cigarette smoking, or these two plus welding (no fiber type specified)
• Main results:
  • Proposed surveillance: chest x-ray film and sputum cytology at 4-month intervals in very high risk individuals
  • Sputum cytology was proposed for current smokers and those within 10 years of quitting smoking
  • The author's cost estimate for the screening program: about $200 per person per year, or $1 million per 5,000 persons
  • The author's estimate, based on asbestos workers' mortality experience: about 13 lung cancers per 1,000 workers per year, or 65 positive cases among 5,000 screened
  • The author estimated that confirming diagnoses would involve 130 bronchoscopies. As a rough calculation from the $1 million screening cost alone and the 65 estimated cancers, the author put the cost at $15,385 per lung cancer detected. The author said diagnostic confirmation and care costs should be borne by the existing medical care system
  • The author calculated that surveillance would be cost-effective if it could prevent 10% to 20% of lung cancer deaths
• The authors' conclusion: The author concluded that an intervention screening, surveillance and chemopreventive trial should be undertaken in shipyard workers exposed to asbestos, cigarette smoke and other possible carcinogens
• Limitations the authors state:
  • Sputum cytology may miss malignant cells or overinterpret metaplastic or dysplastic cells
  • It was unclear whether diagnosing tumors while small improves survival or only lengthens the period of observation, although the author wrote that evidence favored improved salvage
  • In the least hopeful case, screening would detect only some additional, slow-growing cancers

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer.

Medical terms in this study, explained in our Lexicon: Lung Cancer, Relative Risk, Asbestos Exposure, Chest X-Ray, Sputum, Cytology, Monoclonal Antibody, Adenocarcinoma.

Related studies

• Can semi-automated image cytometry on induced sputum become a screening tool for lung cancer? Evaluation of quantitative semi-automated sputum cytometry on radon- and uranium-exposed workers — W. Marek, N. Kotschy-Lang, et al. (2001)
• The costs and effects of screening for cancer among asbestos-exposed workers — B.J. McNeil, D.M. Eddy (1982)
• Experiences of a state-sponsored notification and screening program for asbestos workers — A.P. Bender, A.N. Williams, et al. (1993)
• Factors determining early adherence to a lung cancer screening protocol — U. Montes, L.M. Seijo, et al. (2007)
• Yield of Low-Dose Computerized Tomography Screening for Lung Cancer in High-Risk Workers: The Case of 7189 US Nuclear Weapons Workers — S.B. Markowitz, A. Manowitz, et al. (2018)
• Screening for lung cancer in a high-risk group: but I still haven't found what I'm looking for — G.A. Silvestri (2007)

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