Psychological impact of computed tomography screening for lung cancer and occupational pulmonary disease among asbestos-exposed workers

Our plain-English summary of Psychological impact of computed tomography screening for lung cancer and occupational pulmonary disease among asbestos-exposed workers, by T. Vierikko, S. Kivistö, R. Järvenpää, et al (European Journal of Cancer Prevention, 2009).

The study

• Authors: T. Vierikko, S. Kivistö, R. Järvenpää, J. Uitti, P. Oksa, P. Virtema, T. Vehmas
• Journal: European Journal of Cancer Prevention
• Published: 2009;18(3):203-6
• Cited by: 27 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The objective of this study was to investigate the psychological impact of screening for lung cancer and occupational pulmonary disease among asbestos-exposed workers. Altogether, 633 workers were screened with chest computed tomography (627 men, 6 women, mean age 64.5 years). Participants' views on the necessity of screening,awareness of asbestos-exposure risks, their perceived lung cancer risk, trial adherence intention, health anxiety,and worry about lung cancer were assessed. Health anxiety was reduced significantly after screening (P < 0.001). After 1 year, no significant long-term psychological differences were found between those who immediately received clear results and those who were submitted to additional examinations because of positive findings. In conclusion,computed tomography screening of pulmonary disease was well accepted and did not produce excessive long-term anxiety or other negative psychological effects,which could prevent the participation in the future screening programs.

In plain English

This Finnish study examined the psychological effects of chest computed tomography (CT) screening on asbestos-exposed workers. Of 758 workers invited, 633 (83.5%) had a CT scan. One group had no diagnosed asbestos disease in an earlier screening program; the others had asbestosis or asbestos-related pleural findings. All were scanned for occupational lung and pleural disease, and 180 current or recent ex-smokers were also scanned for lung cancer. Workers answered questionnaires before screening and one year later: 601 men answered the first and 457 answered both. Almost all (99.6%) agreed that health examinations of asbestos-exposed workers are necessary, and 98% were ready to attend future screening. Health anxiety scores fell after screening, from 6.74 to 5.82 on a 0 to 24 scale (P less than 0.001). They fell both among workers with clear results and among the 62 follow-up responders whose positive scans led to further tests that found no cancer. Perceived lung cancer risk, worry about lung cancer and intention to attend again did not change significantly. The authors concluded that screening did not seem to produce excessive long-term anxiety. They noted that only one screening round was studied and that future attendance was measured only as intention.

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: Questionnaire study with a baseline questionnaire and a follow-up questionnaire 1 year later, carried out within a CT screening project of asbestos-exposed workers
• Who was studied: Finnish asbestos-exposed workers from three groups. The first group had taken part in an asbestos screening program in 1990–1992 with no diagnosed asbestos disease at that time. The other two groups had asbestosis or asbestos-related pleural findings and were attending occupational medicine wards for follow-up. Of 758 invited, 633 (83.5%) took part in the CT study. 601 (all men; mean age 64.6, range 45–87) returned the baseline questionnaire, and 457 returned both questionnaires. 97 (15.3%) had a false-positive result, of whom 62 answered the follow-up.
• Exposure: Occupational asbestos exposure (fiber types not stated). Mean years of asbestos exposure was 19.2 (SD 11.5) among the 601 questionnaire respondents. All participants had high-resolution CT for occupational lung and pleural diseases. A high-risk subgroup of 180 current and ex-smokers (who quit within the past 10 years) also had spiral CT for lung cancer.
• Main results:
  • At baseline, 99.6% of participants agreed totally or somewhat that health examinations of asbestos-exposed workers are necessary.
  • At baseline, 98% of participants were ready to attend screening studies in the future.
  • At baseline, 34.2% of participants thought they were at risk of lung cancer, and 36.8% considered that possibility quite small.
  • Across the whole group, health anxiety was significantly lower after screening (P < 0.001). Among 419 participants with both measurements, the mean score fell from 6.74 to 5.82 on a 0–24 scale.
  • Health anxiety fell significantly both in the negative-result group (n=354, mean 6.64 to 5.73, P < 0.001) and in the false-positive group (n=62, mean 7.63 to 6.42, P = 0.027).
  • High asbestos exposure was associated with reduced anxiety after screening (P = 0.003).
  • Perceived lung cancer risk, trial adherence intention and worry about lung cancer showed no significant change between baseline and follow-up, in either the negative or the false-positive group.
• The authors' conclusion: The authors concluded that screening does not seem to produce excessive long-term anxiety or other negative psychological effects that could prevent future participation, and that trial adherence intention was good even after a false-positive result.
• Limitations the authors state:
  • Only a single baseline screening was performed; psychological responses to repeat screenings were not evaluated.
  • Psychological items were not assessed during the screening process itself.
  • Trial adherence was measured only by questionnaire, so it reflects intentions rather than actual screening behavior.
  • The sample was limited to high-risk asbestos-exposed workers, so the results may not apply to unexposed populations.

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.

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• Role of chest computed tomography in prevention of occupational respiratory disease: review of recent literature — D.N. Weissman (2015)
• Relationships (I) of International Classification of High-resolution Computed Tomography for Occupational and Environmental Respiratory Diseases with the ILO International Classification of Radiographs of Pneumoconioses for parenchymal abnormalities — T. Tamura, N. Suganuma, et al. (2015)
• 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)
• 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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