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

Our plain-English summary of Response to comment on: "Low-dose computed tomography screening for lung cancer in people with workplace exposure to asbestos", by P. Maisonneuve, S. Iavicoli, G. Veronesi (Lung Cancer, 2019).

The study

• Authors: P. Maisonneuve, S. Iavicoli, G. Veronesi
• Journal: Lung Cancer
• Published: 2019;136:151-152
• Type of article: Letter
• Read it: PubMed · Publisher

In plain English

In this letter, not a new study, the authors replied to comments by Harris et al. and Barbone et al. on their earlier paper about low-dose CT (LDCT) lung cancer screening in asbestos-exposed workers. Their earlier case-control study came from a screening study that selected people with a strong smoking history. Asbestos exposure was confirmed by interview in 216 subjects but was probably low. By contrast, 61.1% of ARP study participants had pleural plaques. The authors said their study was very small, with a detection rate based on a single cancer case. Restating their earlier review of nine reports, they said 6 of 1891 non-smokers were diagnosed with lung cancer through LDCT screening (pooled detection rate 0.1%, upper 95% limit 0.4%). They agreed these low numbers do not allow firm conclusions. They noted possible screening harms, including false positives, over diagnosis and radiation exposure. They said they had proposed monitoring asbestos-exposed never or light smokers, not unconditionally excluding them. They added that including these workers in LDCT screening should rest on accurate exposure assessment. The authors concluded that further work is required.

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 (authors' reply to published comments on their earlier case-control study and literature review); no new data
• Who was studied: The letter discusses the authors' earlier case-control study: 216 asbestos-exposed subjects identified within a lung cancer screening study (COSMOS) whose participants were selected for a strong smoking history
• Exposure: Workplace asbestos exposure, confirmed by interview. Asbestos exposure was not a selection criterion, and the authors judged the level of exposure probably low. Fiber types are not stated.
• Main results:
  • The authors judged asbestos exposure in their 216 exposed subjects probably low, based on a low prevalence of pleural plaques (10.2%)
  • For comparison, the authors cited the ARP study (Harris et al.): 61.1% of its participants, including 34% non-smokers, had pleural plaques
  • In the authors' earlier study, the detection rate rested on a single cancer case and was lower than in the whole COSMOS population (1.1%)
  • Restating their earlier review, the authors reported that the nine available published reports included 1891 non-smokers, of whom 6 were diagnosed with lung cancer through LDCT screening
  • Pooled detection rate among these non-smokers, from the authors' earlier review: 0.1%, with an upper 95% limit of 0.4%
  • The authors listed possible harms of LDCT screening, including false positive findings, incidental findings, over diagnosis and radiation exposure
  • The authors stated they had not proposed to unconditionally exclude asbestos-exposed never or light smokers from occupational lung cancer screening programs, but to monitor them
  • The authors stated that including asbestos-exposed never or light smokers in LDCT screening programs should be based on an accurate exposure assessment, referring to the 2014 Helsinki criteria
• The authors' conclusion: The authors concluded that further work is required to stratify risk profiles of never-smokers and to determine the benefits and harms of LDCT screening in never-smokers
• Limitations the authors state:
  • The number of subjects in the authors' case-control study was very small
  • The low numbers of screened asbestos-exposed non-smokers reported in the literature do not allow firm conclusions about screening efficacy in this group
  • The authors' review did not include data from Barbone et al., which were published after the review's literature search end date (April 1st 2018)
  • The authors stated that robust information is lacking on false positive LDCT findings in people at low risk of cancer

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" — E.J.A. Harris, A.W. Musk, et al. (2019)
• Comment on: "Low-dose computed tomography screening for lung cancer in people with workplace exposure to asbestos" — F. Barbone, F. Barbiero, 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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