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).
OBJECTIVE
To evaluate the feasibility of using low-dose computed tomography (LDCT) for the early diagnosis of lung cancer and malignant pleural mesothelioma in an asbestos-exposed population.


METHODS
Between February 2002 and October 2003, 1,045 volunteers already enrolled in a surveillance program for asbestos-exposed workers and former workers were recruited. The main eligibility criteria were: written informed consent, definite exposure to asbestos, age 40-75, no prior cancer or severe concomitant conditions, no chest CT scan in the past 2 years. A smoking history was not required. After a structured interview, chest X-ray (CXR) and LDCT were performed. Participants with negative examinations were assigned to annual LDCT. Participants with positive findings received high-resolution CT and additional diagnostic workup as appropriate.


RESULTS
Baseline characteristics of the screened population were: median asbestos exposure time, 30 years; median age, 58; median pack-years in smokers/former smokers, 18.5. Thirty-four percent had never smoked. On LDCT, 834 noncalcified nodules were identified in 44% of participants, versus 43 nodules in 4% on CXR. Pleural abnormalities were observed in 44% and 70% of participants by CXR and LDCT, respectively. Overall, LDCT identified nine cases of non-small cell lung cancer-eight stage I, one stage IIA-and one thymic carcinoid, corresponding to 1% of the enrolled population. All cases were radically treated. None had been detected by CXR. No pleural mesothelioma was diagnosed. There were 11 false-positive results.


CONCLUSIONS
Our findings first suggest that LDCT may be at least as useful in asbestos workers as in heavy smokers for the early diagnosis of lung cancer; this benefit is evident even in a poor-risk population, with low rates of smoking prevalence and a previous history of radiological surveillance. The role of spiral tomography in screening for pleural mesothelioma remains uncertain.
Fasola
Gianpiero
G
Department of Medical Oncology, University Hospital of Udine, P.le S. M. Misericordia 15, 33100 Udine, Italy. fasola.gianpiero@aoud.sanita.fvg.it
Belvedere
Ornella
O
Aita
Marianna
M
Zanin
Tina
T
Follador
Alessandro
A
Cassetti
Paolo
P
Meduri
Stefano
S
De Pangher
Vincenzo
V
Pignata
Giusto
G
Rosolen
Valentina
V
Barbone
Fabio
F
Grossi
Francesco
F
D000230:Adenocarcinoma / Q000000981:diagnostic imaging; D000328:Adult; D000368:Aged; D001194:Asbestos / Q000009:adverse effects*; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000209:etiology; D008297:Male; D008400:Mass Chest X-Ray; D008654:Mesothelioma / Q000000981:diagnostic imaging* / Q000209:etiology; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects*; D010997:Pleural Neoplasms / Q000000981:diagnostic imaging* / Q000209:etiology; D011379:Prognosis; D011446:Prospective Studies; D013902:Radiography, Thoracic; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
D001194:Asbestos