Feasibility of a screening programme for lung cancer in former asbestos workers.
BACKGROUND
Low-dose computed tomography (CT) has been found to detect more Stage IA lung cancer than chest x-ray.


OBJECTIVE
To investigate whether lung cancer screening with CT was effective and acceptable in former asbestos workers.


METHODS
CT scanning was carried out following the protocol previously described in the literature. A questionnaire was used to assess cumulative asbestos exposure. An economic analysis was also performed. Informed consent was obtained from all patients.


RESULTS
A total of 1119 male asbestos workers (58% of invited) were examined, of whom 65% were smokers or ex-smokers. Mean age was 57.1 years with mean cumulative exposure to asbestos of 123 fibres/ml x years. Pleural plaques were found in 375 workers (32%), while 338 workers (29%) were included in the radiological follow-up, which led to 25 biopsies (13 of lung, 9 of pleura, 3 of both) and five screen-detected lung cancers (0.4%), one in Stage I. Incidence rate was 149 per 10(5), equal to that in the male general population of similar age. The expenses for diagnosis were 1014 and 244962 Euro per screened subject and screen-detected lung cancer case, respectively.


CONCLUSIONS
Screening adherence and frequency of detection were low, while costs and radiation dose were high. In spite of a high cumulative asbestos exposure, lung cancer risk was not increased relative to the general population. The screening programme was not felt to be cost-effective from the perspective of the government as a third-party funding agency.
Mastrangelo
Giuseppe
G
Department of Environmental Medicine and Public Health, University of Padova, Padova, Italy. giuseppe.mastrangelo@unipd.it
Ballarin
Maria Nicoletta
MN
Bellini
Ernesto
E
Bizzotto
Rosanna
R
Zannol
Federica
F
Gioffrè
Francesco
F
Gobbi
Mario
M
Tessadri
Gianna
G
Marchiori
Luciano
L
Marangi
Gianluca
G
Bozzolan
Saverio
S
Lange
John H
JH
Valentini
Flavio
F
Spolaore
Paolo
P
D000328:Adult; D001194:Asbestos; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D005240:Feasibility Studies; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000379:methods*; D008654:Mesothelioma / Q000000981:diagnostic imaging*; D008875:Middle Aged; D009784:Occupational Diseases / Q000000981:diagnostic imaging*; D016273:Occupational Exposure; D010995:Pleural Diseases / Q000175:diagnosis; D011829:Radiation Dosage; D014057:Tomography, X-Ray Computed / Q000191:economics
D001194:Asbestos