Modelling prevalence and incidence of fibrosis and pleural plaques in asbestos-exposed populations for screening and follow-up: a cross-sectional study.
BACKGROUND
CT-Scan is currently under assessment for the screening of asbestos-related diseases. However, to date no consensus exists as to how to select high-risk asbestos-exposed populations suitable for such screening programs. The objective of this study is to select the most relevant exposure variables for the prediction of pleural plaques and asbestosis in order to guide clinicians in their use of CT-Scan.


METHODS
A screening program of non malignant asbestos-related diseases by CT-scan was conducted among asbestos-exposed volunteers in France. Precise assessments of asbestos exposure were obtained by occupational hygiene measurements and a job-exposure matrix. Several parameters were calculated (time since first exposure, duration, intensity and cumulative exposure to asbestos). Predictive parameters of prevalence and incidence were then estimated by standard logistic and a complementary log-log regression models.


RESULTS
1011 subjects were recruited in this screening program among them 474 (46.9%) presented with pleural plaques and 61 (6.0%) with interstitial changes compatible with asbestosis on CT-scan. Time since first exposure (p < 0.0001) and either cumulative or mean exposure (p < 0.0001) showed independent associations with both pleural plaques and asbestosis prevalence and pleural plaques incidence. Modelling incidence of pleural plaques showed a 0.8% to 2.4% yearly increase for a mean exposure of 1 f/ml.


CONCLUSIONS
Our findings confirmed the role played by time since first exposure and dose but not duration in asbestos-related diseases. We recommend to include these parameters in high-risk populations suitable for screening of these diseases. Short-periodicity of survey of pleural plaques by CT-Scan seemed not to be warranted.
Paris
Christophe
C
Inserm ERI-11, Assessment and prevention of occupational and environmental risks Medical School, 9 av de la Forêt de Haye - BP 184, 54505 Vandoeuvre-les-Nancy Cedex, France. christophe.paris@nancy.inserm.fr
Martin
Aurélie
A
Letourneux
Marc
M
Wild
Pascal
P
D000395:Air Pollutants, Occupational / Q000633:toxicity*; D001194:Asbestos / Q000633:toxicity*; D001195:Asbestosis / Q000000981:diagnostic imaging / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005355:Fibrosis / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000453:epidemiology; D005602:France; D006801:Humans; D015994:Incidence; D008403:Mass Screening; D008875:Middle Aged; D008954:Models, Biological; D016273:Occupational Exposure / Q000009:adverse effects*; D010995:Pleural Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000453:epidemiology; D015995:Prevalence; D014057:Tomography, X-Ray Computed
D000395:Air Pollutants, Occupational; D001194:Asbestos