Chest CT scan screening for lung cancer in asbestos occupational exposure: a systematic review and meta-analysis.
OBJECTIVE
Lung cancer is the most frequent malignant asbestos-related pathology and remains the most fatal cancer of industrialized countries. In heavy smokers, early detection of lung cancer with chest CT scan leads to a 20% mortality reduction. However, the use of CT scan screening for early detection of lung cancer in asbestos-exposed workers requires further investigation. This study aimed to determine whether CT scan screening in asbestos-exposed workers is effective in detecting asymptomatic lung cancer using a systematic review and meta-analysis.


METHODS
We reviewed all cohort studies involving chest CT scan screening in former asbestos-exposed workers. The search strategy used the following keywords: "asbestos," "lung cancer," "screening," and "occupation*" or "work." Databases were PubMed, Cochrane Library, Science Direct, and Embase.


RESULTS
Seven studies matched our inclusion criteria. Baseline screening detected 49 asymptomatic lung cancers among 5,074 asbestos-exposed workers. Of the 49 reported lung cancers, at least 18 were in the earliest stage (stage I), accessible to complete removal surgery. The prevalence of all lung cancers detected by CT scan screening in asbestos-exposed workers was 1.1% (95% CI, 0.6%-1.8%).


CONCLUSIONS
CT scan screening in asbestos-exposed workers is effective in detecting asymptomatic lung cancer. Detection of lung cancer in asbestos-exposed workers using CT scanning is at least equal to the prevalence in heavy smokers (1%; 95% CI, 0.09%-1.1%) and also shared a similar proportion of stage I diagnoses. Screening asbestos-exposed workers could reduce mortality in proportions previously observed among heavy smokers and, thus, should not be neglected, particularly for individuals combining both exposures.
Department of Occupational Medicine, Clinical Research and Innovation Direction, Sport Medicine and Functional Exploration, University Hospital CHU G. Montpied, Clermont-Ferrand, France; Laboratory of Metabolic Adaptations to Exercise in Physiological and Pathological Conditions EA3533, Blaise Pascal University, Clermont-Ferrand, France.
Marie
M
Ollier
Department of Occupational Medicine, Clinical Research and Innovation Direction, Sport Medicine and Functional Exploration, University Hospital CHU G. Montpied, Clermont-Ferrand, France.
Alain
A
Chamoux
Laboratory of Metabolic Adaptations to Exercise in Physiological and Pathological Conditions EA3533, Blaise Pascal University, Clermont-Ferrand, France.
Geraldine
G
Naughton
Laboratory of Molecular Oncology EA 4677, Centre Jean Perrin, Clermont-Ferrand, France.
Bruno
B
Pereira
Department of Occupational Medicine, Clinical Research and Innovation Direction, Sport Medicine and Functional Exploration, University Hospital CHU G. Montpied, Clermont-Ferrand, France; School of Exercise Science, Australian Catholic University, Fitzroy, VIC, Australia; Laboratory of Metabolic Adaptations to Exercise in Physiological and Pathological Conditions EA3533, Blaise Pascal University, Clermont-Ferrand, France; INRA UMR 1019, UNH, CRNH Auvergne, University of Auvergne, Clermont-Ferrand, France. Electronic address: fred_dutheil@yahoo.fr.
Frédéric
F
Dutheil
D000368:Aged; D001194:Asbestos / Q000009:adverse effects*; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality; D008297:Male; D008654:Mesothelioma / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects*; D015995:Prevalence; D012907:Smoking / Q000009:adverse effects; D015996:Survival Rate; D014057:Tomography, X-Ray Computed
D001194:Asbestos