After completing this course, the reader will be able to:1. Describe the current status of LDCT screening for lung cancer among high-risk individuals.2. Discuss the potential and drawbacks of LDCT for the early detection of lung cancer in asbestos-exposed individuals.3. Describe the limits and possibilities of LDCT for detecting pleural abnormalities and malignant pleural mesothelioma in asbestos workers and former workers.Access and take the CME test online and receive 1 AMA PRA Category 1 Credit ™ at CME.TheOncologist.com CME CME ABSTRACTObjective. 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. 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. The Oncologist 2007; 12:1215-1224

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This cohort experienced an excess in the incidence of both mesothelioma and lung cancer, showing increasing incidence rates at higher level of asbestos exposure. For lung cancer, the relative incidence was highest among workers hired in shipbuilding between 1974 and 1984.

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PurposeIn 2002 subjects already enrolled in a surveillance program for asbestos-exposed workers were recruited in a Low Dose CT scan screening (LDCT) (ATOM002 Study). During the 2-year program LDCT identified 11 lung cancer (LC) cases versus none detected by chest radiographs (CXR). The objective of this study is to evaluate whether, after a 10-year follow-up, this program was effective in reducing mortality for LC as compared with conventional health surveillance.MethodsWithin a cohort of 2,433 occupationally asbestos-exposed men, enrolled in a public health surveillance program, we compared mortality and survival between participants in a screening program based on LDCT (ATOM002-P, n = 926) and non-participants (ATOM002-NP, n = 1,507). For external comparison, we estimated the standardised mortality rate ratio (SMR_ITA) using italian standard rates. For internal comparisons we performed Cox proportional hazard models to assess survival for all causes, all cancers, LC and malignant neoplasm of the pleura. Final models were adjusted for smoking habits, age at start of follow-up, level of exposure to asbestos and Charlson-Quan comorbidity index.ResultsLC crude mortality was 99.4 per 100,000 person-year in ATOM002-P (Obs = 8) compared to 430.4 per 100,000 person-year in ATOM002-NP (Obs = 50). Compared with italian mortality rates, a trend towards reduced mortality for lung cancer was found among ATOM002-P (SMR_ITA = 0.51 95% CI: 0.22–1.01), in contrast to a statistically significant increase in the ATOM002-NP (SMR_ITA = 1.98; 95% CI: 1.47–2.61). Internal comparisons show a significant 59% reduction in mortality for lung cancer in ATOM002 participants (HR = 0.41,95% CI: 0.17–0.96). Mortality was also reduced for all causes (HR = 0.61, 95% CI: 0.44–0.84), but not for all cancers (HR = 0.97, 95% CI: 0.62–1.50) and malignant neoplasm of the pleura (HR = 0.86, 95% CI: 0.31–2.41).ConclusionsIn our cohort, a 2-year LDCT-based screening protocol was more effective in reducing mortality for LC than conventional public health surveillance. Surveillance program for asbestos-exposed workers should include LDCT screening.