LUCSO-1—French pilot study of LUng Cancer Screening with low-dose computed tomography in a smokers population exposed to Occupational lung carcinogens: study protocol

Abstract

IntroductionGuidelines concerning the follow-up of subjects occupationally exposed to lung carcinogens, published in France in 2015, recommended the setting up of a trial of low-dose chest CT lung cancer screening in subjects at high risk of lung cancer.ObjectiveTo evaluate the organisation of low-dose chest CT lung cancer screening in subjects occupationally exposed to lung carcinogens and at high risk of lung cancer.Methods and analysisThis trial will be conducted in eight French departments by six specialised reference centres (SRCs) in occupational health. In view of the exploratory nature of this trial, it is proposed to test initially the feasibility and acceptability over the first 2 years in only two SRCs then in four other SRCs to evaluate the organisation. The target population is current or former smokers with more than 30 pack-years (who have quit smoking for less than 15 years), currently or previously exposed to International Agency for Research on Cancer group 1 lung carcinogens, and between the ages of 55 and 74 years. The trial will be conducted in the following steps: (1) identification of subjects by a screening invitation letter; (2) evaluation of occupational exposure to lung carcinogens; (3) evaluation of the lung cancer risk level and verification of eligibility; (4) screening procedure: annual chest CT scans performed by specialised centres and (5) follow-up of CT scan abnormalities.Ethics and disseminationThis protocol study has been approved by the French Committee for the Protection of Persons. The results from this study will be submitted to peer-reviewed journals and reported at suitable national and international meetings.Trial registration numberNCT03562052; Pre-results.

Cost-Effectiveness of an Organized Lung Cancer Screening Program for Asbestos-Exposed Subjects

“…In light of the usual ICER thresholds applied, biennial LC LDTCT scan screening for smokers with high occupational asbestos exposure is acceptable and preferable to annual LDTCT scan screening. The results of an ongoing prospective clinical trial [ 46 ] are expected to validate the modelization results reported herein.…”

Lung Cancer Screening in Asbestos-Exposed Populations

“…The French recommendations proposed that a screening study be conducted among workers whose eligibility is based on age, smoking, and exposure to IARC Group 1 lung carcinogens. Indeed, Delva and co-investigators have begun such a study in numerous regions in France [ 53 ]).…”

“…In a demonstration of how such surveillance can be used to conduct LDCT-based screening, Delva and colleagues are conducting a multifaceted pilot study of LDCT screening of workers exposed to occupational lung carcinogens in two specialized centers in France. They published a protocol of this feasibility study in 2019 [ 53 ] and based their rationale of risk eligibility on a previous expert-driven consensus process. They defined high-risk workers as those aged 55 through 74, who have various combinations of smoking pack-years and cumulative exposure to occupational lung carcinogens.…”

“…The Delva et al study goals and endpoints are comprehensive, and results should be instructive [ 53 ]. They include study feasibility, study participation and retention, smoking cessation counseling impact, utility of risk determination tools, medical and social impact of screening, and cost effectiveness.…”

What is next for occupational cancer epidemiology?

“…For example, dramatic gains in survival due to early detection have been demonstrated for lung cancer (57). However, occupational (or environmental) exposures are not systematically incorporated into screening algorithms, and further research and collaboration with clinical partners is warranted (58)(59)(60)(61).…”