Lung cancer mortality among construction workers: implications for early detection

Abstract

ObjectivesThis study examined predictors of lung cancer mortality, beyond age and smoking, among construction workers employed at US Department of Energy (DOE) sites to better define eligibility for low-dose CT (LDCT) lung cancer screening.MethodsPredictive models were based on 17 069 workers and 352 lung cancer deaths. Risk factors included age, gender, race/ethnicity, cigarette smoking, years of trade or DOE work, body mass index (BMI), chest X-ray results, spirometry results, respiratory symptoms, beryllium sensitisation and personal history of cancer. Competing risk Cox models were used to obtain HRs and to predict 5-year risks.ResultsFactors beyond age and smoking included in the final predictive model were chest X-ray changes, abnormal lung function, chronic obstructive pulmonary disease (COPD), respiratory symptoms, BMI, personal history of cancer and having worked 5 or more years at a DOE site or in construction. Risk-based LDCT eligibility demonstrated improved sensitivity, specificity and positive predictive value compared with current US Preventive Services Task Force guidelines. The risk of lung cancer death from 5 years of work in the construction industry or at a DOE site was comparable with the risk from a personal cancer history, a family history of cancer or a diagnosis of COPD. LDCT eligibility criteria used for DOE construction workers, which includes factors beyond age and smoking, identified 86% of participants who eventually would die from lung cancer compared with 51% based on age and smoking alone.ConclusionsResults support inclusion of risk from occupational exposures and non-malignant respiratory clinical findings in LDCT clinical guidelines.

Lung Cancer Mortality in the Swiss Working Population

“…Construction workers were also identified as at risk of lung cancer mortality. They were found at higher risk of lung cancer than other blue-collar workers, even after adjusting for smoking and socio-demographic variables 38 and we also observed this. Therefore, we think it is likely that Swiss construction workers may have been exposed to IARC group 1 carcinogens such as asbestos, silica dust, and diesel engine exhaust, 22 highly prevalent in this occupational group.…”

Lung Cancer Screening in Asbestos-Exposed Populations

“…Dement and colleagues used this nuclear weapons construction worker cohort and a related larger construction worker population to develop a lung cancer risk prediction model (BTMed model) that includes age, gender, race, smoking history, spirometry, chest X-ray finding of parenchymal fibrosis and/or pleural plaques, occupational history of ≥5 years of work in construction, body mass index, and personal history of cancer [ 50 ]. Applying the lung cancer screening criteria described above in the Welch et al study yielded an 85.6% sensitivity, a 56.8% specificity, and a 4.2% positive predictive value.…”

“…This level of sensitivity compares favorably with that of the PLCO m2012 model (85.2%) and of the Two-Stage Clonal Expansion (83.8%), though the specificity is somewhat lower. Dement et al applied the 2013 USPSTF-recommended screening criteria (age 50–80 years, ≥30 pack-years of smoking, and quitting <15 years in past) to their dataset and obtained a 50.9% sensitivity, an 81.2% specificity, and a 5.7% positive predictive value [ 50 ]. This large decline in sensitivity, from 85.6% to 50.9%, using the different eligibility criteria, represents a failure of the 2013 USPSTF criteria (which exclude occupation) to detect as many as 40% of the lung cancers detected in the study.…”

“…The United States has very few organized programs that track formerly asbestos-exposed workers or offer medical surveillance to asbestos-exposed workers, especially post-retirement when lung cancer risk is likely to be highest. The Department of Energy Former Worker Medical Screening Program is described above [ 48 , 49 , 50 ]. The US Navy has for several decades sponsored the Navy Asbestos Medical Surveillance Program [ 67 ], though few results appear to have been published in recent decades [ 68 ].…”

Risk Factors of Inability to Exist Independently Among Patients With Lung Cancer

“…In fact it is the main cause of cancer-related mortality worldwide [1][2][3]. In the literature we can nd a variety of works that focus on preventing lung cancer [4][5][6][7] and on implications for early detection [8][9]. It is a cancer that causes signi cant suffering among patients, both physical [10][11][12][13] and mental [14][15][16][17].…”