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Occupational Medicine Advance Access originally published online on March 15, 2008
Occupational Medicine 2008 58(3):175-180; doi:10.1093/occmed/kqn018
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© The Author 2008. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Feasibility of a screening programme for lung cancer in former asbestos workers

Giuseppe Mastrangelo1, Maria Nicoletta Ballarin2, Ernesto Bellini3, Rosanna Bizzotto4, Federica Zannol5, Francesco Gioffrè6, Mario Gobbi7, Gianna Tessadri8, Luciano Marchiori7, Gianluca Marangi2, Saverio Bozzolan9, John H. Lange10, Flavio Valentini11 and Paolo Spolaore12

1 Department of Environmental Medicine and Public Health, University of Padova, Padova, Italy
2 Occupational Health Service, Local Health Authority 12, Venezia, Italy
3 Occupational Health Service, Local Health Authority 18, Rovigo, Italy
4 Occupational Health Service, Local Health Authority 15, Camposampiero, Italy
5 Occupational Health Service, Local Health Authority 8, Montebelluna, Italy
6 Occupational Health Service, Local Health Authority 16, Padova, Italy
7 Occupational Health Service, Local Health Authority 20, Verona, Italy
8 Occupational Health Service, Local Health Authority 6, Vicenza, Italy
9 Department of Economic Sciences, University of Padova, Padova, Italy
10 Envirosafe Training and Consultants, Pittsburgh, PA, USA
11 Occupational Health Service, Local Health Authority 13, Dolo, Italy
12 SER—Epidemiological Department of Veneto Region, Castelfranco Veneto, Italy

Background Low-dose computed tomography (CT) has been found to detect more Stage IA lung cancer than chest x-ray.

Aims To investigate whether lung cancer screening with CT was effective and acceptable in former asbestos workers.

Methods CT scanning was carried out following the protocol previously described in the literature. A questionnaire was used to assess cumulative asbestos exposure. An economic analysis was also performed. Informed consent was obtained from all patients.

Results A total of 1119 male asbestos workers (58% of invited) were examined, of whom 65% were smokers or ex-smokers. Mean age was 57.1 years with mean cumulative exposure to asbestos of 123 fibres/ml x years. Pleural plaques were found in 375 workers (32%), while 338 workers (29%) were included in the radiological follow-up, which led to 25 biopsies (13 of lung, 9 of pleura, 3 of both) and five screen-detected lung cancers (0.4%), one in Stage I. Incidence rate was 149 per 105, equal to that in the male general population of similar age. The expenses for diagnosis were 1014 and 244962 Euro per screened subject and screen-detected lung cancer case, respectively.

Conclusions Screening adherence and frequency of detection were low, while costs and radiation dose were high. In spite of a high cumulative asbestos exposure, lung cancer risk was not increased relative to the general population. The screening programme was not felt to be cost-effective from the perspective of the government as a third-party funding agency.

Keywords      Asbestos; health surveillance; lung cancer screening; low dose computed tomography

Correspondence to: Giuseppe Mastrangelo, Department of Environmental Medicine and Public Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy. Tel: +39 049 821 2543; fax: +39 049 821 2542; e-mail: giuseppe.mastrangelo{at}unipd.it

These authors contributed equally to the work.


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