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Original Research: Lung Cancer |

Chest CT Scan Screening for Lung Cancer in Asbestos Occupational ExposureCT Scan Screening in Asbestos-Exposed Workers: A Systematic Review and Meta-analysis FREE TO VIEW

Marie Ollier, MD; Alain Chamoux, MD, PhD; Geraldine Naughton, PhD; Bruno Pereira, PhD; Frédéric Dutheil, MD, PhD
Author and Funding Information

From the Department of Occupational Medicine (Drs Ollier, Chamoux, and Dutheil), the Clinical Research and Innovation Direction (Dr Pereira), Sport Medicine and Functional Exploration (Dr Dutheil), University Hospital CHU G. Montpied, Clermont-Ferrand, France; the Laboratory of Molecular Oncology EA 4677 (Dr Ollier), Centre Jean Perrin, Clermont-Ferrand, France; the School of Exercise Science (Drs Naughton and Dutheil), Australian Catholic University, Fitzroy, VIC, Australia; the Laboratory of Metabolic Adaptations to Exercise in Physiological and Pathological Conditions EA3533 (Dr Dutheil), Blaise Pascal University, Clermont-Ferrand, France; and INRA UMR 1019 (Dr Dutheil), UNH, CRNH Auvergne, University of Auvergne, Clermont-Ferrand, France.

Correspondence to: Frédéric Dutheil, MD, PhD, Occupational Medicine, University Hospital CHU G. Montpied, 58 rue Montalembert, 63 000 Clermont-Ferrand, France; e-mail: fred_dutheil@yahoo.fr


Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(6):1339-1346. doi:10.1378/chest.13-2181
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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.

Figures in this Article

Asbestos was commonly used over the 20th century1 and remains prevalent in developing countries.1 However, asbestos exposure causes various benign and malignant pathologies.1 Lung cancer is the most prevalent malignant asbestos-related pathology, well in excess of mesotheliomas.1 Lung cancer is associated with asbestos exposure in a dose-response relationship.24 Globally, at least 125 million workers are exposed to asbestos in the workplace. According to the World Health Organization, > 107,000 people die each year from asbestos-related diseases due to occupational exposure.1 All forms of asbestos are now banned in 52 countries. However, a large number of countries still use, import, and export asbestos and asbestos-containing products, particularly in Africa, Latin America, Eastern Europe, and Asia, with China currently being the largest consumer of asbestos in the world.5 Even in countries prohibiting asbestos, it remains widespread in employment and workplaces, and most exposed workers are those involved in asbestos removal.

Asbestos-induced lung cancer has a highly delayed onset of 20 to 40 years following initial exposure.2 Cancers resulting from massive asbestos exposure between 1970 and 1990 are predicted for the next 20 years. Lung cancer remains the most fatal cancer of the industrialized countries,6 and successful strategies to reduce lung cancer mortality are urgently required.

The poor prognosis of lung cancer is because the only available curative treatment today is radical resection surgery, which is only successful at an early stage.7 However, early stages are rarely detected, because clinical symptoms occur late in the evolution of the disease.8 Thus, screening during early stage of lung cancer appears salient. The most sensitive method for detecting lung cancer is low-dose spiral CT (LDCT) scanning. Chest LDCT scan screening identified lung cancer at an early stage in the high-risk population of smokers,9,10 with significant decreases in mortality rates.1113 Results from the large-scale National Lung Screening Trial13 instigated the clinical guidelines recommending an annual lung cancer screening with LDCT scan for smokers and former smokers with a 30 pack-year history of smoking.14

However, compared with smokers, screening for lung cancer in asbestos-exposed workers is less well known. Thus, we aimed to conduct a systematic review and meta-analysis to determine whether CT scan screening in asbestos-exposed workers is effective in detecting asymptomatic lung cancer.

Literature Search

We reviewed all cohort studies involving chest CT scan screening in former asbestos-exposed workers. Specifically, the inclusion criteria for the search strategy were asbestos exposure, cohort studies (minimum number of 10 individuals), without a case-study design, and the following keywords: “asbestos,” “lung cancer,” “screening,” and “occupation*” or “work.” The following databases were searched on September 12th, 2013: PubMed, Cochrane Library, Science Direct, and Embase. The search was not limited to specific years, and no language restrictions applied. To be included, articles needed to describe our primary outcome variable, which is the number of lung cancer diagnoses at baseline following CT scan screening. In addition, reference lists of all publications meeting the inclusion criteria were manually searched to identify any further studies not found through electronic searching. The search strategy is described in Figure 1. One author (M. O.) conducted all literature searches and collated the abstracts. Two authors (M. O. and F. D.) separately reviewed the abstracts and, based on the selection criteria, decided the suitability of the articles for inclusion. A third author (A. C.) was asked to review the article if consensus on suitability was not met. Then, all authors reviewed the eligible articles.

Quality of Assessment

Although not designed for quantifying the integrity of studies,15 the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) criteria were used for checking the quality of reporting.16 The 21 items identified in the STROBE criteria could achieve a maximal score of 34.

Statistical Considerations

Data were analyzed using Comprehensive Meta-analysis Version 2.0 (BioStat Solutions Inc). Heterogeneity in the study results was evaluated by examining forest plots and CIs and using formal tests for homogeneity based on the I2 statistic. Random effects meta-analyses (DerSimonian and Laird approach) were conducted when data could be pooled.

An initial search produced a possible 1,781 articles (Fig 1). Selection criteria and removal of duplicates reduced these articles to seven studies1723 on lung cancer screening by chest CT scan in asbestos-exposed workers. All identified articles were written in English. Table 1 summarizes the seven retrieved studies.

Table Graphic Jump Location
Table 1 —Characteristics of the 5,074 Asbestos-Exposed Workers From the Seven Included Studies and Baseline Results From LDCT Scan Screening for Lung Cancer

LDCT = low-dose spiral CT; n/a = not available.

a 

Current + former smokers = 68.

b 

n/a at baseline: 57% of stage I on the three consecutive screenings.

c 

Former or current smokers (not specified).

Quality of Articles

Quality assessment of the seven included studies, as outlined by the STROBE criteria, varied from 50%21 to 70%,17,19,22,23 where a higher percentage implies a higher quality of scientific reporting. Overall, the studies performed best in the methods section and worst in the discussion section. All studies described ethical approval, except one.22

Inclusion Criteria for Asbestos-Exposed Workers

Asbestos exposure was the shared inclusion criterion of the seven studies.1823 However, eligibility criteria for occupational asbestos exposure varied: “important” according to the French conference consensus,17 “heavily” exposed (estimation of the authors taking into account type of work and exposure time) or with asbestosis or pleural plaque,24 former asbestos workers who were “presumed to have been exposed to the highest concentrations of asbestos fibers,”23 a minimum exposure of “20 years” or pleural plaques,20 former workers “with asbestos-related diseases” (asbestosis or bilateral pleural plaques),22 unspecified asbestos exposure,19 and asbestos exposure from specific work-related tasks.18 In three of the seven studies, age was a criterion that varied between 40 to 75 years,19 50 to 75 years,17 and < 80 years.20 Smoking (> 10 years) was included in addition to asbestosis among eligibility criteria in one study.22 Risk classification included age and smoking in addition to the duration of asbestos exposure in one of the aforementioned studies.18 One of the studies excluded women because of low numbers (36 of 1,165).23

Sample Populations
Sample Size:

Population sizes ranged from 18718 to 1,119.23 In total 5,074 asbestos-exposed workers were included in this meta-analysis.

Sex:

The proportions of female exposed workers remained low (0.95%-5.3%). One study did not report sex,18 and one excluded women.23

Age:

Regardless of whether age was expressed as a median or a mean value, studies reported participants being between 58 and 68 years of age. Thus, we investigated studies of aging asbestos-exposed workers.

Smoking:

Percentages of current smokers varied. Four studies reported low proportions of smokers, < 20%,1921,23 whereas the remaining studies reported substantially higher percentages: 68%,17 89%,18 and 97%.22 In only one study, the prevalence of current and former smokers was not separately described.

Asbestos Exposure:

Mean asbestos exposure duration for five of the studies ranged from 17.7 to 30 years, with two failing to report exposure time.17,20 Time from the beginning of the asbestos exposure was not reported in any studies, with the exception of one study reporting a mean of 34.2 years elapsed from first exposure.23

Types of Occupation:

In four of the seven studies, the occupation of previously exposed workers was not specified. The three other studies described former power plant workers with known long-term exposure to asbestos18; construction workers who had been installing heat and fire insulation, building with asbestos-containing walls ceiling panels, or using asbestos paints22; and former workers engaged in asbestos-cement manufacturing, railway rolling stock fabrication, and repair or installation of insulation in shipyards or elsewhere.23

Outcome and Aim of the Studies

All seven studies shared similar outcomes, with varying degrees of clarity. Four studies reported number and size of pulmonary nodules as primary outcomes, in combination with the number of malignancies (pulmonary cancer and mesothelioma).17,18,21,22 The three other studies included additional pulmonary abnormalities19 and pleural plaques.20,23

Study Designs

All studies described a cohort follow-up design, analyzing chest LDCT scan screening in former asbestos-exposed workers. The studies also shared a generic focus of the feasibility of chest CT scans in screening for lung cancer among this high-risk population. The studies included follow-up, with four reporting no drop-outs.18,19,21,22 In one study, two individuals with lung cancer were lost during the study prior to the diagnosis of the stage of the cancer,20 another study reported 2.8% (of 972) lost to follow-up, and the seventh did not report loss to follow-up.23

Prevalence of Lung Cancer

Within the seven studies, prevalence of lung cancer at baseline screening ranged from 0.4% to 4.28%. The lowest prevalence (0.4%) was reported in the study23 with the lowest mean duration of exposure to asbestos (17.7 years) and a low percentage of current (17.8%) and former (47.2%) smokers. The highest prevalence (4.28%) was reported in a high-risk population combining heavy asbestos exposure (16-45 years) and smoking.18 Proportions of early onset (stage I) ranged from 20%22,23 to 100%.19 Follow-up of the diagnosis of lung cancer was heterogeneous across the seven studies; however, reports ranged from successful and complete removal of the lung cancer in all nine diagnosed cases19 to no survival in all five diagnosed cases22 (Table 1).

Meta-analysis

The meta-analysis (Fig 2) was conducted on the prevalence of lung cancer in asbestos-exposed workers following CT scan screening with data from the seven selected studies.1723 Meta-analysis from these seven studies showed the global prevalence of lung cancer detected by LDCT scanning in asbestos-exposed workers was 1.1% (95% CI, 0.6%-1.8%). Forty-nine lung cancers were detected in 5,074 asbestos-exposed workers (Table 1). As a marker of quality, the meta-analysis rated heterogeneity (I2) of the studies. The seven studies were heterogeneous, with an associated probability of P = .002 (I2 = 71.9).

Figure Jump LinkFigure 2. Lung cancer prevalence and CIs of the seven studies.Grahic Jump Location

Seven studies met our inclusion criteria for examining the detection of lung cancer in asbestos-exposed workers. The main finding was that lung cancer was detected by LDCT scan with a prevalence of 1.1% (95% CI, 0.6%-1.8%) in approximately 5,000 workers. The prevalence compared favorably with the reported prevalence of lung cancer in the largest available trial in heavy smokers (1%; 95% CI, 0.09%-1.1%).13 Thus, CT scan screening for lung cancer should be considered with equal importance for smokers and asbestos-exposed workers.

Heterogeneity of Lung Cancer Screening in Asbestos-Exposed Workers

Medical recommendations are unclear for the detection of lung cancer in asbestos-exposed populations, with minimal discussion of the possible use of LDCT scanning.25 In 2010, tomography was not used in the diverse forms of screening in Europe,25 with the exception of Italy, where, to our knowledge, radiography remains the first screening of asbestos-related pathologies.25 Therefore, it appears that some well-established recommendations would be pertinent.

Rate of Stage I Lung Cancer

Early detection (stage I) of lung cancer is commonly associated with curative surgery and reduced mortality, unlike more advanced stages. In the National Lung Screening Trial of heavy smokers,13 one-half of the lung cancers detected were stage I, which is similar to the results from our seven studies. The only study that evaluated the severity of lung cancer across three successive screenings also consistently reported 57% of stage I diagnoses.17 Even if low numbers of early-stage detections in asbestos-exposed workers were insufficient for meta-analysis from these seven studies, a similar impact of screening could be expected on reduced mortality.

Toxicity of Asbestos Fibers

Toxicity depends of the type of asbestos. Asbestos is the generic name for a group of polysilicate fibrous minerals. Serpentine and amphibole are the two families of asbestos fibers. From the serpentine family, chrysotile is the most frequently used asbestos fiber in industry.5 The amphibole family comprises actinolite, amosite, anthophyllite, crocidolite, and tremolite. Toxicity varies among fibers relative to the pathology being considered.4 However, all types of asbestos fibers are carcinogenic to humans (classified into group I by the International Agency for Research on Cancer).4

Quantifying Asbestos Exposure

Unlike the pack-year quantification of smoking, quantifying asbestos exposure seems to be more difficult, particularly retrospectively. However, in the absence of atmospheric reliable measures, assessment of the quantity of asbestos exposure was shown to be valid when based on information given by the workers regarding job history and knowledge provided by industrial hygiene experts.26 The exposure metrics involve probability, type, frequency, and intensity of exposure. These metrics have the advantage of being convenient and quick to provide feedback on occupational asbestos exposure.26 The seven studies used for the meta-analysis demonstrated wide variation in estimates of exposure assessment. However, it seems that former workers undoubtedly exposed to asbestos, irrespective of smoking status, should benefit from screening. Specific sectors requiring a medical follow-up should be asbestos production or manufacturing industries, asbestos containment and removal, and occupations in contact with products containing asbestos.

Smoking Status

Even if smoking status was heterogeneous in our seven studies, asbestos exposure unequivocally increases lung cancer risk in nonsmokers,27 up to fivefold.28 Moreover, the coexposure with smoking is a multiplicative risk for lung cancer.3 Thus, individuals combining both risks factors should particularly benefit from screening.

Screening Frequency

We have demonstrated that lung cancer screening in asbestos-exposed workers is efficacious in detecting asymptomatic lung cancer. Thus, questions surrounding the timing of CT scan screening should be addressed. In agreement with the National Lung Screening Trial,13 asbestos-exposed workers from the seven studies in our review experienced CT scan screening for the first time and shared a similar prevalence of lung cancer at baseline. The seven studies on asbestos-exposed workers did not report results from subsequent CT scan screening. However, CT scan screening failed to decrease lung cancer detection in 3 consecutive years of screening in heavy smokers.13 It is reasonable to suggest that a similar incidence could be identified in asbestos-exposed workers if annual screening was introduced. A large randomized controlled trial is urgently required to address the best frequency of screening, both in heavy smokers and asbestos-exposed workers.

Irradiation of Screening

Recommendations have been established to minimize radiation in CT scan screening for asbestos-exposed workers.29 Nevertheless, the use of CT scanning represents the major medical source of human-made irradiation,3032 and increased exposure to radiation underpins the consequences of cancer induction.33 Indeed, an upper limit of 5.5% increase in lung cancer risk is estimated from an annual CT scan screening,34 given that a standard chest CT scan without injection delivers 400 mGy/cm (5.8 mSv).31 The more recent use of LDCT scanning delivers around 150 mGy/cm (2.1 mSv).35 However, continued strategies to reduce radiation exposure include new ultra-low-dose algorithms.36,37 Even if the consequences of such radiations on health outcomes have not been studied, the reduced doses delivered may soon represent a less problematic concern for population-wide screening in asbestos-exposed workers.

Limitations

There are limitations to this study. The meta-analysis is based on limited studies, because most of the literature on asbestos was published prior to 1990, when CT scanning was not common. Heterogeneous inclusion criteria within our seven studies were encountered in terminology describing asbestos exposure (duration, quantity, absence of atmospheric measure at the time of exposure) and smoking status (percentage of smokers, pack-years). Without accurate measures of the intensity of exposures, the characteristics of asbestos-exposed workers who stand to benefit most from screening require further investigation. Although smoking is a confounder for asbestos exposure, it is problematic to recruit a sufficient population of nonsmoking asbestos-exposed workers. When screening was recommended in heavy smokers, the cost generated much controversy. However, with asbestos, the population is more targeted and smaller. Lung cancer in asbestos-exposed workers occurred at least 20 to 25 years following the initial exposure. Thus, such screening should not start prior to the prolonged latency period. Finally, this screening could be part of the reparation of their occupational exposure, in the framework of a recognized occupational disease.

CT scan screening in asbestos-exposed workers is effective in detecting asymptomatic lung cancer. Our meta-analysis showed that lung cancer was detected by low-dose CT scan with a prevalence of 1.1% (95% CI, 0.6%-1.8%) in approximately 5,000 workers, which is at least equal to the reported prevalence of lung cancer in the largest available trial in heavy smokers (1%; 95% CI, 0.09%-1.1%).13 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. However, more specific characteristics of asbestos-exposed workers who stand to benefit most from screening require further investigation.

Author contributions: Dr Dutheil had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Dr Ollier: contributed to conducting all literature searches, collated the abstracts, reviewed the abstracts and based on the selection criteria decided the suitability of the articles for inclusion, reviewed the eligible articles, drafted the manuscript, and read and approved the final manuscript.

Dr Chamoux: contributed to reviewing the articles when consensus on suitability was not met, reviewed the eligible articles, and read and approved the final manuscript.

Dr Naughton: reviewed the eligible articles, revised the manuscript, and read and approved the final manuscript.

Dr Pereira: performed the statistical analysis, reviewed the eligible articles, and read and approved the final manuscript.

Dr Dutheil: contributed to the conception and design, reviewed the abstracts and based on the selection criteria decided the suitability of the articles for inclusion, reviewed the eligible articles, revised the manuscript, and read and approved the final manuscript.

Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Stayner L, Welch LS, Lemen R. The worldwide pandemic of asbestos-related diseases. Annu Rev Public Health. 2013;34:205-216.
 
Hein MJ, Stayner LT, Lehman E, Dement JM. Follow-up study of chrysotile textile workers: cohort mortality and exposure-response. Occup Environ Med. 2007;64(9):616-625.
 
Villeneuve PJ, Parent ME, Harris SA, Johnson KC; Canadian Cancer Registries Epidemiology Research Group. Occupational exposure to asbestos and lung cancer in men: evidence from a population-based case-control study in eight Canadian provinces. BMC Cancer. 2012;12:595.
 
Hodgson JT, Darnton A. The quantitative risks of mesothelioma and lung cancer in relation to asbestos exposure. Ann Occup Hyg. 2000;44(8):565-601.
 
LaDou J, Castleman B, Frank A, et al. The case for a global ban on asbestos. Environ Health Perspect. 2010;118(7):897-901.
 
Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 2010;60(5):277-300.
 
Silvestri GA, Gould MK, Margolis ML, et al. Noninvasive staging of non-small cell lung cancer: ACCP evidenced-based clinical practice guidelines (2nd edition). Chest. 2007;132(3_suppl):178S-201S.
 
Hippisley-Cox J, Coupland C. Identifying patients with suspected lung cancer in primary care: derivation and validation of an algorithm. Br J Gen Pract. 2011;61(592):e715-e723.
 
Menezes RJ, Roberts HC, Paul NS, et al. Lung cancer screening using low-dose computed tomography in at-risk individuals: the Toronto experience. Lung Cancer. 2010;67(2):177-183.
 
Yau G, Lock M, Rodrigues G. Systematic review of baseline low-dose CT lung cancer screening. Lung Cancer. 2007;58(2):161-170.
 
Kramer BS, Berg CD, Aberle DR, Prorok PC. Lung cancer screening with low-dose helical CT: results from the National Lung Screening Trial (NLST). J Med Screen. 2011;18(3):109-111.
 
Pedersen JH, Ashraf H, Dirksen A, et al. The Danish randomized lung cancer CT screening trial—overall design and results of the prevalence round. J Thorac Oncol. 2009;4(5):608-614.
 
Aberle DR, Adams AM, Berg CD, et al; National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365(5):395-409.
 
Jacobson FL, Austin JH, Field JK, et al. Development of The American Association for Thoracic Surgery guidelines for low-dose computed tomography scans to screen for lung cancer in North America: recommendations of The American Association for Thoracic Surgery Task Force for Lung Cancer Screening and Surveillance. J Thorac Cardiovasc Surg. 2012;144(1):25-32.
 
da Costa BR, Cevallos M, Altman DG, Rutjes AW, Egger M. Uses and misuses of the STROBE statement: bibliographic study. BMJ Open. 2011;1(1):e000048.
 
Vandenbroucke JP, von Elm E, Altman DG, et al; STROBE initiative. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Ann Intern Med. 2007;147(8):W163-94.
 
Clin B, Morlais F, Guittet L, et al. Performance of chest radiograph and CT scan for lung cancer screening in asbestos-exposed workers. Occup Environ Med. 2009;66(8):529-534.
 
Das M, Mühlenbruch G, Mahnken AH, et al. Asbestos Surveillance Program Aachen (ASPA): initial results from baseline screening for lung cancer in asbestos-exposed high-risk individuals using low-dose multidetector-row CT. Eur Radiol. 2007;17(5):1193-1199.
 
Fasola G, Belvedere O, Aita M, et al. Low-dose computed tomography screening for lung cancer and pleural mesothelioma in an asbestos-exposed population: baseline results of a prospective, nonrandomized feasibility trial—an Alpe-adria Thoracic Oncology Multidisciplinary Group Study (ATOM 002). Oncologist. 2007;12(10):1215-1224.
 
Roberts HC, Patsios DA, Paul NS, et al. Screening for malignant pleural mesothelioma and lung cancer in individuals with a history of asbestos exposure. J Thorac Oncol. 2009;4(5):620-628.
 
Vierikko T, Järvenpää R, Autti T, et al. Chest CT screening of asbestos-exposed workers: lung lesions and incidental findings. Eur Respir J. 2007;29(1):78-84.
 
Tiitola M, Kivisaari L, Huuskonen MS, et al. Computed tomography screening for lung cancer in asbestos-exposed workers. Lung Cancer. 2002;35(1):17-22.
 
Mastrangelo G, Ballarin MN, Bellini E, et al. Feasibility of a screening programme for lung cancer in former asbestos workers. Occup Med (Lond). 2008;58(3):175-180.
 
Koskinen K, Pukkala E, Martikainen R, Reijula K, Karjalainen A. Different measures of asbestos exposure in estimating risk of lung cancer and mesothelioma among construction workers. J Occup Environ Med. 2002;44(12):1190-1196.
 
Massardier-Pilonchery A, Bergeret A. Follow-up after occupational asbestos exposure: terms and devices in foreign [in French]. Rev Mal Respir. 2011;28(4):556-564.
 
Gramond C, Rolland P, Lacourt A, et al; PNSM Study Group. Choice of rating method for assessing occupational asbestos exposure: study for compensation purposes in France. Am J Ind Med. 2012;55(5):440-449.
 
Lee PN. Relation between exposure to asbestos and smoking jointly and the risk of lung cancer. Occup Environ Med. 2001;58(3):145-153.
 
Hammond EC, Selikoff IJ, Seidman H. Asbestos exposure, cigarette smoking and death rates. Ann N Y Acad Sci. 1979;330:473-490.
 
Beigelman-Aubry C, Ferretti G, Mompoint D, et al. Computed tomographic atlas of benign asbestos related pathology [in French]. J Radiol. 2007;88(6):845-862.
 
Mettler FA Jr, Thomadsen BR, Bhargavan M, et al. Medical radiation exposure in the US in 2006: preliminary results. Health Phys. 2008;95(5):502-507.
 
Shrimpton PC, Hillier MC, Lewis MA, Dunn M. National survey of doses from CT in the UK: 2003 [published correction appears inBr J Radiol. 2007;80(956):685]. Br J Radiol. 2006;79(948):968-980.
 
Samara ET, Aroua A, Bochud FO, et al. Exposure of the Swiss population by medical x-rays: 2008 review. Health Phys. 2012;102(3):263-270.
 
Brenner DJ, Hall EJ. Computed tomography—an increasing source of radiation exposure. N Engl J Med. 2007;357(22):2277-2284.
 
Brenner DJ. Radiation risks potentially associated with low-dose CT screening of adult smokers for lung cancer. Radiology. 2004;231(2):440-445.
 
Remy-Jardin M, Sobaszek A, Duhamel A, Mastora I, Zanetti C, Remy J. Asbestos-related pleuropulmonary diseases: evaluation with low-dose four-detector row spiral CT. Radiology. 2004;233(1):182-190.
 
Silva AC, Lawder HJ, Hara A, Kujak J, Pavlicek W. Innovations in CT dose reduction strategy: application of the adaptive statistical iterative reconstruction algorithm. AJR Am J Roentgenol. 2010;194(1):191-199.
 
Singh S, Kalra MK, Gilman MD, et al. Adaptive statistical iterative reconstruction technique for radiation dose reduction in chest CT: a pilot study. Radiology. 2011;259(2):565-573.
 

Figures

Figure Jump LinkFigure 2. Lung cancer prevalence and CIs of the seven studies.Grahic Jump Location

Tables

Table Graphic Jump Location
Table 1 —Characteristics of the 5,074 Asbestos-Exposed Workers From the Seven Included Studies and Baseline Results From LDCT Scan Screening for Lung Cancer

LDCT = low-dose spiral CT; n/a = not available.

a 

Current + former smokers = 68.

b 

n/a at baseline: 57% of stage I on the three consecutive screenings.

c 

Former or current smokers (not specified).

References

Stayner L, Welch LS, Lemen R. The worldwide pandemic of asbestos-related diseases. Annu Rev Public Health. 2013;34:205-216.
 
Hein MJ, Stayner LT, Lehman E, Dement JM. Follow-up study of chrysotile textile workers: cohort mortality and exposure-response. Occup Environ Med. 2007;64(9):616-625.
 
Villeneuve PJ, Parent ME, Harris SA, Johnson KC; Canadian Cancer Registries Epidemiology Research Group. Occupational exposure to asbestos and lung cancer in men: evidence from a population-based case-control study in eight Canadian provinces. BMC Cancer. 2012;12:595.
 
Hodgson JT, Darnton A. The quantitative risks of mesothelioma and lung cancer in relation to asbestos exposure. Ann Occup Hyg. 2000;44(8):565-601.
 
LaDou J, Castleman B, Frank A, et al. The case for a global ban on asbestos. Environ Health Perspect. 2010;118(7):897-901.
 
Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 2010;60(5):277-300.
 
Silvestri GA, Gould MK, Margolis ML, et al. Noninvasive staging of non-small cell lung cancer: ACCP evidenced-based clinical practice guidelines (2nd edition). Chest. 2007;132(3_suppl):178S-201S.
 
Hippisley-Cox J, Coupland C. Identifying patients with suspected lung cancer in primary care: derivation and validation of an algorithm. Br J Gen Pract. 2011;61(592):e715-e723.
 
Menezes RJ, Roberts HC, Paul NS, et al. Lung cancer screening using low-dose computed tomography in at-risk individuals: the Toronto experience. Lung Cancer. 2010;67(2):177-183.
 
Yau G, Lock M, Rodrigues G. Systematic review of baseline low-dose CT lung cancer screening. Lung Cancer. 2007;58(2):161-170.
 
Kramer BS, Berg CD, Aberle DR, Prorok PC. Lung cancer screening with low-dose helical CT: results from the National Lung Screening Trial (NLST). J Med Screen. 2011;18(3):109-111.
 
Pedersen JH, Ashraf H, Dirksen A, et al. The Danish randomized lung cancer CT screening trial—overall design and results of the prevalence round. J Thorac Oncol. 2009;4(5):608-614.
 
Aberle DR, Adams AM, Berg CD, et al; National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365(5):395-409.
 
Jacobson FL, Austin JH, Field JK, et al. Development of The American Association for Thoracic Surgery guidelines for low-dose computed tomography scans to screen for lung cancer in North America: recommendations of The American Association for Thoracic Surgery Task Force for Lung Cancer Screening and Surveillance. J Thorac Cardiovasc Surg. 2012;144(1):25-32.
 
da Costa BR, Cevallos M, Altman DG, Rutjes AW, Egger M. Uses and misuses of the STROBE statement: bibliographic study. BMJ Open. 2011;1(1):e000048.
 
Vandenbroucke JP, von Elm E, Altman DG, et al; STROBE initiative. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Ann Intern Med. 2007;147(8):W163-94.
 
Clin B, Morlais F, Guittet L, et al. Performance of chest radiograph and CT scan for lung cancer screening in asbestos-exposed workers. Occup Environ Med. 2009;66(8):529-534.
 
Das M, Mühlenbruch G, Mahnken AH, et al. Asbestos Surveillance Program Aachen (ASPA): initial results from baseline screening for lung cancer in asbestos-exposed high-risk individuals using low-dose multidetector-row CT. Eur Radiol. 2007;17(5):1193-1199.
 
Fasola G, Belvedere O, Aita M, et al. Low-dose computed tomography screening for lung cancer and pleural mesothelioma in an asbestos-exposed population: baseline results of a prospective, nonrandomized feasibility trial—an Alpe-adria Thoracic Oncology Multidisciplinary Group Study (ATOM 002). Oncologist. 2007;12(10):1215-1224.
 
Roberts HC, Patsios DA, Paul NS, et al. Screening for malignant pleural mesothelioma and lung cancer in individuals with a history of asbestos exposure. J Thorac Oncol. 2009;4(5):620-628.
 
Vierikko T, Järvenpää R, Autti T, et al. Chest CT screening of asbestos-exposed workers: lung lesions and incidental findings. Eur Respir J. 2007;29(1):78-84.
 
Tiitola M, Kivisaari L, Huuskonen MS, et al. Computed tomography screening for lung cancer in asbestos-exposed workers. Lung Cancer. 2002;35(1):17-22.
 
Mastrangelo G, Ballarin MN, Bellini E, et al. Feasibility of a screening programme for lung cancer in former asbestos workers. Occup Med (Lond). 2008;58(3):175-180.
 
Koskinen K, Pukkala E, Martikainen R, Reijula K, Karjalainen A. Different measures of asbestos exposure in estimating risk of lung cancer and mesothelioma among construction workers. J Occup Environ Med. 2002;44(12):1190-1196.
 
Massardier-Pilonchery A, Bergeret A. Follow-up after occupational asbestos exposure: terms and devices in foreign [in French]. Rev Mal Respir. 2011;28(4):556-564.
 
Gramond C, Rolland P, Lacourt A, et al; PNSM Study Group. Choice of rating method for assessing occupational asbestos exposure: study for compensation purposes in France. Am J Ind Med. 2012;55(5):440-449.
 
Lee PN. Relation between exposure to asbestos and smoking jointly and the risk of lung cancer. Occup Environ Med. 2001;58(3):145-153.
 
Hammond EC, Selikoff IJ, Seidman H. Asbestos exposure, cigarette smoking and death rates. Ann N Y Acad Sci. 1979;330:473-490.
 
Beigelman-Aubry C, Ferretti G, Mompoint D, et al. Computed tomographic atlas of benign asbestos related pathology [in French]. J Radiol. 2007;88(6):845-862.
 
Mettler FA Jr, Thomadsen BR, Bhargavan M, et al. Medical radiation exposure in the US in 2006: preliminary results. Health Phys. 2008;95(5):502-507.
 
Shrimpton PC, Hillier MC, Lewis MA, Dunn M. National survey of doses from CT in the UK: 2003 [published correction appears inBr J Radiol. 2007;80(956):685]. Br J Radiol. 2006;79(948):968-980.
 
Samara ET, Aroua A, Bochud FO, et al. Exposure of the Swiss population by medical x-rays: 2008 review. Health Phys. 2012;102(3):263-270.
 
Brenner DJ, Hall EJ. Computed tomography—an increasing source of radiation exposure. N Engl J Med. 2007;357(22):2277-2284.
 
Brenner DJ. Radiation risks potentially associated with low-dose CT screening of adult smokers for lung cancer. Radiology. 2004;231(2):440-445.
 
Remy-Jardin M, Sobaszek A, Duhamel A, Mastora I, Zanetti C, Remy J. Asbestos-related pleuropulmonary diseases: evaluation with low-dose four-detector row spiral CT. Radiology. 2004;233(1):182-190.
 
Silva AC, Lawder HJ, Hara A, Kujak J, Pavlicek W. Innovations in CT dose reduction strategy: application of the adaptive statistical iterative reconstruction algorithm. AJR Am J Roentgenol. 2010;194(1):191-199.
 
Singh S, Kalra MK, Gilman MD, et al. Adaptive statistical iterative reconstruction technique for radiation dose reduction in chest CT: a pilot study. Radiology. 2011;259(2):565-573.
 
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