Screening for Lung Cancer in Asbestos Workers

The united states preventive services Task Force (USPSTF) has endorsed screening for lung cancer in selected smokers by means of a series of three low-dose CT scans. This Level B endorsement has met with some resistance. The Medicare Advisory Panel has reviewed the evidence (2014), including a 20% reduction in lung cancer mortality and a 7% reduction in total mortality seen in the National Lung Screening Trial (n = 53,454), and has not advocated paying for screening. A similar position has been taken by the American Academy of Family Physicians, whose position statement expresses doubt about the achievable benefits in typical clinical settings.

Asbestos workers, even when non-smokers, are recognized to be at increased risk of lung cancer. Ollier et al reviewed data from seven clinical trials in which chest CT scans were used to screen former asbestos workers (n = 5074). Within this population, 49 cases of asymptomatic lung cancer were found, of which about one-third were stage 1, indicative of high potential for cure.

The prevalence of lung cancer detected among asbestos workers (1.1%) was quite similar to that found in the National Lung Screening Trial (1.0%). This would lead to the conclusion that specifically screening asbestos workers might be at least as beneficial as screening the recommended population of smokers suggested by the USPSTF guidance.