Lung screening targets asbestos workers

Low-dose CT lung cancer screening for high-risk smoking populations may be controversial, but adding asbestos to the mix could tip the scales in favor of annual imaging.

Researchers in Italy and Germany have begun testing screening in patients at risk for lung cancer or malignant pleural mesothelioma following years of asbestos exposure and smoking. After decades of both, a retired worker could have a risk for cancer as great as 87 times that of a person with no exposure to either, according to Dr. Marco Das from Aachen, Germany.

Italian imagers have so far evaluated 943 former asbestos workers with an average 30 years of exposure. Low-dose CT was far more effective at finding nodules than radiography: 778 nodules compared with 459. Among the 943 patients, 46% had some sort of positive finding that was followed up with another CT; 15 patients went on to invasive diagnostic procedures.

In a German study of 100 former power plant workers, almost all of whom were current or former smokers, low-dose 16-row CT found 104 nodules, four cancers, and 48 patients with asbestos-related plaques or fibrosis.

The relatively high number of cancers discovered on the initial screening is mixed news for the researchers: Three of the patients were untreatable, leading one audience member to question whether the screening was worthwhile. With cancer and mesothelioma rates expected to rise over the next 20 years, the screening may eventually pay off in the form of early detection for suspicious nodules, Das said Saturday at the ECR.