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Lung Cancer

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)

Departments of ^aMedical Oncology and ^bRadiology and ^cInstitute of Hygiene and Epidemiology, University Hospital of Udine, Udine, Italy; ^dUnit of Occupational Health and Departments of ^eRadiology, ^fOncology, and ^gSurgery, San Polo Hospital, Monfalcone, Italy; ^hMedical Oncology A, Disease Management Team - Lung Cancer, National Institute for Cancer Research, Genoa, Italy

Key Words. Occupational exposure • Asbestos • Screening • Spiral computed tomography • Lung cancer Malignant pleural mesothelioma

Correspondence: Gianpiero Fasola, M.D., Department of Medical Oncology, University Hospital of Udine, P.le S. M. Misericordia 15, 33100 Udine, Italy. Telephone: 39-0432-552-750; Fax: 39-0432-552-751; e-mail: fasola.gianpiero{at}aoud.sanita.fvg.it

Disclosure: P.C. received an honorarium for his contribution to the study. No other potential conflicts of interest were reported by the authors, planners, reviewers, or staff managers of this article.

Objective. To evaluate the feasibility of using low-dose computed tomography (LDCT) for the early diagnosis of lung cancer and malignant pleural mesothelioma in an asbestos-exposed population.

Methods. Between February 2002 and October 2003, 1,045 volunteers already enrolled in a surveillance program for asbestos-exposed workers and former workers were recruited. The main eligibility criteria were: written informed consent, definite exposure to asbestos, age 40–75, no prior cancer or severe concomitant conditions, no chest CT scan in the past 2 years. A smoking history was not required. After a structured interview, chest X-ray (CXR) and LDCT were performed. Participants with negative examinations were assigned to annual LDCT. Participants with positive findings received high-resolution CT and additional diagnostic workup as appropriate.

Results. Baseline characteristics of the screened population were: median asbestos exposure time, 30 years; median age, 58; median pack-years in smokers/former smokers, 18.5. Thirty-four percent had never smoked. On LDCT, 834 noncalcified nodules were identified in 44% of participants, versus 43 nodules in 4% on CXR. Pleural abnormalities were observed in 44% and 70% of participants by CXR and LDCT, respectively. Overall, LDCT identified nine cases of non-small cell lung cancer—eight stage I, one stage IIA—and one thymic carcinoid, corresponding to 1% of the enrolled population. All cases were radically treated. None had been detected by CXR. No pleural mesothelioma was diagnosed. There were 11 false-positive results.

Conclusions. Our findings first suggest that LDCT may be at least as useful in asbestos workers as in heavy smokers for the early diagnosis of lung cancer; this benefit is evident even in a poor-risk population, with low rates of smoking prevalence and a previous history of radiological surveillance.

The role of spiral tomography in screening for pleural mesothelioma remains uncertain.

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