Lung cancer mortality among construction workers: implications for early detection

• Published in: Occupational and environmental medicine (London, England) England), 2020-04, Vol.77 (4), p.207-213
• Main Authors: Dement, John M, Ringen, Knut, Hines, Stella, Cranford, Kim, Quinn, Patricia
• Format: Article
• Language: English
• Subjects: Age; Asbestos; Beryllium; Body mass index; Body size; Chest; Chronic obstructive pulmonary disease; Cigarette smoking; Construction; Construction industry; Ethnicity; Federal agencies; Gender; Genetics; Guidelines; Health risk assessment; Lung cancer; Lung diseases; Medical screening; Mortality; Obstructive lung disease; Occupational exposure; Occupational health; Prediction models; Public, Environmental & Occupational Health; Respiratory function; Risk analysis; Risk factors; Signs and symptoms; Smoking; Workers; X-rays
• ISSN: 1351-0711; 1470-7926
• DOI: 10.1136/oemed-2019-106196

ObjectivesThis study examined predictors of lung cancer mortality, beyond age and smoking, among construction workers employed at US Department of Energy (DOE) sites to better define eligibility for low-dose CT (LDCT) lung cancer screening.MethodsPredictive models were based on 17 069 workers and 352 lung cancer deaths. Risk factors included age, gender, race/ethnicity, cigarette smoking, years of trade or DOE work, body mass index (BMI), chest X-ray results, spirometry results, respiratory symptoms, beryllium sensitisation and personal history of cancer. Competing risk Cox models were used to obtain HRs and to predict 5-year risks.ResultsFactors beyond age and smoking included in the final predictive model were chest X-ray changes, abnormal lung function, chronic obstructive pulmonary disease (COPD), respiratory symptoms, BMI, personal history of cancer and having worked 5 or more years at a DOE site or in construction. Risk-based LDCT eligibility demonstrated improved sensitivity, specificity and positive predictive value compared with current US Preventive Services Task Force guidelines. The risk of lung cancer death from 5 years of work in the construction industry or at a DOE site was comparable with the risk from a personal cancer history, a family history of cancer or a diagnosis of COPD. LDCT eligibility criteria used for DOE construction workers, which includes factors beyond age and smoking, identified 86% of participants who eventually would die from lung cancer compared with 51% based on age and smoking alone.ConclusionsResults support inclusion of risk from occupational exposures and non-malignant respiratory clinical findings in LDCT clinical guidelines.