Lung cancer mortality among construction workers: implications for early detection.

Area of Science:

• Occupational health
• Pulmonology
• Cancer screening

Background:

• Lung cancer mortality remains a significant concern, particularly among specific worker populations.
• Current lung cancer screening guidelines may not adequately identify all high-risk individuals.

Purpose of the Study:

• To identify predictors of lung cancer mortality beyond age and smoking in US Department of Energy (DOE) construction workers.
• To refine eligibility criteria for low-dose CT (LDCT) lung cancer screening in this cohort.

Main Methods:

• Analysis of data from 17,069 workers with 352 lung cancer deaths.
• Utilized competing risk Cox models to determine hazard ratios and predict 5-year risks.
• Included factors such as smoking, occupational history, BMI, respiratory symptoms, and medical history.

Main Results:

• Factors beyond age and smoking, including chest X-ray changes, abnormal lung function, COPD, respiratory symptoms, BMI, personal cancer history, and years at DOE/construction sites, were significant predictors.
• Risk-based LDCT eligibility criteria demonstrated improved sensitivity, specificity, and positive predictive value compared to current guidelines.
• Work history at DOE sites or in construction for 5+ years showed a risk comparable to personal/family cancer history or COPD diagnosis.

Conclusions:

• Occupational exposures and non-malignant respiratory findings should be considered in LDCT clinical guidelines.
• Revised screening criteria for DOE construction workers identified 86% of lung cancer deaths, compared to 51% with age and smoking alone.