Identifying occupationally exposed populations for lung cancer screening: it is about time

Abstract

Lung cancer is responsible for nearly one in five of all cancer deaths in the world and is the leading occupationally\xa0related cancer type.1 Tobacco smoke exposure contributes the most significant risk although in developed countries, occupational exposures are estimated to contribute to 10%–30% of all lung cancers.1 The International Agency for Research on Cancer recognises at least 13 occupational exposures that are associated with a raised risk of lung cancer and at least 6 of these (asbestos, arsenic, radon, polyaromatic hydrocarbons, silica and nickel) may have a more than additive (ie, synergistic) risk when combined with tobacco smoke exposure.1 \n\nThe National Lung Screen Trial (NLST) demonstrated a 20.0% mortality reduction for lung cancer deaths with three screening rounds using low-dose CT (LDCT) of the chest.2 However, LDCT screening for lung cancer is only effective when a high-risk population is screened. The number of lung cancer deaths prevented by LDCT is strongly related to the underlying risk of lung cancer in the population. The NLST used criteria of aged 55–74 years, at least 30 pack-year history and <15 years since quitting to identify the population at risk. The result from NLST is more remarkable considering that the lowest quintile of risk had just 1 lung cancer death prevented, compared …