Secondary prevention of asbestos-related mesothelia and lung cancers in special regards of morphology and kinetics of parenchymal and pleural findings

Status:

completed 11/2005

Aims:

Modern equipment for cancer early diagnosis shall help to meet further increase of number of asbestos-related cancers.

Activities/Methods:

Medical inspection of workers with known exposition to crocydolite especially with X-ray high resolution computer tomography and analysis of morphology and kinetics of asbestos related plaques.

Results:

The aim of this study was to improve secundary preventive measures for asbestos induced mesothelioma and lung cancer cases with regard to morphology and kinetics of parenchymal and pleural findings. 1146 workers, who gave their informed consent, were divided into 3 risk groups according to their time since first exposure (latency). In cases of a latency of more than 30 years, they were examined every two years including low-dose spiral computed tomography (LDSCT). LDSCT slices and the follow-up of pulmonary nodules (PN) was performed according to a standardised protocol. In cases with PN volumetric analysis was done. Chest X-rays as well as LDSCT slices were examined by two independent readers. The detection rate for lung cancer of 0.3% in the prevalent screen and 0.5% in the incident screen was relatively low compared to the literature. This might be due to the applied risk model which focused only on latency. Cumulative detection rate in the whole cohort was 0.5% (6 cases out of 1148). Despite of an intensive care and frequent interventions from the investigators, it was difficult to apply systematically new therapy concepts in mesothelioma cases. This emphasizes the need for specialized centres for diagnosis and therapy of this disease.
Future strategies for the surveillance of asbestos-exposed cohorts should be based on risk models for lung cancer. Age, exposure duration and smoking habits seem to be important factors. In high risk groups LDSCT should be performed annually. With regard to risk groups and surveillance strategies for mesothelioma further study results will be expected soon checking the value of molecular markers.

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