Lung cancer screening in patients with Libby amphibole disease: High yield despite predominantly environmental and household exposure.
Lung cancer screening in patients with Libby amphibole disease: High yield despite predominantly environmental and household exposure.
复制标题
利比角闪石病患者的肺癌筛查：尽管主要是环境和家庭暴露，但筛查结果仍较高。
DOI：
10.1002/ajim.23042
复制
发表时间：
2019
影响因子：
3.5
通讯作者：
Miller,Albert
中科院分区：
文献类型：
--
作者：
Loewen,Gregory;Black,Brad;McNew,Tracy;Miller,Albert
低剂量计算机断层扫描（CT）扫描（LDCT）是一种公认的肺癌筛查工具，但其在暴露于公认的职业或环境致癌物的人群中的应用是有限的。我们将LDCT应用于非职业性暴露于公认的人类肺癌致癌物利比角孔石棉（LA）的人群。方法在蒙大拿州Libby的一家石棉疾病诊所，年龄在50岁至84岁之间，吸烟史大于或等于20包年（不考虑戒烟日期），并在高分辨率CT扫描上显示石棉相关胸膜肺疾病的患者，每年免费进行肺癌筛查，为期39个月。结果2897例临床患者中，1149例（39.7%）符合入选标准，567例（49%）接受了1014次低剂量CT扫描。大多数筛查的患者主要是环境暴露（333例或59%）或家庭暴露（145例或25%）。17例原发性肺癌被确定，大多数在早期阶段：10例为1期，2例为2期，3至4期3例，2例为有限的小细胞癌。基线扫描的筛查率为1.9，第一次年度扫描的筛查率为1.5%。结论与美国国家综合癌症网络和美国胸外科协会的指导方针一致，对于职业性或环境性人类肺癌致癌物暴露显著的人群，应提供LDCT早期肺癌检测。
BackgroundLung cancer screening with low‐dose computed tomography (CT) scanning (LDCT) is accepted as a screening tool, but its application to populations exposed to recognized occupational or environmental carcinogens is limited. We apply LDCT to a population with a predominantly nonoccupational exposure to a recognized human lung carcinogen, Libby amphibole asbestos (LA).MethodsPatients in an asbestos disease clinic in Libby, Montana who were aged 50 to 84 years, greater than or equal to 20 pack‐year history of tobacco use (irrespective of quit date), and asbestos‐related pleuropulmonary disease on high‐resolution CT scan were offered free annual lung cancer screening over a 39‐month period.ResultsOf 2897 clinic patients, 1149 (39.7%) met eligibility criteria, and 567 (49%) were screened with 1014 low‐dose CT scans. Most screened patients had principally environmental (333 or 59%) or household exposure (145 or 25%) to LA. Seventeen primary lung cancers were identified, mostly in early stages: 10 at stage 1, two at stage 2, three at stages 3 to 4, and two at limited small‐cell cancers. The screening yield was 1.9 at baseline scan and 1.5% on the first annual scan.ConclusionsConsistent with the guidelines of the National Comprehensive Cancer Network and American Association of Thoracic Surgery, LDCT for early lung cancer detection should be offered to people with significant exposure to occupational or environmental human lung carcinogens.