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Markowitz S, Ringen K, Dement JM, Straif K, Christine Oliver L, Algranti E, Nowak D, Ehrlich R, McDiarmid MA, Miller A. Occupational lung cancer screening: A Collegium Ramazzini statement. Am J Ind Med 2024; 67:289-303. [PMID: 38440821 DOI: 10.1002/ajim.23572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 02/01/2024] [Indexed: 03/06/2024]
Affiliation(s)
- Steven Markowitz
- Barry Commoner Center for Health & the Environment, Queens College, City University of New York, New York, New York State, USA
| | - Knut Ringen
- CPWR-The Center for Construction Research and Training, Silver Spring, Maryland, USA
| | - John M Dement
- Duke University School of Medicine, Division of Occupational & Environmental Medicine, Durham, North Carolina, USA
| | - Kurt Straif
- ISGlobal, Barcelona, Spain
- Boston College, Chestnut Hill, Massachusetts, USA
| | - L Christine Oliver
- Dalla Lana School of Public Health, Division of Occupational and Environmental Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU Klinikum, LMU Munich, CPC Munich, Comprehensive Pneumology Center Munich, #DZL, Deutsches Zentrum für Lungenforschung, Munich, Germany
| | - Rodney Ehrlich
- Division of occupational Medicine, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Melissa A McDiarmid
- Division of Occupational & Environmental Medicine, University of Maryland School of Medicine, USA
| | - Albert Miller
- Barry Commoner Center for Health & the Environment, Queens College, City University of New York, New York, New York State, USA
- Department of Medicine, Mount Sinai School of Medicine, New York, New York State, USA
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Tuomi T, Lyyränen J. Measuring Respirable Crystalline Silica (Quartz) from Powdery Materials through Sedimentation and X-ray Diffractometry. TOXICS 2024; 12:241. [PMID: 38668464 PMCID: PMC11054955 DOI: 10.3390/toxics12040241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/12/2024] [Accepted: 03/21/2024] [Indexed: 04/29/2024]
Abstract
When possible, choosing materials with a low quartz content is the most effective and cost-efficient way to prevent the respirable quartz exposure of workers and other end users of powdery products. Therefore, methods are needed to analyze low amounts of quartz from powdery products, such as sand, gravel, plaster, cement, and concrete. To this end, we present a method to analyze respirable dust and quartz from powdered materials, such as construction products. The method includes separation of the respirable dust fraction by liquid sedimentation, followed by gravimetric analysis and determination of the crystalline silica content by X-ray diffractometry. While also aiding in the development of less harmful products, analysis of the quartz concentration of powdery products is statutory in Eu countries, excluding natural products not chemically modified. According to EU Regulation No. 1272/2008, products must be classified if they contain harmful substances in concentrations above 0.1 wt.%, and clauses pertaining to cancerous properties and harmfulness to lungs should be included. Also, mineral producers in the EU recommend that products containing respirable quartz should be labelled based on their quartz concentration, provided the concentration exceeds 1 wt.%. The present method meets these needs. The analysis can be performed in parallel from 50 to 1000 mg (dry weight) of powdery materials. The quantitative limit of determination was 10 µg per sample, corresponding to 0.01 wt.%, and the linear range 0.02-10 wt.% (10-5000 µg quartz per sample, Pearson correlation coefficient 0.99). The accuracy of the method was 82% and the repeatability 11%.
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Affiliation(s)
- Tapani Tuomi
- Finnish Institute of Occupational Health, Topeliuksenkatu 41 B, Työterveyslaitos, FI-00032 Helsinki, Finland;
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Ringen K, Dement J, Cloeren M, Almashat S, Hines S, Grier W, Quinn P, Chen A, Haas S. Mortality of older construction and craft workers employed at Department of Energy (DOE) nuclear sites: Follow-up through 2021. Am J Ind Med 2024; 67:261-273. [PMID: 38273456 DOI: 10.1002/ajim.23567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/07/2023] [Accepted: 01/11/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND To determine if construction and trades workers formerly employed at US Department of Energy (DOE) nuclear weapons sites are at significant risk for occupational diseases, we studied the mortality experience of participants in the Building Trades National Medical Screening Program (BTMed). METHODS The cohort included 26,922 participants enrolled between 1998 and 2021 and 8367 deaths. Standardized mortality ratios were calculated based on US death rates. Cox models compared construction workers (n = 22,747; 7487 deaths) to two nonconstruction subpopulations: administrative, scientific and security workers (n = 1894; 330 deaths), and all other nonconstruction workers (n = 2218; 550 deaths). RESULTS Mortality was elevated for all causes, all cancers, cancers of the trachea, bronchus, lung, kidneys, and lymphatic and hematopoietic system, mesothelioma, chronic obstructive pulmonary disease (COPD), asbestosis, transportation injuries, and other injuries, particularly accidental poisonings. There were 167 deaths from coronavirus disease 2019 (COVID-19), which was lower than expected using US death rates. Overall cause-specific mortality was significantly higher among construction workers than for internal comparison groups. CONCLUSIONS Construction workers employed at DOE sites have a significantly increased risk for occupational illnesses. Apart from COVID-19 deaths, this update: (1) found that mortality among construction workers is significantly elevated compared to the US population and significantly higher than in the internal comparison populations, and (2) confirmed excess risk for these workers for first employment after 1990. Cancer mortality risks are similar to the cancers identified for DOE compensation from radiation exposures. The high lung cancer risk supports the value of early lung cancer detection. Continued medical surveillance is important.
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Affiliation(s)
- Knut Ringen
- CPWR - The Center for Construction Research and Training, Seattle, Washington, USA
| | - John Dement
- Division of Occupational and Environmental Medicine, Duke University Medical Center, Durham, North Carolina
| | - Marianne Cloeren
- Division of Occupational and Environmental Medicine, School of Medicine, University of Maryland, College Park, Maryland, USA
| | - Sammy Almashat
- Division of Occupational and Environmental Medicine, School of Medicine, University of Maryland, College Park, Maryland, USA
| | - Stella Hines
- Division of Occupational and Environmental Medicine, School of Medicine, University of Maryland, College Park, Maryland, USA
| | - William Grier
- Division of Pulmonary and Critical Care Medicine, School of Medicine, University of Maryland, College Park, Maryland, USA
| | - Patricia Quinn
- CPWR - The Center for Construction Research and Training, Seattle, Washington, USA
| | - Anna Chen
- Zenith American Solutions, Tampa, Florida, USA
| | - Scott Haas
- Zenith American Solutions, Tampa, Florida, USA
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Lee PN, Coombs KJ, Hamling JS. Evidence relating cigarette, cigar and pipe smoking to lung cancer and chronic obstructive pulmonary disease: Meta-analysis of recent data from three regions. World J Meta-Anal 2023; 11:228-252. [DOI: 10.13105/wjma.v11.i5.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/10/2023] [Accepted: 05/30/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND There is a need to have up-to-date information for various diseases on the risk related to the use of different smoked products and the use of other nicotine-containing products. Here, we contribute to the information pool by presenting up-to-date quantitative evidence for North America, Europe and Japan and for both lung cancer and chronic obstructive pulmonary disease (COPD) on the relative risk (RR) relating to current vs never product use for each of the three smoked tobacco products, cigarettes, cigars and pipes.
AIM To estimate lung cancer and COPD current smoking RRs for the three products using recent data for the three regions.
METHODS Publications in English from 2010 to 2020 were considered that, based on epidemiological studies in the three regions, estimated the current smoking RR of lung cancer and/or COPD for one or more of the three products. The studies should involve at least 100 cases of the disease considered, not be restricted to specific lung cancer types or populations with specific medical conditions, and should be of cohort or nested case-control study design or randomized controlled trials. Literature searches were conducted on MEDLINE separately for lung cancer and for COPD, examining titles and abstracts initially, and then full texts. Additional papers were sought from reference lists of selected papers, reviews and meta-analyses. For each study identified, the most recent available data on each product were entered on current smoking, as well as on characteristics of the study and the RR estimates. Combined RR estimates were derived using random-effects meta-analysis. For cigarette smoking, where far more data were available, heterogeneity was studied by a wide range of factors. For cigar and pipe smoking, a more limited heterogeneity analysis was carried out. Results were compared with those from previous meta-analyses published since 2000.
RESULTS Current cigarette smoking: For lung cancer, 44 studies (26 North American, 14 European, three Japanese, and one in multiple continents), gave an overall estimate of 12.14 [95% confidence interval (CI) 10.30-14.30]. The estimates were higher (heterogeneity P < 0.001) for North American (15.15, CI 12.77-17.96) and European studies (12.30, CI 9.77-15.49) than for Japanese studies (3.61, CI 2.87-4.55), consistent with previous evidence of lower RRs for Asia. RRs were higher (P < 0.05) for death (14.85, CI 11.99-18.38) than diagnosis (10.82, CI 8.61-13.60). There was some variation (P < 0.05) by study population, with higher RRs for international and regional studies than for national studies and studies of specific populations. RRs were higher in males, as previously reported, the within-study male/female ratio of RRs being 1.52 (CI 1.20-1.92). RRs did not vary significantly (P ≥ 0.05) by other factors. For COPD, RR estimates were provided by 18 studies (10 North American, seven European, and one Japanese). The overall estimate of 9.19 (CI 6.97-12.13), was based on heterogeneous data (P < 0.001), and higher than reported earlier. There was no (P > 0.1) variation by sex, region or exclusive use, but limited evidence (0.05 < P < 0.1) that RR estimates were greater where cases occurring shortly after baseline were ignored; where bronchiectasis was excluded from the COPD definition; and with greater confounder adjustment. Within-study comparisons showed adjusted RRs exceeded unadjusted RRs. Current cigar smoking: Three studies gave an overall lung cancer RR of 2.73 (CI 2.36-3.15), with no heterogeneity, lower than the 4.67 (CI 3.49-6.25) reported in an earlier review. Only one study gave COPD results, the RR (2.44, CI 0.98-6.05) being imprecise. Current pipe smoking: Four studies gave an overall lung cancer RR of 4.93 (CI 1.97-12.32), close to the 5.20 (CI 3.50-7.73) given earlier. However, the estimates were heterogeneous, with two above 10, and two below 3. Only one study gave COPD results, the RR (1.12, CI 0.29-4.40), being imprecise. For both diseases, the lower RR estimates for cigars and for pipes than for current smoking of cigarettes aligns with earlier published evidence.
CONCLUSION Current cigarette smoking substantially increases lung cancer and COPD risk, more so in North America and Europe than Japan. Limited evidence confirms lower risks for cigars and pipes than cigarettes.
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Affiliation(s)
- Peter Nicholas Lee
- Medical Statistics and Epidemiology, P.N.Lee Statistics and Computing Ltd., Sutton SM2 5DA, Surrey, United Kingdom
| | - Katharine J Coombs
- Statistics, P.N.Lee Statistics and Computing Ltd, Sutton SM2 5DA, Surrey, United Kingdom
| | - Jan S Hamling
- Statistics, RoeLee Statistics Ltd, Sutton SM2 5DA, United Kingdom
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Wang M, Yao G, Sun Y, Yang Y, Deng R. Exposure to construction dust and health impacts - A review. CHEMOSPHERE 2023; 311:136990. [PMID: 36309055 DOI: 10.1016/j.chemosphere.2022.136990] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/03/2022] [Accepted: 10/20/2022] [Indexed: 06/16/2023]
Abstract
Construction dust contributes a significant proportion of airborne particulate matter, affecting the health of its surrounding environment and population. Construction workers are normally exposed to dust at high levels and bear severe health risks. The existing articles concerning the exposure and health impacts of construction dust are limited, but this research field has received more and more attention. This work reviews literature in the field and tries to systematically assess the current research state. Here, we review (1) methods used to monitor or sample construction dust; (2) main characteristics of construction dust, including dust classification, exposed populations, and exposure concentrations; (3) potential health hazards and (4) health risk assessment of construction dust. From existing literature, the exposure concentrations of different types and sources of construction dust are usually the focus of attention, while its particle size distribution and chemical composition are rarely mentioned. The classification and characteristics of populations exposed to construction dust ought to be a key consideration but not clear enough so far. There still lacks in-depth study of health hazards and systematic assessment of risks associated with construction dust. In future, it is valuable to develop utility instruments to precisely monitor construction dust. Besides, control means to reduce the pollution of construction dust deserve more studies. Health hazards of construction dust should be verified by biological experiments. Moreover, emerging algorithm models should be utilized in the risk assessment. The findings will help gain a better understanding of construction dust exposure and associated health risks.
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Affiliation(s)
- Mingpu Wang
- School of Civil Engineering, Chongqing University, Chongqing, 400045, China; Key Laboratory of New Technology for Construction of Cities in Mountain Area, Ministry of Education, Chongqing, 400045, China
| | - Gang Yao
- School of Civil Engineering, Chongqing University, Chongqing, 400045, China; Key Laboratory of New Technology for Construction of Cities in Mountain Area, Ministry of Education, Chongqing, 400045, China
| | - Yujia Sun
- School of Civil Engineering, Chongqing University, Chongqing, 400045, China; Key Laboratory of New Technology for Construction of Cities in Mountain Area, Ministry of Education, Chongqing, 400045, China
| | - Yang Yang
- School of Civil Engineering, Chongqing University, Chongqing, 400045, China; Key Laboratory of New Technology for Construction of Cities in Mountain Area, Ministry of Education, Chongqing, 400045, China
| | - Rui Deng
- School of Civil Engineering, Chongqing University, Chongqing, 400045, China.
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Ringen K, Dement J, Welch L, Quinn P. How much have adverse occupational health outcomes among construction workers improved over time? Evidence from 25 years of medical screening. Am J Ind Med 2023; 66:18-29. [PMID: 36398410 DOI: 10.1002/ajim.23445] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Construction workers have always had a high risk of occupational illnesses. We used 25 years of data from a medical screening program serving older construction workers to determine how much health outcomes have improved over the past 60 years. METHODS We investigated changes in relative risk for chest radiographs consistent with pneumoconiosis, COPD by spirometry, lung cancer mortality, and audiometry-assessed hearing impairment among workers participating in a medical screening program. Results were stratified by decade of first construction employment: before 1960, 1960-1969, 1970-1979, 1980-1989, and after 1990. Poisson and Cox regression analyses assessed relative risk by decade adjusted for age, sex, smoking, and years of construction trade work. RESULTS Subjects were 94% male and, on average, 60 years old with 25 years of construction work. When compared to workers employed before 1960, those first employed after 1990 experienced the following reductions in model-adjusted relative risks: chronic obstructive pulmonary disease, 32%; all pneumoconiosis, 68%; parenchymal abnormalities, 35%; pleural abnormalities, 71%; hearing impairment, 20%; and lung cancer mortality, 48%. Risks started to decline in the 1960s with greatest reductions among workers first employed after 1970. CONCLUSIONS This study demonstrates the positive impact that adoption of occupational health protections have had over the past 60 years. The greatest risk reductions were observed for outcomes with strong regulatory and legal incentives to reduce exposures and associated risks, such as those associated with inhalation hazards (asbestos and silica), while lowest improvement was for hearing impairment, for which little regulatory enforcement and few prevention incentives have been adopted.
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Affiliation(s)
- Knut Ringen
- Energy Employees Department, CPWR-The Center for Construction Research and Training, Silver Spring, Maryland, USA
| | - John Dement
- Division of Occupational and Environmental Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Laura Welch
- Energy Employees Department, CPWR-The Center for Construction Research and Training, Silver Spring, Maryland, USA
| | - Patricia Quinn
- Energy Employees Department, CPWR-The Center for Construction Research and Training, Silver Spring, Maryland, USA
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Lee D, Lee KS, Kim H, Lee Y, Lee MJ, Lee H, Myong JP, Kim H, Lee J. Awareness and Needs of Smoking Cessation Services for Female Emotional Laborers, Parcel Delivery Workers, Transportation Workers, and Construction Workers in South Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15220. [PMID: 36429938 PMCID: PMC9690047 DOI: 10.3390/ijerph192215220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/28/2022] [Accepted: 11/15/2022] [Indexed: 06/16/2023]
Abstract
Although South Korea has implemented various smoking cessation services, women who are emotional laborers, as well as parcel delivery, transportation, and construction workers, have poor access to these services. This study evaluated the smoking-related characteristics of workers in these four occupations as well as the awareness of and need for smoking cessation services. In total 808 workers in these four occupations aged 19 years and above were recruited nationwide and had their data analyzed. The participants' age, marital status, number of work hours per week, job-related stress, age when they started smoking, average number of cigarettes a day, types of tobacco products, close relationships to others who smoke, number of attempts to quit smoking, plans to quit smoking, awareness of cessation services, prior utilization of cessation services, and need for cessation services were surveyed. Compared with parcel delivery workers, female emotional laborers and transportation and construction workers had more attempts to quit smoking, plans to quit smoking, and prior utilization of smoking cessation services, moreover, construction workers had a significantly lower awareness of smoking cessation services. Parcel delivery workers need smoking cessation programs, mobile applications to help them quit smoking, and improvements in their work environments. Cessation services and education should be promoted at workplaces and among managers.
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Affiliation(s)
- Dahyeon Lee
- Department of Health Promotion, Graduate School of Public Health and Healthcare Management, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
| | - Kang-Sook Lee
- Department of Health Promotion, Graduate School of Public Health and Healthcare Management, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
- Seoul Tobacco Control Center, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
- Korean Association on Smoking or Health, Seoul 07238, Republic of Korea
| | - Haena Kim
- Seoul Tobacco Control Center, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
| | - Yeonwoo Lee
- Seoul Tobacco Control Center, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
| | - Mi-Ji Lee
- Seoul Tobacco Control Center, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
| | - Hyunkyung Lee
- Korean Association on Smoking or Health, Seoul 07238, Republic of Korea
| | - Jun-Pyo Myong
- Department of Occupational and Environmental Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Hyekyeong Kim
- Department of Health Convergence, Ewha Women’s University, Seoul 03760, Republic of Korea
| | - Jakyoung Lee
- Graduate School of Public Health, Yonsei University, Seoul 03722, Republic of Korea
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Brey C, Consonni D, Sarquis LMM, Miranda FMD. Lung cancer and occupational exposure: hospital-based case-control study. Rev Gaucha Enferm 2022; 43:e20210043. [PMID: 35920477 DOI: 10.1590/1983-1447.2022.20210043.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 12/16/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To analyze the relationship between occupation and lung cancer in patients at a national referral hospital for cancer care in southern Brazil. METHOD Hospital-based case-control study conducted between February and October 2019. Occupational histories were coded according to international classifications and translated into occupations associated with lung cancer (List A and B). The odds ratios were adjusted for smoking, with a 95% confidence interval, calculated by conditional logistic regression. RESULTS 99 cases and 227 controls were included. Among men, the occupation of painters (list A) was associated with lung cancer (OR = 14.3; 95% CI: 1.8-116.5), there were no occupations in list B associated with lung cancer. In women, no increased risks were found. CONCLUSIONS It has been shown that exposure to occupational carcinogens among repair and construction painters increases the risk of lung cancer.
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Affiliation(s)
- Christiane Brey
- Instituto Federal do Paraná (IFPR), Coordenação de Enfermagem. Curitiba, Paraná, Brasil
| | - Dario Consonni
- Università degli Studi di Milano (UNIMI). Clinica Del Lavoro. Milano, Lombardia, Italia
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Rampariag R, Chernyavskiy I, Al-Ajam M, Tsay JCJ. Controversies and challenges in lung cancer screening. Semin Oncol 2022; 49:S0093-7754(22)00056-2. [PMID: 35907666 DOI: 10.1053/j.seminoncol.2022.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/01/2022] [Accepted: 07/01/2022] [Indexed: 11/11/2022]
Abstract
Two large randomized controlled trials have shown mortality benefit from lung cancer screening (LCS) in high-risk groups. Updated guidelines by the United State Preventative Service Task Force in 2020 will allow for inclusion of more patients who are at high risk of developing lung cancer and benefit from screening. As medical clinics and lung cancer screening programs around the country continue to work on perfecting the LCS workflow, it is important to understand some controversial issues surrounding LCS that should be addressed. In this article, we identify some of these issues, including false positive rates of low-dose CT, over-diagnosis, cost expenditure, LCS disparities in minorities, and utility of biomarkers. We hope to provide clarity, potential solutions, and future directions on how to address these controversies.
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Affiliation(s)
- Ravindra Rampariag
- Section of Pulmonary, Critical Care and Sleep Medicine, Medical Service, Veterans Administration (VA) New York Harbor Healthcare System, NY, USA
| | - Igor Chernyavskiy
- Section of Pulmonary, Critical Care and Sleep Medicine, Medical Service, Veterans Administration (VA) New York Harbor Healthcare System, NY, USA; Section of Pulmonary, Critical Care and Sleep Medicine, Medical Service, Veterans Administration (VA) Northport Healthcare System, NY, USA
| | - Mohammad Al-Ajam
- Section of Pulmonary, Critical Care and Sleep Medicine, Medical Service, Veterans Administration (VA) New York Harbor Healthcare System, NY, USA; Division of Pulmonary, Critical Care, and Sleep, Department of Medicine, SUNY Downstate Medical Center, NY, USA
| | - Jun-Chieh J Tsay
- Section of Pulmonary, Critical Care and Sleep Medicine, Medical Service, Veterans Administration (VA) New York Harbor Healthcare System, NY, USA; Division of Pulmonary, Critical Care, and Sleep, Department of Medicine, New York University Grossman School of Medicine, NY, USA.
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Grier W, Abbas H, Gebeyehu RR, Singh AK, Ruiz J, Hines S, Alghanim F, Deepak J. Military exposures and lung cancer in United States veterans. Semin Oncol 2022; 49:S0093-7754(22)00050-1. [PMID: 35882571 DOI: 10.1053/j.seminoncol.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/24/2022] [Accepted: 06/25/2022] [Indexed: 11/11/2022]
Abstract
Lung cancer screening begins at age 50, with yearly low dose computed tomography (LDCT) scans until age 80, for patients determined to be high risk due to tobacco smoking. Veterans serving from World War II to the Gulf War are now at the age where LDCT is recommended. This recommendation from the United States Preventative Service Task Force includes patients who have a 20-pack year tobacco history and currently smoke or quit within the last 15 years. This recommendation does not consider additional risk factors such as exposures to lung carcinogens. We discuss unique operational and occupational exposures encountered while serving in the armed forces, which may potentially increase the risk of lung cancers in the Veteran population. The additional risk of lung cancer due to military exposure history is unclear and more work is needed to identify and quantify risk at an individual level. Increasing awareness at the provider level regarding the carcinogenic exposures encountered may allow a larger population of Veterans, not meeting traditional LDCT criteria, to benefit from lung cancer screening.
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Affiliation(s)
- William Grier
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Maryland Medical Center, Baltimore, MD, United States
| | - Hatoon Abbas
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Maryland Medical Center, Baltimore, MD, United States
| | - Rediet Regassa Gebeyehu
- Department of Medicine (Hematology & Oncology), Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Ankur Kumar Singh
- Department of Medicine (Hematology & Oncology), Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Jimmy Ruiz
- Department of Medicine (Hematology & Oncology), Wake Forest School of Medicine, Winston-Salem, NC, United States; Department of Medicine, W.G. (Bill) Hefner Veteran Administration Medical Center, Cancer Center, Salisbury, NC, United States
| | - Stella Hines
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Maryland Medical Center, Baltimore, MD, United States; Baltimore VA Medical Center, Department of Medicine, Baltimore, MD, United States
| | - Fahid Alghanim
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Maryland Medical Center, Baltimore, MD, United States
| | - Janaki Deepak
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Maryland Medical Center, Baltimore, MD, United States; Baltimore VA Medical Center, Department of Medicine, Baltimore, MD, United States.
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Lung Cancer Screening in Asbestos-Exposed Populations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052688. [PMID: 35270380 PMCID: PMC8910511 DOI: 10.3390/ijerph19052688] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 12/19/2022]
Abstract
Asbestos exposure is the most important cause of occupational lung cancer mortality. Two large randomized clinical trials in the U.S. and Europe conclusively demonstrate that annual low-dose chest CT (LDCT) scan screening reduces lung cancer mortality. Age and smoking are the chief risk factors tested in LDCT studies, but numerous risk prediction models that incorporate additional lung cancer risk factors have shown excellent performance. The studies of LDCT in asbestos-exposed populations shows favorable results but are variable in design and limited in size and generalizability. Outstanding questions include how to: (1) identify workers appropriate for screening, (2) organize screening programs, (3) inform and motivate people to screen, and (4) incorporate asbestos exposure into LDCT decision-making in clinical practice. Conclusion: Screening workers aged ≥50 years with a history of ≥5 years asbestos exposure (or fewer years given intense exposure) in combination with either (a) a history of smoking at least 10 pack-years with no limit on time since quitting, or (b) a history of asbestos-related fibrosis, chronic lung disease, family history of lung cancer, personal history of cancer, or exposure to multiple workplace lung carcinogens is a reasonable approach to LDCT eligibility, given current knowledge. The promotion of LDCT-based screening among asbestos-exposed workers is an urgent priority.
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Risk factors of inability to live independently in the course of lung cancer. POSTEP HIG MED DOSW 2022. [DOI: 10.2478/ahem-2022-0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Introduction
A number of articles focus on functioning with lung cancer. However, there are no articles on factors which result in the inability to live independently in the course of this disease. This study assesses risk factors regarding the inability to live independently among individuals with lung cancer.
Materials and Methods
This study included 134 patients who displayed interest in obtaining a certificate of the inability to live independently.
Results
Over the study period, 75% of the patients obtained the certificate of inability to live independently (group A) and 25% of them did not obtain the certificate (group B). In group A, 56.4% of individuals were men, and in group B, 42.4% of them were men. In group A, 11.8% of patients were diagnosed with small cell lung cancer; no such case was found in group B. Metastases were revealed in 83.2% of patients from group A and in 57.6% from group B. Patients from group A had a significantly lower score in the Barthel Index for Activities of Daily Living and lower body mass index compared with those from group B.
Conclusions
Information on body mass index, histopathological diagnosis, and the presence of metastases is useful in assessing the risk of being unable to live independently in patients with lung cancer. The Barthel Index for Activities of Daily Living is helpful in assessing the inability to live independently.
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Brey C, Consonni D, Sarquis LMM, Miranda FMD. Câncer de pulmão e exposição ocupacional: estudo caso-controle de base hospitalar. Rev Gaucha Enferm 2022. [DOI: 10.1590/1983-1447.2022.20210043.pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
RESUMO Objetivo Analisar a relação entre ocupação e câncer de pulmão em pacientes de um hospital de referência nacional para atendimento oncológico no Sul do Brasil. Método Estudo caso-controle de base hospitalar realizado entre fevereiro e outubro de 2019. Os históricos ocupacionais foram codificados de acordo com classificações internacionais e traduzidos em ocupações associadas ao câncer de pulmão (Lista A e B). As odds ratios foram ajustadas para tabagismo, com intervalo de confiança de 95%, calculadas por regressão logística condicional. Resultados Foram incluídos 99 casos e 227 controles. Entre os homens a ocupação de pintores (lista A) estava associada ao câncer de pulmão (OR= 14,3; IC 95%: 1,8-116,5), não houve ocupações da lista B associadas ao câncer de pulmão. Nas mulheres não foram encontrados riscos aumentados. Conclusões Evidenciou-se que a exposição aos carcinógenos ocupacionais entre pintores de reparo e da construção civil aumentam o risco de câncer de pulmão.
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Bovio N, Wild P, Guseva Canu I. Lung Cancer Mortality in the Swiss Working Population: The Effect of Occupational and Non-Occupational Factors. J Occup Environ Med 2021; 63:1029-1036. [PMID: 34173787 PMCID: PMC8631151 DOI: 10.1097/jom.0000000000002302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess the effect of occupational exposures on lung cancer mortality in Switzerland after adjustment for non-occupational lung carcinogens. METHODS Using data on 4,351,383 Swiss residents, we used negative binomial regression to assess the effect occupation on lung cancer mortality between 1990 and 2014, accounting for socio-demographic factors, predicted probabilities of smoking and measured environmental radon exposure. RESULTS After adjustment, male machine operators and workers in mining, stone working and building materials manufacturing showed the highest risk. Women working in electrical engineering, electronics, watchmaking, vehicle construction and toolmaking, and transport occupations also remained at high risk. Radon exposure had no effect on lung cancer mortality, while smoking demonstrated a significant effect in both sexes. CONCLUSIONS The results suggest the presence of occupational exposures to lung carcinogens in addition to non-occupational factors.
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Affiliation(s)
- Nicolas Bovio
- Department of Occupational and Environmental Health, Center for Primary Care and Public Health (unisanté), University of Lausanne, Lausanne, Switzerland (Mr Bovio, Dr Wild, and Pr Canu); INRS, Vandoeuvre Les Nancy Cedex, France (Dr Wild)
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Khamraev K, Cheriyan D, Choi JH. A review on health risk assessment of PM in the construction industry - Current situation and future directions. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 758:143716. [PMID: 33223176 DOI: 10.1016/j.scitotenv.2020.143716] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/06/2020] [Accepted: 11/10/2020] [Indexed: 06/11/2023]
Abstract
Particulate matter (PM) is one of the primary pollutants of the environment. The amount of PM discharged from construction projects is considerably high; it generates 70-80% of the overall PM. The composition of PM is complex and may contain various toxic substances that have severe health effects on human health. Existing health risk assessment in the construction industry lacks the efficiency to reduce the risk level of PM exposure. This study systematically reviews literature in this research area to understand the primary reasons which generates PM health risk assessments. The authors reviewed health risk assessment studies in the construction industry to analyze the current situation, and then reviewed health risk assessment studies from four different industries to compare the advancement of research and outcomes in all the five industries. From the study it is understood that the area of research related to ambient air were more developed compared to those in other areas due to their sampling methods and the size of the PM studied. From the findings of the systematic review, it is understood that majority of the risk assessment studies still rely on a two decade-old system and neglect recent research findings pertaining inhalation rate and size of PM. To overcome this, the level of risk involved in various common construction activities needs to be explored using real-time location-based PM monitoring and real-time inhalation monitoring methods. The findings of this review will help researchers gain a better perspective while conducting occupational health risk studies in the construction industry.
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Affiliation(s)
- Khusniddin Khamraev
- Dong-A Univ., Dept. of Civil Engrg., P4401-1, 550 Bungil 37, Nakdong-Daero, Saha-Gu, Busan 49315, Republic of Korea.
| | - Daniel Cheriyan
- Dong-A Univ., Dept. of Civil Engrg., P4401-1, 550 Bungil 37, Nakdong-Daero, Saha-Gu, Busan 49315, Republic of Korea.
| | - Jae-Ho Choi
- Dong-A Univ., Dept. of Civil Engrg., P4401-1, 550 Bungil 37, Nakdong-Daero, Saha-Gu, Busan 49315, Republic of Korea.
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Abstract
Selected occupational populations are at the highest risk of lung cancer, because they smoke at increased rates and are concurrently exposed to workplace lung carcinogens. Low-dose computed tomography (CT)-based lung cancer screening has an enormous potential to reduce lung cancer mortality in these populations, as shown both in the lung cancer screening studies in the general population and in studies of workers at high risk of lung cancer. Pulmonologists can play a key role in identifying workers at high risk of lung cancer and ensuring that they are offered annual low-dose CT scans for early lung cancer detection.
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Affiliation(s)
- Steven B Markowitz
- Barry Commoner Center for Health and the Environment, Queens College, City University of New York, 65-30 Kissena Boulevard, Remsen Hall, Queens, NY 11367, USA.
| | - Brittany Dickens
- Barry Commoner Center for Health and the Environment, Queens College, City University of New York, 65-30 Kissena Boulevard, Remsen Hall, Queens, NY 11367, USA
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