Lung cancer screening guidelines do not detect disease among first responders
Chicago—National lung cancer screening guidelines are inadequate to diagnose patients who contract lung cancer from occupational exposure, including first responders, according to a study reported today at the International Association for the Study of Lung Cancer's North America Conference on Lung Cancer in Chicago.
The United States Preventative Task Force recommends annual lung cancer screening with low dose computed tomography in adults ages 55-80, who have a thirty-pack per year history of smoking and are currently smoking or quit within the past 15 years. However, 30% of lung cancers are attributed to occupational exposure, including first responders.
A large study conducted by the National Institutes of Occupational Safety and Health found that first responders have a 14% increased risk of dying from cancer compared to the general population. Recently, the incidence of lung cancer among 9/11 first responders is increasing and expected to continue to rise in the next 10 years.
"Current practice for lung cancer screenings in most U.S. fire stations include a chest X-ray every five years, but low-dose lung CT is underutilized," said Dr. Vershalee Shukla, of the Vincere Cancer Center in Scottsdale, Ariz. "Fire fighters can only obtain a low-dose lung CT at 55 and older per current cancer screening guidelines."
To address this, Dr. Shukla and her team screened 350 first responders, ages 27-76 who had worked for more than 21 years. Of the 195 patients scanned 86 (44.1%) resulted in abnormal findings. An abnormal finding or a positive finding warranted additional close monitoring with another low dose lung CT in three, six or nine-month intervals or a study that prompted further diagnostic work-up with PET/CT and or biopsy, she said.
"This study demonstrates value for low-dose CT as a screening modality for first responders, who are often diagnosed with lung cancer earlier than smokers for various reasons and therefore screened earlier in this study. The very early results are promising, and ongoing follow-up will likely lead to further diagnosis of early lung cancer. This is a small study and warrants further investigation on a larger scale," Dr. Shukla said.
Her research is part of a state-wide and national effort to raise awareness of the cancer risk for first responders.
"Currently there are no occupational guidelines for Fire Fighters, who are at greater risk for cancers in general. We have purposed to do a low dose lung CT at baseline for every fire fighter in Phoenix and then routine screening at age 40. I am also recommending doing colonoscopies and upper endoscopies in their early to mid-thirties as well as other screening measures for first responders," Shulka said.