Health surveillance of asbestos-
exposed workers
Prof. Massimo Corradi, MD
University Hospital of Parma, Italy
massimo.cor...
No conflict of interest
Clin Respir J 2014; 8: 1–10
 Asbestsosis
 Pleural plaques
 Benign asbestos pleural effusion
 Rounded atelectasis
 Dif...
NIOSH 2007
Asbestosis deaths in USA
Time trend in age-adjusted
mesothelioma worldwide
Delgermaa. Bull World Health Organ 2011;89:716–724C
Peak incidence of mesothelioma
Int. Agency Res. Cancer (IARC). 2007.
Asbestos-exposed workers have
justifiable anxiety about their future and
seek reassurance from the medical
profession
Thes...
Clin Respir J 2014; 8: 1–10
 Asbestsosis
Asbestosis is commonly associated with prolonged
exposure, usually over 10 to 20...
 The chest radiograph (ILO-BIT, B-reader)
remains an useful tool for the radiographic
diagnosis of asbestosis
 HRCT has ...
Health surveillance for asbestosis
There is no effective treatment for
asbestosis but this is an independent
risk factor ...
Clin Respir J 2014; 8: 1–10
Asbestsosis
 Pleural plaques
 Benign asbestos pleural effusion
 Rounded atelectasis
 Diffu...
Health surveillance for asbestos-
related benign pleural diseases
There is no effective treatment for
asbestos-related be...
The threshold limit
80 % for FEV1 74 % for DLCO
`Vehmas et al. Int Arch Occup Environ Health (2013)
Health surveillance of benign
asbestos related diseases
Imaging techniques (RX/CT) are
mandatory for diagnostic purposes
...
Clin Respir J 2014; 8: 1–10
 Asbestsosis
 Pleural plaques
 Benign asbetos pleural effusion
 Rounded atelectasis
 Diff...
Medical and public health benefits of screening
for mesothelioma have not been demonstrated
To date, there are no scientif...
Blood/pleural biomarkers for
mesothelioma
 Mesothelin
 Osteopontin
 YKL-40
 Fibulin
 Megakaryocyte potentiating
facto...
Clin Respir J 2014; 8: 1–10
 Asbestsosis
 Pleural plaques
 Benign asbetos pleural effusion
 Rounded atelectasis
 Diff...
Lung Cancer (C33-C34): 2003-2006
One-Year Relative Survival (%) by Stage, Adults 15-99, Former Anglia Cancer Network
1950-1990
 Randomised and non randomised controlled trials:
 John Hopkins Lung Project
 Memorial Sloan Kettering Lung P...
1950-1990
 Intervention groups:
 More lung cancers
 More early stage lung cancers
 More resectable lung cancers
 No r...
Lung Cancer Screening Tools
 Sputum Cytology
 Chest X-ray
Bach. ACCP guidelines, Chest 2007
Computed Tomography Screening
and Lung Cancer Outcomes
Increase of
• cases
• operated cases
Back. JAMA 2007
No change in
•...
CT Screening for Lung Cancer
Spiraling Into Confusion?
Black, WC, and Baron, JA
Editorial
Formulation of screening policy ...
NLST: Design
time
0 1 2 3 4 5 6 7 8
N 53,476
•Age 55-74 ys
•Smoking hist.
≥30 PY
CT Arm
CXR Arm
Randomize
F/U
T0
T1
T2 Abe...
National lung screening trial (NLST)
Aberle. N Engl J Med 2011
320 participants were needed to screen
to prevent 1 lung ca...
….and CT Scan in asbestos exposed workers…..?
Ollier. Chest 2014
A meta-analysis of cohort studies involving CT
scan in former asbestos-exposed workers
Ollier. Chest 2014
The prevalence compared favourably with the
reported prevalence in the larger available trials in
heavy smokers (1%; CI 95...
European Screening Trials Overview
NELSON DLCST ITALUNG LUSI DANTE MILD
Nr rounds 4 5 4 5 5 10 or 5
Enrollement 15,464 4,1...
Lung cancer in asbestos-exposed workers occurred at least 20-25
years following the initial exposure. Thus, such screening...
From: Benefits and Harms of CT Screening for Lung Cancer: A Systematic Review
JAMA. 2012;307(22):2418-2429.
Journal of Surgical Oncology 2014
Journal of Surgical Oncology 2014
Potential harms with CT scan
Post-occupational follow-up may involve
risks to health, particularly repeated
irradiation a...
Nodule(s) (%) Cancer (%)
ELCAP 23 2.7
Shinshu Univ 5.1 0.4
Hitachi HCC 26.3 0.44
ALCA 11.5 0.8
Mayo 51 2.0
Univ of Munster...
Number of pulmonary nodules
CT scans
(UH Parma)
• 5000/year
• 100%
Solitary
Nodules
• 500/year*
• 10% of CT scans
Stage I
...
 Lung function tests
 Biomarkers
CT screening in
higher individual risk
mRNA
One miRNA
mRNA
mRNA
mRNA
mRNA
…
small noncoding RNAs that
regulate gene expression
by binding complementary
sequences...
PNAS, 2011
Conclusions
 Post-occupational follow-up might reduce the
mortality of lung cancer due to asbestos
 Lung fuction and bio...
Thanks to
 Antonio Mutti
 Matteo Goldoni
 Marcello Tiseo
 Nicola Sverzellati
Università degli Studi di Parma
Health Surveillance of asbestos-exposed workers at Helsinki Asbestos 2014
Health Surveillance of asbestos-exposed workers at Helsinki Asbestos 2014
Health Surveillance of asbestos-exposed workers at Helsinki Asbestos 2014
Health Surveillance of asbestos-exposed workers at Helsinki Asbestos 2014
Health Surveillance of asbestos-exposed workers at Helsinki Asbestos 2014
Health Surveillance of asbestos-exposed workers at Helsinki Asbestos 2014
Health Surveillance of asbestos-exposed workers at Helsinki Asbestos 2014
Health Surveillance of asbestos-exposed workers at Helsinki Asbestos 2014
Upcoming SlideShare
Loading in …5
×

Health Surveillance of asbestos-exposed workers at Helsinki Asbestos 2014

1,375 views
1,137 views

Published on

Presented by Professor Massimo Corradi from University of Parma, Italy.

Published in: Health & Medicine
1 Comment
2 Likes
Statistics
Notes
No Downloads
Views
Total views
1,375
On SlideShare
0
From Embeds
0
Number of Embeds
17
Actions
Shares
0
Downloads
57
Comments
1
Likes
2
Embeds 0
No embeds

No notes for slide

Health Surveillance of asbestos-exposed workers at Helsinki Asbestos 2014

  1. 1. Health surveillance of asbestos- exposed workers Prof. Massimo Corradi, MD University Hospital of Parma, Italy massimo.corradi@unipr.it
  2. 2. No conflict of interest
  3. 3. Clin Respir J 2014; 8: 1–10  Asbestsosis  Pleural plaques  Benign asbestos pleural effusion  Rounded atelectasis  Diffuse pleural thickening  Mesothelioma  Lung cancer
  4. 4. NIOSH 2007 Asbestosis deaths in USA
  5. 5. Time trend in age-adjusted mesothelioma worldwide Delgermaa. Bull World Health Organ 2011;89:716–724C
  6. 6. Peak incidence of mesothelioma Int. Agency Res. Cancer (IARC). 2007.
  7. 7. Asbestos-exposed workers have justifiable anxiety about their future and seek reassurance from the medical profession These people consult physicians for many reasons: •to be screened for asbestos-related disease •for evaluation of specific symptoms •for treatment and advice •for evaluation of impairment
  8. 8. Clin Respir J 2014; 8: 1–10  Asbestsosis Asbestosis is commonly associated with prolonged exposure, usually over 10 to 20 years. However, short, intense exposures to asbestos, lasting from several months to 1 year or more, can be sufficient to cause asbestosis.
  9. 9.  The chest radiograph (ILO-BIT, B-reader) remains an useful tool for the radiographic diagnosis of asbestosis  HRCT has an important role when experienced readers disagree about the presence or absence of abnormalities on a high quality chest film
  10. 10. Health surveillance for asbestosis There is no effective treatment for asbestosis but this is an independent risk factor for bronchial carcinoma and it is evidence of heavy asbestos exposure Stopping smoking in subjects suffering from asbestosis will reduce the incidence of bronchial carcinoma Markowitz. AJRCCM Vol. 188, No. 1 (2013), pp. 90-96.
  11. 11. Clin Respir J 2014; 8: 1–10 Asbestsosis  Pleural plaques  Benign asbestos pleural effusion  Rounded atelectasis  Diffuse pleural thickening
  12. 12. Health surveillance for asbestos- related benign pleural diseases There is no effective treatment for asbestos-related benign pleural diseases but these are markers of exposure The presence of pleural plaques has not been shown to be an aetiological factor for thoracic cancers Ameille. Rev Mal Respir. 2011
  13. 13. The threshold limit 80 % for FEV1 74 % for DLCO `Vehmas et al. Int Arch Occup Environ Health (2013)
  14. 14. Health surveillance of benign asbestos related diseases Imaging techniques (RX/CT) are mandatory for diagnostic purposes Lung function test (spirometry and DLCO) are necessary to grade the disease and to define the prognosis (thus useful in the follow up)
  15. 15. Clin Respir J 2014; 8: 1–10  Asbestsosis  Pleural plaques  Benign asbetos pleural effusion  Rounded atelectasis  Diffuse pleural thickening  Mesothelioma
  16. 16. Medical and public health benefits of screening for mesothelioma have not been demonstrated To date, there are no scientific data that quantitate the contribution of imaging to the early detection of mesothelioma Early detection will result in early treatment (however prognosis seems to be more closely linked to cell type than timing of treatment)
  17. 17. Blood/pleural biomarkers for mesothelioma  Mesothelin  Osteopontin  YKL-40  Fibulin  Megakaryocyte potentiating factor  CA125  High-mobility group box 1 (HMGB1)  Vascular endothelial growth factor  Circulating tumor cells  “omic”approach  Endothelial cell  miR625-3P  Thioredoxin 1  miR126  Procalcitonin Pubmed search 2014-2012
  18. 18. Clin Respir J 2014; 8: 1–10  Asbestsosis  Pleural plaques  Benign asbetos pleural effusion  Rounded atelectasis  Diffuse pleural thickening  Mesothelioma  Lung cancer
  19. 19. Lung Cancer (C33-C34): 2003-2006 One-Year Relative Survival (%) by Stage, Adults 15-99, Former Anglia Cancer Network
  20. 20. 1950-1990  Randomised and non randomised controlled trials:  John Hopkins Lung Project  Memorial Sloan Kettering Lung Project  Mayo Lung Project  Czechoslovakian Study  North London Cancer Study  Erfurt County Study  Kaiser Permanente Study  Chest radiograph ± sputum cytology every 4 to 12 months compared to less frequent or no screening over 3 to 16 years  52000 subjects in intervention groups and 48000 in control groups
  21. 21. 1950-1990  Intervention groups:  More lung cancers  More early stage lung cancers  More resectable lung cancers  No reduction in lung cancer mortality
  22. 22. Lung Cancer Screening Tools  Sputum Cytology  Chest X-ray Bach. ACCP guidelines, Chest 2007
  23. 23. Computed Tomography Screening and Lung Cancer Outcomes Increase of • cases • operated cases Back. JAMA 2007 No change in • late diagnosis • mortality
  24. 24. CT Screening for Lung Cancer Spiraling Into Confusion? Black, WC, and Baron, JA Editorial Formulation of screening policy should await the rigorous assessment provided by ongoing randomized controlled trials (National Lung Screening Trial and NELSON Trial). JAMA 2007
  25. 25. NLST: Design time 0 1 2 3 4 5 6 7 8 N 53,476 •Age 55-74 ys •Smoking hist. ≥30 PY CT Arm CXR Arm Randomize F/U T0 T1 T2 Aberle. N Engl J Med 2011 Non-calcified nodules ≥4 mm in CT or any size in X-ray were referred for diagnostic work-up Primary outcome: lung cancer related mortality
  26. 26. National lung screening trial (NLST) Aberle. N Engl J Med 2011 320 participants were needed to screen to prevent 1 lung cancer death
  27. 27. ….and CT Scan in asbestos exposed workers…..?
  28. 28. Ollier. Chest 2014 A meta-analysis of cohort studies involving CT scan in former asbestos-exposed workers
  29. 29. Ollier. Chest 2014
  30. 30. The prevalence compared favourably with the reported prevalence in the larger available trials in heavy smokers (1%; CI 95%: 0.09% - 1.1%) Ollier. Chest 2014
  31. 31. European Screening Trials Overview NELSON DLCST ITALUNG LUSI DANTE MILD Nr rounds 4 5 4 5 5 10 or 5 Enrollement 15,464 4,104 3,206 3,551 2,472 3,581 Completed Y Y Y N Y N Baseline detection 0.9% 0.8% 1.5% 1.0% 2.2% 0.8% Incidence 0.5% 0.6% 0.4% - 0.5% 0.5% de Koning, ECCO-ESMO meeting, Sept. 2011
  32. 32. Lung cancer in asbestos-exposed workers occurred at least 20-25 years following the initial exposure. Thus, such screening should not start prior to the prolonged latency period
  33. 33. From: Benefits and Harms of CT Screening for Lung Cancer: A Systematic Review JAMA. 2012;307(22):2418-2429.
  34. 34. Journal of Surgical Oncology 2014
  35. 35. Journal of Surgical Oncology 2014
  36. 36. Potential harms with CT scan Post-occupational follow-up may involve risks to health, particularly repeated irradiation and invasive diagnostic procedures It is also necessary to consider the psychological consequences inherent in all screening programmes
  37. 37. Nodule(s) (%) Cancer (%) ELCAP 23 2.7 Shinshu Univ 5.1 0.4 Hitachi HCC 26.3 0.44 ALCA 11.5 0.8 Mayo 51 2.0 Univ of Munster 43 1.5 Univ of Milano 19 1.1 Univ de Navarra 31.9 1.32 Beaumont, Ire 20.7 0.23 SMC, Korea 35 0.17 Helsinki Univ. 18.4 0.8 LSS, NCI 20.5 1.9 City Univ, NY 32 0.7 IELCAP 13 1.3 NY-ELCAP 41.8 1.6 Can-ELCAP 76 2.0 Depiscan, France 45.2 2.4 Cosmos, Italy 43 1.7 Pittsburgh 40.6 1.5 DANTE, Italy 15 2.2
  38. 38. Number of pulmonary nodules CT scans (UH Parma) • 5000/year • 100% Solitary Nodules • 500/year* • 10% of CT scans Stage I lung cancer • 25/year • 0.5% of CT scans • 5% of nodules PET FOR ALL? Biomarkers to be developed?
  39. 39.  Lung function tests  Biomarkers CT screening in higher individual risk
  40. 40. mRNA One miRNA mRNA mRNA mRNA mRNA … small noncoding RNAs that regulate gene expression by binding complementary sequences of target mRNAs and inducing their degradation or translational repression One miRNA has multiple targets microRNA: a new class of biomarkers
  41. 41. PNAS, 2011
  42. 42. Conclusions  Post-occupational follow-up might reduce the mortality of lung cancer due to asbestos  Lung fuction and biomarker driven screening procedures may reduce the very hight rate of false positives observed with CT scan  The theoretical benefits, have to be seen in perspective with the risks to physical and psychological health related to diagnostic procedures  SMOKING CESSATION is still a priority!
  43. 43. Thanks to  Antonio Mutti  Matteo Goldoni  Marcello Tiseo  Nicola Sverzellati Università degli Studi di Parma

×