Prevalence of Pulmonary Nodules Detected by Computed Tomography in World Trade Center Rescue and Recovery Workers

Details

• Personal Author:
  Celedón JC ; de la Hoz RE ; Sigel KM ; Weber J ; Wisnivesky JP ; Xu D
• Description:
  The collapse of the World Trade Center (WTC) after the terrorist attacks of September 11, 2001, exposed a large number of rescue and disaster recovery workers (hereafter "WTC responders") to potentially toxic inhalable particulates. Lower respiratory symptoms and functional and imaging abnormalities have been common among WTC responders. Although early studies have not revealed an increased risk of lung cancer, the WTC Health Program covers lung cancer screening. Workers in the WTC responder cohorts (>50,000) had substantial tobacco and relevant pre-WTC and WTC-related occupational exposures, and as they age, many are becoming eligible for lung cancer screening with low-dose computed tomography (LDCT). Because the presence of lung nodules and other abnormalities may impact the cost-benefit balance of lung cancer screening, we analyzed chest imaging data of a large group of WTC responders, hypothesizing that 1) WTC responders would have increased prevalence of noncalcified nodules (NCNs), and 2) this prevalence would be related to WTC-related and other pre-WTC occupational exposures. The prevalence of pulmonary nodules in this WTC responder cohort is similar to that reported in lung cancer screening cohorts. In these WTC responders, age and pleural thickening were significantly associated with severity of Lung-RADS findings. Aside from pleural thickening, consistent with pre-WTC asbestos exposure, neither WTC nor pre-WTC occupational exposure variables were associated with nodular lung disease. Our findings, if replicated, could be supportive of the recommendation to "relax" lung cancer screening eligibility criteria in consideration of occupational and environmental exposures, which may be highly relevant in the WTC and other occupationally exposed populations. With LDCT-based lung cancer screening for heavy smokers now a standard of care in the United States, and with a sizable proportion of smokers among the WTC responder population, many may be referred for screening as the cohort ages. Estimating the influence of WTC-related and WTC-unrelated occupational exposures on the basis of the presence of NCNs is an additional factor to consider when assessing the benefits associated with lung cancer screening in this group. The strengths of our study included the relatively large number of participants with imaging interpretations collected in a research setting, systematically ascertained smoking and occupational exposure data, and individual-level comparisons with a large screening trial. Notable limitations included the small size of our sample of patients meeting NLST inclusion criteria. In addition, because our study included only an initial imaging encounter for WTC responders, it did not determine the incidence of lung nodules or their longitudinal progression. [Description provided by NIOSH]
• Subjects:
  Diagnosis Emergency Responders Lung Occupational Health Respiratory System Safety September 11 Terrorist Attacks
• Keywords:
  Author Keywords: Occupational Lung Disease Diagnostic Techniques Emergency Responders Imaging Techniques Lung Cancer Screening Lung Imaging Lung Nodules Pulmonary Disorders Pulmonary Effects Pulmonary Function Rescue Workers Respiratory Function World Trade Center WTC WTC Disaster

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• ISSN:
  2329-6933
• Document Type:
  Text
• Funding:
  Cooperative Agreement ; Contract
• Genre:
  Journal Article
• Place as Subject:
  New York ; OSHA Region 2 ; OSHA Region 3 ; Pennsylvania
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  125-128
• Volume:
  17
• Issue:
  1
• NIOSHTIC Number:
  nn:20057263
• Citation:
  Ann Am Thorac Soc 2020 Jan; 17(1):125-128
• Contact Point Address:
  Rafael E. de la Hoz, Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, USA
• Email:
  Rafael.delaHoz@mssm.edu
• Federal Fiscal Year:
  2020
• Performing Organization:
  Icahn School of Medicine at Mount Sinai, New York
• Peer Reviewed:
  False
• Start Date:
  20120901
• Source Full Name:
  Annals of the American Thoracic Society
• End Date:
  20260831
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:6f90f46f293985cce241c6a474bd5a93d16d4266d05957a739008fde22cb356807972dfd74b99d4575c76efbc7416a4bb331662ab332373a2b36bce1fe734d21
• Download URL:
  https://stacks.cdc.gov/view/cdc/214667/cdc_214667_DS1.pdf
• File Type:
  [PDF - 527.39 KB ]