Optimizing Lung Cancer Screening in World Trade Center Rescue and Recovery Workers

Details

• Personal Author:
  de la Hoz RE ; Sigel KM ; Wisnivesky J
• Description:
  Exposure to carcinogens at the WTC site in combination with significant rates (approx. 40%) of smoking has raised concerns about the risk of lung cancer among WTC responders. The National Lung Screening Trial (NLST) demonstrated that low-dose computed tomography (LDCT) screening leads to a 20% decrease in lung cancer mortality among smokers in the general population. However, extrapolating NLST results to the WTC responder population is challenging. Several factors may influence the harms and benefits of screening in this population including a unique set of lung cancer risk factors, an increased rate of false positive LDCTs due to exposure-related lung disease, high prevalence of decreased lung function, lower overall mortality due to a 'healthy worker' effect, and decreased quality of life due to WTC-related physical and mental health conditions. Thus, the harms, benefits, and cost-effectiveness (CE) of lung cancer screening in the general population may be different in WTC responders. Thus, the goal of this project was to use simulation modeling to evaluate the effectiveness of LDCT screening in this unique group. The Specific Aims of the study were to: 1) enhance a well-validated lung cancer microsimulation model (the LCPM) to replicate the natural history, treatment and outcomes of lung cancer screening and estimate the benefits of LDCT screening based on current guidelines in WTC responders; 2) identify the optimal lung cancer screening regimen (i.e., duration, frequency of scans) and eligibility criteria (i.e., age, smoking history, occupational risk, WTC exposure) for smokers who were WTC responders; 3) evaluate different follow-up evaluation protocols for positive lung cancer screening tests in WTC responders to maximize benefits and minimize harms; and 4) evaluate the cost-effectiveness (CE) of LDCT screening vs. no screening in WTC responders. To accomplish these Aims, we enhanced the well-validated LCPM to capture the unique harms and benefits and CE of LDCT screening in WTC responders. We analyzed several large, relevant datasets to create new LCPM modules and modified key input parameters to accurately represent lung cancer screening in WTC responders. In analyses to parameterize the novel simulation we found that although pulmonary nodules were frequent in the WTC responder cohort, the prevalence of suspicious nodules was not significantly more than expected. In addition, in an updated analysis of lung cancer incidence in the WTC responder cohort, we did not find an increased risk of lung cancer associated with WTC exposure. Simulation model output evaluating lung cancer screening eligibility in the WTC responder cohort yielded extensive output and suggested that more inclusive screening criteria (lowering smoking intensity eligibility thresholds) may be associated with mortality benefits without substantially increased harms. Last, in cost-effectiveness analyses we found many cost-effective screening strategies for WTC responders, including initiating screening at age 40 with a minimum 20 pack-years of smoking ($92,652 per quality adjusted life year gain). [Description provided by NIOSH]
• Subjects:
  Cohort Studies Emergency Responders Lung Lung Diseases Neoplasms Occupational Health Respiratory System Respiratory Tract Diseases Safety September 11 Terrorist Attacks
• Keywords:
  Cancer Rates Cohort Studies Emergency Responders Lung Cancer Lung Disease Medical Screening Rescue Workers Surveillance World Trade Center WTC
• Series:
  Grant Final Reports
• Publisher:
  National Institute for Occupational Safety and Health
• Document Type:
  Text
• Funding:
  Cooperative Agreement
• Genre:
  Final Cooperative Agreement Report
• Place as Subject:
  New York ; OSHA Region 2
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  OEP - Office of Extramural Programs
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  1-23
• NIOSHTIC Number:
  nn:20066953
• Citation:
  Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, U01-OH-011479, 2022 Sep; :1-23
• Contact Point Address:
  Keith Magnus Sigel, BS MD MPH, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029-6574
• Email:
  keithsigel@gmail.com
• Federal Fiscal Year:
  2022
• Performing Organization:
  Icahn School of Medicine at Mount Sinai, New York
• Peer Reviewed:
  False
• Start Date:
  20180701
• Source Full Name:
  National Institute for Occupational Safety and Health
• End Date:
  20210630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:f3f0dc84a10bf13579ac00f9d59accdf1a6cfb7939fcf6c8bd6b4d5bc1f9c4bd42ad70ba42a9e9f2733368a2ee471a4dcfd1ab8ee229e34f5474ffdd8d8172e3
• Download URL:
  https://stacks.cdc.gov/view/cdc/219177/cdc_219177_DS1.pdf
• File Type:
  [PDF - 1.21 MB ]