Chest computed tomography screening for lung cancer in asbestos occupational exposure: A systematic review and meta-analysis
A partir d'une revue systématique de la littérature (7 études, 5 074 participants), cette méta-analyse évalue la performance de la tomographie numérique de la région thoracique pour détecter précocement un cancer du poumon (49 cas) chez les travailleurs exposés à l'amiante
Background : Lung cancer is the most frequent malignant asbestos-related pathology and remains the most fatal cancer of industrialized countries. In heavy smokers, early detection of lung cancer with chest computed tomography (CT) leads to a 20% mortality reduction. However, the use of CT screening for early detection of lung cancer in asbestos-exposed workers requires further investigation.
Aims : To determine whether CT screening in asbestos-exposed workers is effective in detecting asymptomatic lung cancer using a systematic review and meta-analysis.
Methods : We reviewed all cohort studies involving chest CT screening in former asbestos-exposed workers. The search strategy used the keywords: “asbestos”, “lung cancer”, “screening” and “occupation*” or “work”. Databases were PubMed, Cochrane Library, Science Direct, Embase.
Results : Seven studies matched our inclusion criteria. Baseline screening detected 49 asymptomatic lung cancers among 5074 asbestos-exposed workers. Of the 49 reported prevalences, at least 18 were in the earliest stage (stage 1) accessible to complete removal surgery. The prevalence of all lung cancers detected by CT screening in asbestos-exposed workers was 1.1% (CI 95%: 0.6%-1.8%).
Conclusions : CT screening in asbestos-exposed workers is effective in detecting asymptomatic lung cancer. Detection of lung cancer in asbestos-exposed workers using CT is at least equal to the prevalence in heavy smokers (1%; 95%CI: 0.09%-1.1%) (Aberle et al., N Engl J Med, 2011), and also shared a similar proportion of stage 1 diagnoses. Screening asbestos-exposed workers could reduce mortality in proportions previously observed among heavy smokers and thus, should not be neglected, particularly for individuals combining both exposures.
CHEST Journal , résumé, 2013