Early Lung Cancer Detection Program

Former Worker Medical Screening Program (FWP)

Since 2000, DOE has made screening for occupational lung cancer with low-dose helical computed tomography (CT) scans available to workers at high risk for lung cancer. Because former workers undertook essential activities to fulfill the Department's mission, many of them were at risk for lung cancer. Through the FWP, DOE initiated the Early Lung Cancer Detection (ELCD) program using low-dose helical CT scans to detect lung cancers at an earlier, more treatable stage. Lung cancer results in about 160,000 deaths in the U.S. every year. The most common causes of lung cancer are long-term exposures to tobacco smoke and residential radon emissions, but occupational hazards, such as asbestos and ionizing radiation, also cause or contribute to the disease.

In 2000, the Worker Health Protection Program (WHPP), one of the FWP projects that is administered by Queens College of the City University of New York and the United Steelworkers, began using low-dose helical CT scans to screen individuals who met established eligibility criteria, including a history of at-risk occupational exposure to lung carcinogens such as asbestos, beryllium, radioactive materials, nickel, and chromium. WHPP offers the ELCD program at the following DOE sites: Oak Ridge K-25, Paducah, and Portsmouth Gaseous Diffusion Plants; Y-12 National Security Complex; Oak Ridge National Laboratory; Mound Plant; and the Feed Materials Production Center (FMPC or Fernald).

FWP medical screening services, including the ELCD, are covered by DOE human subjects protection requirements, and DOE has taken steps to ensure that participants are fully informed of the possible risks and benefits of the ELCD. The WHPP screening program is overseen and approved by the Central DOE Institutional Review Board (IRB), which was established to oversee the protection of human subjects research. The IRB's role is to review FWP information provided to potential participants and informed consent material to ensure that they clearly and accurately depict the benefits and risks of participating in the screening program, the screening process, and how individuals' test results will be stored and protected.

From 2000 through September 30, 2012, WHPP performed chest CT scans on 12,148 workers, for a total of 32,684 CT scans (including repeat scans for indeterminate nodules). The results are summarized in Table 1 below. Eighty-seven ELCD program participants were identified as having primary lung cancer. WHPP determined the stage of these cancers - indicated by a descriptor (usually numbers I to IV) of how much the cancer has spread - and found that 57 of the 77 (74%) individuals whose lung cancers have been staged to date (10 are pending) had a Stage I or II non-small cell or limited small cell cancer at the time of diagnosis. CT screening detected these cancers at an early stage, when treatment is more likely to be effective, and proved to be better for early detection than conventional chest x-rays.

Table 1. Stage of Lung Cancers Detected by WHIPP
Early Lung Cancer Detection Program, 2000-September 30, 2012¹

¹ Early cancer is defined as State I or II non-small cell or limited small cell.

More recently, WHPP expanded its ELCD program to former Nevada National Security Site (NNSS, formerly known as the Nevada Test Site) workers who may have been exposed to lung carcinogens such as asbestos, silica, beryllium, radioactive materials, and diesel exhaust. The opening ceremony for the NNSS ELCD program was held on August 8, 2012, at the National Atomic Testing Museum in Las Vegas. Featured speakers included HSS Chief Health, Safety and Security Officer; Principal Investigator for the NNSS ELCD program; local representatives from the offices of Senator Harry Reid, Senator Dean Heller, Congressman Joe Heck, and Congresswoman Shelley Berkley; and a member of the Southern Nevada Building and Construction Trades. Data from this new program will be presented in next year's annual report.

In addition, the Building Trades National Medical Screening Program, another component of the FWP, began a pilot screening program in April 2011. This pilot program, coordinated by CPWR - The Center for Construction Research and Training and supported by the Building and Construction Trades Department of the American Federation of Labor and Congress of Industrial Organizations (AFL-CIO) and the Knoxville Building and Construction Trades Council that represent construction workers at the Oak Ridge Reservation, included 100 participants at Oak Ridge. Baseline scans have been completed, and workers are now coming back for either their follow-up scans to check on indeterminate nodules or their annual scan. Two workers were found to have Stage IV lung cancer, and one individual was found to have kidney cancer.

Ultimately, the results of low-dose helical CT scans and medical examinations provide valuable insights to advance the scientific and public health communities' understanding of the health effects that may result from work-related exposures. This improved knowledge is likely to lead to enhanced safety and health measures that will better protect the current and future generation of workers.

In early FY 2013, the ELCD program was expanded to former Idaho National Laboratory production workers. Additional plans for expansion to other projects are underway.

Program Element:

• Low-dose Spiral CT Scans for Early Lung Cancer Detection
• Worker Health Protection Program Photo Essay

Program Manager: Mary Fields