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
Site of ELCD
Program
|
Number of Participants
Screened
|
Number of Lung
Cancers Detected
|
Number of Detected
Lung Cancers That Were Staged
|
Number (%)
of Early (Stage I or II Non-Small Cell or Limited Small
Cell) Cancers Detected
|
Paducah
|
1,942
|
12
|
9
|
8 (67%)
|
Portsmouth
|
2,218
|
19
|
19
|
15 (79%)
|
K-25
|
2,804
|
25
|
23
|
19 (76%)
|
ORNL
|
1,249
|
10
|
8
|
2 (20%)
|
Y-12
|
2,866
|
16
|
15
|
10 (63%)
|
Mound Plant
|
575
|
4
|
3
|
3 (75%)
|
FMPC
|
400
|
0
|
N/A
|
N/A
|
TOTAL
|
12,148
|
87
|
77
|
57 (66%)
|
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:
Program Manager: Mary
Fields
|