Lung-Cancer-Screening Guidelines Fail to Address Risk in First Responders

By Megan Brooks

October 16, 2019

NEW YORK (Reuters Health) - Current guidelines for lung-cancer screening are inadequate to detect lung cancer from occupational exposures, including those in first responders, researchers say.

The U.S. Preventive Services Task Force recommends annual lung-cancer screening with low-dose computed tomography (CT) starting at age 55 in adults with a 30-pack-year smoking history and are current smokers or who quit within the past 15 years.

But about 30% of all lung cancers diagnosed in the U.S. stem from occupational exposure and most of these are in first responders. There are no occupationally specific lung-cancer-screening recommendations for first responders, however.

"Today's modern-built structural environments use an increase in synthetic products resulting in unknown and more contaminated environments for fire fighters. Benzene, arsenic, asbestos, cadmium and diesel engine exhaust are the known, more common lung-cancer carcinogens that fire fighters inhale routinely," Dr. Vershalee Shukla, of the Vincere Cancer Center in Scottsdale, Arizona, told Reuters Health by email.

Dr. Shukla and colleagues assessed the value of low-dose lung CT as a screening modality in 195 first responders (185 men), ages 27 to 76, with an average of 22 years of occupational exposure.

Eighty-six (44%) had abnormal results, including 133 pulmonary nodules; the mean age in this subset was 51. Five patients had evidence of pulmonary injury from smoke inhalation. On Lung-RADS screening, most lesions were benign or probably benign, but three were "suspicious."

"My small study confirmed what is already known, that fire fighters are at an increased risk of lung cancer despite wearing a self-contained breathing apparatus," Dr. Shukla said. "The surprising part of my study is the number of lung nodules we found in young fire fighters. We found double the number of lung nodules when compared to smokers aged 55 years and older, or those that had a smoking history of 30 years or more."

Dr. Shukla presented her findings October 11 at the International Association for the Study of Lung Cancer (IASLC) 2019 North America Conference on Lung Cancer in Chicago.

"This study demonstrates value for low-dose CT as a screening modality for first responders, who are often diagnosed with lung cancer earlier than smokers for various reasons and therefore screened earlier in this study," she said in a statement. "The very early results are promising, and ongoing follow-up will likely lead to further diagnosis of early lung cancer. This is a small study and warrants further investigation on a larger scale."

Dr. Shukla's research is part of state and national effort to raise awareness of the cancer risk for first responders.

"This study is one of the main instigators for the City of Phoenix to develop a pilot project with Vincere Cancer Center to change current screening guidelines and screen fire fighters earlier with safe technologies," she told Reuters Health.

"The City of Phoenix is self-insured and therefore able to pay for all firefighters to have low-dose lung CT scans starting at the age of 40 or earlier as need be. The city has also lowered the ages for colonoscopies and other screening tests. Our goal is to detect early cancers in fire fighters when the cancer is curable and treatment has minimal morbidity. We also believe this will be cost-effective for the City of Phoenix as early-stage cancer requires less treatment. Finally, we are trying to develop cancer-screening guidelines that can be used throughout all of North America in order to keep fire fighters safe and healthy throughout their careers."


IASLC 2019 North America Conference on Lung Cancer.