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Why Certain Workers Should Be Screened for Lung Cancer

Age and smoking history are well-known lung cancer risk factors. The U.S. Preventive Services Task Force recommends that adults of a certain age range and smoking history be screened for lung cancer every year. But new research by Professor Steven Markowitz, M.D. (GG/Queens College, Earth and Environmental Sciences) shows that occupation is another factor that should be used to identify who would benefit from annual lung cancer screenings. 
In a study published in the American Journal of Public Health, Dr. Markowitz and colleagues conducted CT scans to detect lung cancer in over 7,000 nuclear weapons workers, who can be exposed to carcinogens in the workplace.
Markowitz discussed his research and findings with The Graduate Center.
Graduate Center: What did this study reveal?
Dr. Markowitz: Using occupational exposure as a risk factor in combination with age and smoking history, we found a sizable number of lung cancers in the workers. Two-thirds of the cases were at an early stage, when surgery should be able to cure the disease.
Also, while most large studies are done in tertiary care medical centers in urban areas, we did this screening among blue-collar workers in largely rural areas where diagnostic and therapeutic care occurred in community hospitals. This demonstrates that lung cancer screening outside of major metropolitan areas is feasible.
GC: What is the next step in making occupation-based screening a reality in the medical world?
Dr. Markowitz: We need two-way communication. Workers need to tell their providers what kind of work they did and whether, to the extent that they know, they worked with materials such as asbestos, silica, or other carcinogens. Doctors have to ask patients what kind of work they do and have done in the past, in addition to taking a smoking history, to determine who might benefit from LDCT (low-dose computed tomography). We also need public education campaigns to promote LDCT for people at high risk, since few people know about this screening tool.
GC: Where will you take this research from here?
Dr. Markowitz: We are continuing to screen a large number of workers on an annual basis and new participants as well. Lung cancer screening has to be done on an annual basis for many years.
We are also continuing to look at our LDCT data; we want to help determine how to minimize harm from LDCT, such as surgery for lung nodules that turn out benign. Finally, we have begun to work to introduce LDCT to construction workers, who have the highest prevalence of cigarette smoking of any occupational group in the U.S.
GC: How did you become interested in the field of occupational and environmental medicine?
Dr. Markowitz: During my summers in college I did research on lead poisoning in kids, and I investigated an outbreak of bladder cancer among chemical workers in New Jersey during medical school. It is an endlessly fascinating way to prevent people from becoming ill, since identifying the toxic effects of exposures permits reduction or elimination of those exposures and elimination of related illnesses.
GC: What work led up to this research?
Dr. Markowitz: I helped start an occupational disease screening program, called the Worker Health Protection Program, for former Department of Energy nuclear weapons workers in 1997. When CT scanning was first identified as able to detect lung cancers at an early, curable stage in 1999, we introduced the same low-dose CT (LDCT) scanning for Department of Energy workers, many of whom had been exposed to workplace lung carcinogens, such as asbestos, beryllium, and radiation.

Submitted on: NOV 15, 2018

Category: Earth and Environmental Sciences | Faculty | General GC News