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Background We previously showed that low-dose computed tomography (LDCT) screening in asbestos-exposed workers is effective in detecting lung cancer (LC) at an early stage. Here, we evaluate whether LDCT screening could reduce mortality from LC in such a high-risk population. Methods Within a cohort of 2433 asbestos-exposed men enrolled in an Occupational Health surveillance programme, we compared mortality between the participants in the ATOM002 study (LDCT-P, N = 926) and contemporary non-participants (LDCT-NP, N = 1507). We estimated standardized mortality ratios for the LDCT-P and LDCT-NP populations using regional and national rates (SMR_FVG and SMR_ITA, respectively). We compared survival for all causes, all neoplasms, LC and malignant neoplasm of pleura (MNP) between LDCT-P and LDCT-NP using Cox proportional hazard models adjusted for age, smoking history, asbestos exposure level and comorbidities. Results A reduction in mortality from LC was observed in the LDCT-P group compared with regional and national figures (SMR_FVG = 0.55, 95% confidence interval (CI) 0.24-1.09; SMR_ITA = 0.51, 95% CI 0.22-1.01); this was not the case for the LDCT-NP group (SMR_FVG = 2.07, 95% CI 1.53-2.73; SMR_ITA = 1.98, 95% CI 1.47-2.61). A strong reduction in LC mortality was observed for the LDCT-P compared with the LDCT-NP [hazard ratio (HR) = 0.41, 95% CI 0.17-0.96]. Mortality was also reduced for all causes (HR = 0.61, 95% CI 0.44-0.84), but not for all neoplasms (HR = 0.97, 95% CI 0.62-1.50) and MNP (HR = 0.86, 95% CI 0.31-2.41) within the LDCT-P population. Conclusions In our cohort, participation in the LDCT screening study was associated with reduced mortality from LC. This finding supports the use of LDCT in surveillance programmes for asbestos-exposed workers.

Objectives. To compare a local cohort of 2,488 men occupationally exposed to asbestos and enrolled in a public health surveillance program with the 1995 – 2009 cancer incidence of the general population of Friuli Venezia Giulia (FVG) region, Northeast Italy, we conducted a historical cohort study. Methods. Standardized incidence ratios (SIRs), with 95% confidence interval (95%CI), for specific cancer sites were estimated in the cohort and in subgroups of workers employed in shipbuilding between 1974-1994. For internal comparisons, we estimated incidence rate ratios (IRRs) for all cancers, lung cancer and mesothelioma, by level of exposure to asbestos and sector of employment adjusted for smoking habits and age at start of follow-up. Results. Among cohort members the SIR was 8.82 (95%CI 5.95-12.61) for mesothelioma and 1.61 (95%CI 1.26-2.04) for lung cancer. In subgroup analyses, the SIR for lung cancer in subjects hired in shipbuilding between 1974-1984 was 2.09 (95%CI 1.32-3.13). In the overall cohort, a borderline increased incidence was also found for stomach cancer (SIR=1.53 95%CI 0.96-2.31). Internal comparisons within the cohort show that among men with high asbestos exposure level the relative risk was almost three-fold for lung cancer (IRR=2.94 95%CI 1.01-8.57). Conclusions. This cohort experienced an excess in the incidence of both mesothelioma and lung cancer, showing increasing incidence rates at higher level of asbestos exposure. For lung cancer, the relative incidence was highest among workers hired in shipbuilding between 1974-1984.

Purpose In 2002 subjects already enrolled in a surveillance program for asbestos-exposed workers were recruited in a Low Dose CT scan screening (LDCT) (ATOM002 Study). During the 2-year program LDCT identified 11 lung cancer (LC) cases versus none detected by chest radiographs (CXR). The objective of this study is to evaluate whether, after a 10-year follow-up, this program was effective in reducing mortality for LC as compared with conventional health surveillance. Methods Within a cohort of 2,433 occupationally asbestos-exposed men, enrolled in a public health surveillance program, we compared mortality and survival between participants in a screening program based on LDCT (ATOM002-P, n = 926) and non-participants (ATOM002-NP, n = 1,507). For external comparison, we estimated the standardised mortality rate ratio (SMR_ITA) using italian standard rates. For internal comparisons we performed Cox proportional hazard models to assess survival for all causes, all cancers, LC and malignant neoplasm of the pleura. Final models were adjusted for smoking habits, age at start of follow-up, level of exposure to asbestos and Charlson-Quan comorbidity index. Results LC crude mortality was 99.4 per 100,000 person-year in ATOM002-P (Obs = 8) compared to 430.4 per 100,000 person-year in ATOM002-NP (Obs = 50). Compared with italian mortality rates, a trend towards reduced mortality for lung cancer was found among ATOM002-P (SMR_ITA = 0.51 95% CI: 0.22–1.01), in contrast to a statistically significant increase in the ATOM002-NP (SMR_ITA = 1.98; 95% CI: 1.47–2.61). Internal comparisons show a significant 59% reduction in mortality for lung cancer in ATOM002 participants (HR = 0.41,95% CI: 0.17–0.96). Mortality was also reduced for all causes (HR = 0.61, 95% CI: 0.44–0.84), but not for all cancers (HR = 0.97, 95% CI: 0.62–1.50) and malignant neoplasm of the pleura (HR = 0.86, 95% CI: 0.31–2.41). Conclusions In our cohort, a 2-year LDCT-based screening protocol was more effective in reducing mortality for LC than conventional public health surveillance. Surveillance program for asbestos-exposed workers should include LDCT screening.

1554Background: Our prospective non-randomized ATOM002 study showed that LDCT screening of asbestos-exposed subjects can identify LC at an earlier, potentially more curable, stage than chest radiog...