Department of Systems and Control

Jožef Stefan Institute

Early detection of lung cancer in workers with asbestos disease

Principal investigator:

Asst. Prof. Dr. Marjeta Terčelj-Zorman, University Medical Centre Ljubljana
Responsible investigator at the department: Asst. Prof. Dr. Đani Juričić

Duration:

September 1, 2005 - August 31, 2008

Funding:

ARRS - Slovenian Research Agency, L3-7123

Abstract:

Background: Lung cancer is the leading cause of cancer related deaths. In Slovenia, it afflicts 1 100 persons yearly and fewer than 10% survive 5 years after initial diagnosis. The 5 year survival rate is closely linked to the stage of the disease at the diagnosis: it is up to 70% for stage I and falls below 10% for stage III and zero for stage IV. Among the known risk factors for lung cancer, cigarette smoking and asbestos exposure are the most prominent. Till now screening for early stages of lung cancer has not been successful. However, several newly developed technologies offer new hope of early detection of lung cancer: • Spiral computerized tomography, now in clinical trials – expensive and not easily accessible • Automatic quantitative cytometry of sputa and bucal mucosa, assessing probability of lung cancer on basis of “malignancy associated changes” in “normal cells”; now in clinical trials – less expensive, easier access. • Fluorescence bronchoscopy coupled with newly developed spectroscopic assay of suspicious areas in bronchial mucosa, that uncover previously occult early lesions of conventional (white light) bronchoscopy. The main idea of the project is to take advantage of the emerging and considerably more accurate diagnostic means for detection of early lung cancer and combine that with geographic information systems technologies in order to carry out wide screening of the population with asbestosis and those with history of asbestos exposure. Asbestos has been widely used, especially in Anhovo, until it was forbidden in 1996. About 30 000 persons have been exposed, 2 500 are diagnosed with asbestosis and we expect most cases will develop lung cancer during the next 2-3 decades, 80% being smokers and the latent period for lung cancer in asbestosis being about 27 years. Aim of the study: The primary aim of this project is to develop a screening method for early detection of lung cancer, in patients who already suffer for asbestosis and have approximately 7-times higher risk to get lung cancer comparing with those who do not have asbestosis. The authors believe that developing screening method for early detection of lung cancer would be much more effective in a group of asbestosis patients than in any other group. Namely, patients with asbestosis are at the greatest risk to get lung cancer, especially if we consider that almost 80% of them have been long term also smokers. Specific aims are as follows: • To assess the risk ob lung cancer in our population exposed to asbestos, on the basis of cumulative asbestos exposure calculation, cytological assess and, when necessary, bronchoscopy with spectroscopy and biopsy. • To detect, by these means, a larger proportion of lungs cancer in an early, more curable stage, thus improving the long term survival; • To develop, based on the analysis of this cohort of patients, a strategy for future evidence, screening for early lung cancers, accurate diagnosis, treatment policies and follow-up of these patients, applicable at the primary care level. Methods: A prospective cohort study will be done. The observed population will include all ex-workers with recognised asbestos related disease and those who are in the process of recognition of occupational disease. The cohort will be followed from the year 2005 to 2008, from 2009 to 2025 it will be followed at primary medical care. Laboratory analysis: Sputum analysis, bronchial mucosa smear with classic cytology, automatic quantitative cytometry (Papanicoulau, AQC) and endoscopic examination of bronchial mucosa with white and fluorescent light bronchoscopy will be performed on patients with high suspicion of precancerosis or early stage lung cancer. All biopsies made by spectrographic bronchoscopy will be examined with classic and automatic quantitative cytometry and pathology with the intention of decreasing both the subjectivity of the classification of early lesions and the number of unne...