Lung cancer mortality among construction workers: implications for early detection

Occup Environ Med. 2020 Apr;77(4):207-213. doi: 10.1136/oemed-2019-106196. Epub 2020 Jan 29.


Objectives: This study examined predictors of lung cancer mortality, beyond age and smoking, among construction workers employed at US Department of Energy (DOE) sites to better define eligibility for low-dose CT (LDCT) lung cancer screening.

Methods: Predictive models were based on 17 069 workers and 352 lung cancer deaths. Risk factors included age, gender, race/ethnicity, cigarette smoking, years of trade or DOE work, body mass index (BMI), chest X-ray results, spirometry results, respiratory symptoms, beryllium sensitisation and personal history of cancer. Competing risk Cox models were used to obtain HRs and to predict 5-year risks.

Results: Factors beyond age and smoking included in the final predictive model were chest X-ray changes, abnormal lung function, chronic obstructive pulmonary disease (COPD), respiratory symptoms, BMI, personal history of cancer and having worked 5 or more years at a DOE site or in construction. Risk-based LDCT eligibility demonstrated improved sensitivity, specificity and positive predictive value compared with current US Preventive Services Task Force guidelines. The risk of lung cancer death from 5 years of work in the construction industry or at a DOE site was comparable with the risk from a personal cancer history, a family history of cancer or a diagnosis of COPD. LDCT eligibility criteria used for DOE construction workers, which includes factors beyond age and smoking, identified 86% of participants who eventually would die from lung cancer compared with 51% based on age and smoking alone.

Conclusions: Results support inclusion of risk from occupational exposures and non-malignant respiratory clinical findings in LDCT clinical guidelines.

Keywords: LDCT; chest radiography; lung cancer; pulmonary function.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Construction Industry*
  • Early Detection of Cancer
  • Federal Government
  • Female
  • Humans
  • Lung Neoplasms / etiology
  • Lung Neoplasms / mortality*
  • Male
  • Middle Aged
  • Occupational Diseases / etiology
  • Occupational Diseases / mortality*
  • Occupational Exposure / adverse effects*
  • Proportional Hazards Models
  • Risk Factors
  • Smoking / adverse effects
  • United States / epidemiology