FWP Scientific Publications
Former Worker Medical Screening Program (FWP)
Scientific publications either directly studying former workers
in the context of the screening program or recruiting former
workers in the program as research participants for scientific
studies funded by the National Institutes of Health or other
research funding sources are summarized below according to publication
Manowitz A., Sedlar M., Griffon M., Miller A., Miller J.,
Markowitz S. Use of BMI guidelines and individual dose tracking
to minimize radiation exposure from low-dose helical chest CT
scanning in a lung cancer screening program. Academic Radiology,
19(1): 84-88, 2012.
The increasing use of computed tomography (CT) has
been accompanied by rising concerns over potential radiation-related
health risks, especially cancer, and a need to minimize such
risks. The authors conducted 2,186 low-dose helical chest CT
scans among 1,235 nuclear weapons workers at elevated risk of
lung cancer, setting the CT scanner tube current at 30 mAs for
all partipants with Body Mass Index (BMI) <35 kg/m2 and permitting
technologists to raise mAs levels for participants with BMI
≥35 kg/m2. Dose-length product (DLP) was recorded from the CT
scanner, permitting calculation of effective dose. Phantom-based
estimates of effective dose were also made. A chest radiologist
recorded acceptability of image quality. The study population
was significantly overweight. Nearly 90% of CT scans were performed
using a tube current setting of 30 mAs and had a mean DLP-based
effective dose of 1.3 mSv. The phantom-based estimate of effective
dose was lower at 1.1 mSv. Among participants with a BMI ≥35
kg/m2, 92% were scanned at 40 or 50 mAs, which was associated
with a DLP-based effective dose of 1.6 and 2.0 mSv, respectively.
Image quality was satisfactory in 99.8% of scans. Application
of simple BMI-based guidelines and DLP tracking of low-dose
helical chest CT scans in a lung cancer screening program minimizes
radiation dose, even in a largely overweight population.
Leavey A., Frank A., Pinson B., Shepherd S., and Burstyn
I. Hypothyroidism among former workers of a nuclear weapons
facility. American Journal of Industrial Medicine, 54(12):955-964,
Hypothyroid status was determined for 622 former workers
of a nuclear weapons facility located in Texas, using a combination
of measured thyroid stimulating hormone (TSH) levels and thyroid
medication history, as part of an on-going health surveillance
program. The authors classified 916 unique job titles into 35
job categories. According to the most stringent TSH definition
used in this study (0.3-3.0 IU/ml), 174 (28.0%) former workers
were considered to be hypothyroid; of these, 66 (41.8%) were
females and 108 (23.3%) were males. In logistic regression analysis
adjusted for age, gender, and smoking status, only having worked
as a material handler (n = 18) exhibited an elevated risk of
developing hypothyroidism compared to other jobs (OR 3.88, 95%
CI 1.43-11.07). Material handlers perform a job that has suspected
exposure to radiation. No excess risk of hypothyroidism was
observed for any of the other job categories. There is suggestive
evidence that only material handlers at this nuclear weapons
facility may have elevated risk of hypothyroidism; further evaluation
of thyroid health in this population is warranted.
Mikulski M., Hartley P., Sprince N., Sanderson W., Lourens
S., Worden N., Wang K., and Fuortes L. Risk and significance
of chest radiograph and pulmonary function abnormalities in
an elderly cohort of former nuclear weapons workers. Journal
of Occupational and Environmental Medicine, 53(9):1046-53, 2011.
A study to estimate prevalence and risk factors for
International Labour Organization radiographic abnormalities
and assess relationship of these abnormalities with spirometry
results in former U.S. Department of Energy (DOE) nuclear weapons
workers was undertaken. Participants were offered chest x-ray
and lung function testing. Three occupational medicine physicians
read the chest x-rays. Forty-five (5.9%) of the 757 screened
workers were found to have isolated parenchymal abnormalities
on chest x-ray; this rate is higher than that in many DOE studies.
Parenchymal and pleural abnormalities and isolated pleural abnormalities
were found in 19 (2.5%) and 37 (4.9%) workers, respectively,
and these rates are lower than those in other DOE studies to
date. Lung function impairment was associated with radiographic
abnormalities. This study found an elevated rate of parenchymal
abnormalities compared to other DOE populations, but the effect
of age or other causes could not be ruled out.
Mikulski M., Leonard S., Sanderson W., Hartley P., Sprince
N., and Fuortes L. Risk of beryllium sensitization in a low-exposed
former nuclear weapons cohort from the cold war era. American
Journal of Industrial Medicine; 2010 October 28. [E-published
ahead of print]
The nuclear weapons industry has long been known as
a source of beryllium exposure. A total of 1,004 former workers
from a nuclear weapons assembly site at the Iowa Army Ammunition
Plant were screened for sensitization to beryllium. Twenty-three
(2.3%) workers were found sensitized to beryllium, and this
prevalence was comparable to other U.S. Department of Energy
sites. Occasional, direct exposure to beryllium through machining
and grinding of copper-beryllium 2% alloy tools was found to
increase the risk of sensitization compared to background exposure
(OR=3.83; 95% CI: 1.04-14.03) with a statistically significant
trend (P=0.03) revealing that particular jobs are associated
with sensitization. Exposure potential in this study was estimated
based on job titles and not personal exposure information.
Dement J., Welch L., Ringen K., Bingham E., and Quinn P.
Airways obstruction among older construction and trade workers
at Department of Energy nuclear sites. American Journal of Industrial
Medicine, 53:224-240, 2010.
A study of chronic obstructive pulmonary disease (COPD) among
7,579 current and former workers participating in medical
screening programs at U.S. Department of Energy (DOE) nuclear
weapons facilities through September 2008 was undertaken.
Participants provided a detailed work and exposure history
and underwent a respiratory examination that included a respiratory
history, respiratory symptoms, a posterior-anterior chest
radiograph classified by International Labour Organization
criteria, and spirometry. The study of construction workers
employed at DOE sites demonstrated increased COPD risk due
to occupational exposures and was able to identify specific
exposures increasing risk.
Dement J., Ringen K., Welch L., Bingham E., and Quinn P.
Mortality among older construction and craft workers employed
at Department of Energy (DOE) sites. American Journal of Industrial
Medicine, 52:671-682, 2009.
A cohort of 8,976 former construction workers from Hanford Site, Savannah River Site, Oak Ridge, and Amchitka was followed using the National Death Index through December 31, 2004, to ascertain vital status and causes of death. DOE construction workers at these four sites were found to have significantly excess risk for combined cancer sites included in the Department of Labor Energy Employees Occupational Illness Compensation Program. Asbestos-related cancers were significantly elevated.
Dobis D.R., Sawyer R.T., Gillespie M.M., Huang J., Newman
L.S., Maier L.A., Day B.J. Modulation of lymphocyte proliferation
by antioxidants in chronic beryllium disease. American Journal
of Respiratory and Critical Care Medicine, 177(9):1002-11, 2008.
Occupational exposure to beryllium can result in chronic granulomatous inflammation characterized by the presence of beryllium-specific CD4+ T cells. Studies show that oxidative stress plays a role in the pathogenesis of chronic inflammatory disorders. Thirty-three subjects with chronic beryllium disease (CBD), 15 subjects with beryllium sensitization, and 28 healthy normal control subjects were consecutively enrolled from the Occupational and Environmental Health Clinic of National Jewish Health. The authors concluded that beryllium can mediate a thiol imbalance leading to oxidative stress that may modulate the proliferation and clonal expansion of beryllium-specific blood CD4+ T cells. These data suggest that beryllium-induced oxidative stress plays a role in the pathogenesis of granulomatous inflammation in CBD.
Rodrigues E., McClean M., Weinberg J., and Pepper L. Beryllium
sensitization and lung function among former workers at the
Nevada Test Site. American Journal of Industrial Medicine, 51:512-523,
Beryllium use at the Nevada Test
Site was not acknowledged until the late 1990s. An observational
study was conducted to identify work-related factors associated
with the odds of having beryllium sensitization (BeS). Among
the 1,786 former workers tested for BeS, the prevalence of BeS
was 1.3%. An increased risk of BeS was found among workers who
performed cleanup (OR = 2.68, 95% confidence interval [CI]:
1.10, 6.56) and those who worked in Building B where beryllium
parts were machined (OR = 2.52, 95% CI: 1.02, 6.19).
Markowitz S.B., Miller A., Miller J., Manowitz A., Kieding
S., Sider L., and Morabia A. Ability of low-dose helical computed
tomography to distinguish between benign and malignant non-calcified
lung nodules. Chest, 131:1028-1034, 2007.
Low-dose helical computed tomography (CT) scanning identifies
early stage lung malignancies and also a large proportion of
lung nodules of uncertain diagnostic and prognostic significance
(i.e., indeterminate nodules). In this study, a total of 4,401
participants were CT scanned for lung cancer with an initial
full-chest low-dose CT scan; interval CT scans at 3, 6, and
12 months for indeterminate lung nodules (e.g., nodules not
immediately suspicious for lung cancer); and an 18-month, full-chest,
low-dose incidence CT scan. Only 3 of 727 indeterminate nodules
were identified as being malignant during the subsequent 18
months. The radiologist's designation of a nodule as suspicious
had a sensitivity of 84.2% and a specificity of 96.6%. Overall,
the authors detected 33 primary lung cancers, including 19 stage
I cancers, 5 stage II cancers, 7 stage III-IV cancers, and 3
limited-stage small cell cancers.
Sato H., Spagnolo P., Silveira L., Welsh K.I., du Bois R.M.,
Newman L.S., Maier L.A. BTNL2 allele associations with chronic
beryllium disease in HLA-DPB1*Glu69-negative individuals. Tissue
Antigens, 70(6):480-6, 2007.
Butyrophilin-like 2 (BTNL2) polymorphisms have been associated
with sarcoidosis. Genomic DNA was obtained from chronic beryllium
disease (CBD, n= 88), beryllium sensitized (BeS, n= 86), and
beryllium exposed nondiseased control subjects (Be-exp, n= 173).
The authors concluded that both DRB1*13 and rs3117099TT homozygosity
are associated with CBD in *Glu69-negative subjects, while DPB1*Glu69
is associated with CBD and BeS compared with Be-exp. As a result
of the small sample size and strong linkage disequilibrium between
DRB1*13-DQB1*0603/4/9 and the BTNL2 rs3117099T allele, it is
difficult to assess the primary association in DPB1*Glu69-negative
Sawyer R.T., Fontenot A.P., Barnes T.A., Parsons C.E.,
Tooker B.C., Maier L.A., Gillespie M.M., Gottschall E.B., Silveira
L., Hagman J., and Newman L.S. Beryllium-induced TNF-alpha production
is transcription-dependent in chronic beryllium disease. American
Journal of Respiratory Cell and Molecular Biology, 36(2):191-200,
Beryllium-antigen presentation to beryllium-specific CD4(+) T
cells from the lungs of patients with chronic beryllium disease
(CBD) results in T cell proliferation and TNF-alpha secretion.
The authors tested the hypothesis that beryllium-induced, CBD
bronchoalveolar lavage T cell, transcription-dependent, TNF-alpha
secretion was accompanied by specific transcription factor upregulation.
The data suggest that beryllium exposure induces transcription-dependent
TNF-alpha production, potentially due to upregulation of specific
Bingham E., Ringen K., Dement J., Cameron, W., McGowan W.,
Welch, L., and Quinn, P. Frequency and quality of radiation
monitoring at two gaseous diffusion plants. Annals of the New
York Academy of Sciences, 1076:394-404, 2006.
Since World War II, large numbers of construction workers were
employed at U.S. Department of Energy nuclear weapons sites,
performing tasks during new construction and maintenance, repair,
renovation, and demolition of existing facilities. Such tasks
may have involved emergency situations and may have entailed
opportunities for significant radiation exposures. This paper
provides data from interviews with more than 750 construction
workers at two gaseous diffusion plants at Paducah, Kentucky,
and Portsmouth, Ohio, regarding radiation monitoring practices.
Dement J., Ringen K., Welch L., Bingham E., and Quinn P.
Surveillance of hearing loss among construction and trade workers
at Department of Energy nuclear sites. American Journal of Industrial
Medicine, 48:348-358, 2005.
Medical screening programs for construction workers at Hanford
Site, Oak Ridge, and Savannah River Site have included audiometric
testing since approximately 1996. Hearing thresholds among U.S.
Department of Energy workers examined before 3/31/03 were much
higher than observed in a comparison population of industrial
workers with low noise exposures. Overall, 59.7% of workers
examined were found to have material hearing impairment by National
Institute for Occupational Safety and Health criteria. Age,
duration of construction work, smoking, and self-reported noise
exposure increased the risk of hearing loss.
Fontenot A.P., Palmer B.E., Sullivan A.K., Joslin F.G.,
Wilson C.C., Maier L.A., Newman L.S., and Kotzin B.L. Frequency
of beryllium-specific, central memory CD4+ T cells in blood
determines proliferative response. The Journal of Clinical Investigation,
Beryllium exposure can lead to the development of beryllium-specific
CD4+ T cells and chronic beryllium disease (CBD), which is characterized
by the presence of lung granulomas and a CD4+ T cell alveolitis.
Studies have documented the presence of proliferating and cytokine-secreting
CD4+ T cells in blood of CBD patients after beryllium stimulation.
However, some patients were noted to have cytokine-secreting
CD4 T cells in blood in the absence of beryllium-induced proliferation,
and overall, the correlation between the two types of responses
was poor. The authors hypothesized that the relative proportion
of memory T cell subsets determined antigen-specific proliferation.
In most CBD patients, the majority of beryllium-specific CD4+
T cells in blood expressed an effector memory T cell maturation
phenotype. However, the ability of blood cells to proliferate
in the presence of beryllium strongly correlated with the fraction
expressing a central memory T cell phenotype. In addition, the
authors found a direct correlation between the percentage of
beryllium-specific CD4+ T(EM) cells in blood and T cell lymphocytosis
in the lung. Together, these findings indicate that the functional
capability of antigen-specific CD4+ T cells is determined by
the relative proportion of memory T cell subsets, which may
reflect internal organ involvement.
Makie T., Adcoc D., Lackland D., and Hoel D.G. Pulmonary
abnormalities associated with occupational exposures at the
Savannah River Site. American Journal of Industrial Medicine,
This study includes data from 1,368 former Savannah River Site
(SRS) workers aged 45 years or older who were assessed regarding
work history and exposures to industrial agents. Chest radiographs
were evaluated by a single radiologist, and the results were
compared with the National Health and Nutrition Examination
Survey (NHANES) II results. The odds ratio of the SRS male aged
45-75 compared to NHANES was 2.4 for pleura abnormalities and
0.8 for parenchymal abnormalities. The highest-risk worker division
was construction (OR = 2.76). Asbestos and possibly other exposures
were related to pulmonary disease in this population.
Newman L.S., Mroz M.M., and Ruttenber A.J. Lung fibrosis
in plutonium workers. Radiation Research, 164(2):123-31, 2005.
There have been few systematic studies of the non-malignant
health effects of alpha-particle radiation in humans. Animal
studies and a report on plutonium-exposed workers from Russia
suggest an association between high doses to the lung from plutonium
exposure and the development of fibrotic lung disease. Prompted
by a case of lung fibrosis in a retired plutonium worker, the
authors tested the hypothesis that plutonium inhalation increases
the risk for developing chest radiograph abnormalities consistent
with pulmonary fibrosis. A retrospective study of nuclear weapons
workers was conducted that included estimating absorbed doses
to the lung with an internal dosimetry model. The study population
consisted of 326 plutonium-exposed workers with absorbed lung
doses from 0 to 28 Sv and 194 unexposed workers. This study
shows that plutonium may cause lung fibrosis in humans at absorbed
lung doses above 10 Sv.
Newman L.S., Mroz M.M., Balkissoon R., and Maier L.A. Beryllium
sensitization progresses to chronic beryllium disease: a longitudinal
study of disease risk. American Journal of Respiratory Cell
and Molecular Biology, 171(1):54-60, 2005.
The blood beryllium lymphocyte proliferation test is used in
medical surveillance to identify both beryllium sensitization
(BeS) and chronic beryllium disease (CBD). Approximately 50%
of individuals with BeS have CBD at the time of their initial
clinical evaluation; however, the rate of progression from BeS
to CBD is unknown. The authors monitored a cohort of beryllium-sensitized
patients at 2-year intervals, using bronchoalveolar lavage and
repeated transbronchial lung biopsies to determine progression
to CBD as evidenced by granulomatous inflammation in lung tissue.
No difference was found in average age, sex, race or ethnicity,
smoking status, or beryllium exposure time between those who
progressed to CBD and those who remained sensitized without
disease. The authors concluded that BeS is an adverse health
effect in beryllium-exposed workers and merits medical follow-up.
Pott G.B., Palmer B.E., Sullivan A.K., Silviera L., Maier
L.A., Newman L.S., Kotzin B.L., and Fontenot A.P. Frequency
of beryllium-specific, TH1-type cytokine-expressing CD4+ T cells
in patients with beryllium-induced disease. Journal of Allergy
and Clinical Immunology, 115(5):1036-42, 2005.
Beryllium sensitization is caused by exposure to beryllium in
the workplace. A subset of beryllium-sensitized (BeS) subjects
progress to chronic beryllium disease (CBD), a disorder characterized
by a CD4+ T-cell alveolitis and granulomatous inflammation. The
aim of this study was to determine whether the quantity of beryllium-specific
T cells in blood of patients with CBD differs from that found
in BeS subjects. Beryllium-induced T-cell proliferation and TH1-type
cytokine secretion were determined in blood cells from 33 patients
with CBD and 18 BeS subjects. The study concluded that the frequency
of beryllium-specific T cells in the blood of beryllium-exposed
subjects may be a useful biomarker that helps discriminate between
beryllium sensitization and progression to CBD.
Miller A., Markowitz S., Manowitz A., and Miller J.A. Lung
cancer screening using low-dose high-resolution CT scanning
in a high-risk workforce: 3500 nuclear fuel workers in three
US states. Chest, 125(5 Suppl):152S-3S, 2004.
Past and present nuclear fuel workers with demonstrated or
potential exposure to lung carcinogens (e.g., asbestos, radiation,
and/or beryllium) have been screened for early lung cancer with
a low-dose mobile CT scanner at three sites in the states of
Kentucky, Ohio, and Tennessee. Indeterminate nodules on low-dose
CT scans were re-scanned using a full-dose high-resolution technique.
Patients with nodules that remained indeterminate were re-scanned
at 3, 6, 12, and 18 months. Incidence screens were performed
18 months after the initial scan. The authors demonstrated the
practicality of lung cancer screening using low-dose CT scanning
in a large occupationally defined population in three states.
The overall lung cancer rate was 20 of 3,598 subjects; 0.7%.
Sackett H.M., Maier L.A., Silveira L.J., Mroz M.M., Ogden
L.G., Murphy J.R., and Newman L.S. Beryllium medical surveillance
at a former nuclear weapons facility during cleanup operations.
Journal of Occupational and Environmental Medicine, 46(9):953-61,
Despite the increasing need to remediate beryllium-contaminated
buildings in industry, little is known about the magnitude of
risk associated with beryllium abatement or the merits of beryllium
medical surveillance for cleanup workers. The authors examined
beryllium lymphocyte proliferation tests (BeLPTs) and reviewed
medical evaluations of workers at a nuclear weapons facility
during the process of decontamination and decommissioning. Of
2,221 workers, 19 (0.8%) were beryllium sensitized based on
two or more abnormal BeLPTs. Eight of 19 sensitized individuals
underwent full clinical evaluation, of whom two were diagnosed
with chronic beryllium disease (CBD). Notably, seven beryllium
sensitized and CBD cases were hired after the start of cleanup
operations. Beryllium medical surveillance detects sensitization
and CBD in cleanup workers. Exposure controls and medical surveillance
need to be 'broad-based' to include all cleanup workers involved
in beryllium-contaminated building remediation.
Sawyer R.T., Parsons C.E., Fontenot A.P., Maier L.A., Gillespie
M.M., Gottschall E.B., Silveira L., and Newman L.S. Beryllium-induced
tumor necrosis factor-alpha production by CD4+ T cells is mediated
by HLA-DP. American Journal of Respiratory Cell and Molecular
Biology, 31(1):122-30, 2004.
Beryllium presentation to CD4+ T cells from patients with chronic
beryllium disease (CBD) results in T cell activation, and these
beryllium-specific CD4+ T cells undergo clonal proliferation
and T-helper 1-type cytokine production. In exposed workers,
genetic susceptibility to this granulomatous disorder is associated
with particular HLA-DPB1 alleles. The authors hypothesized that
these HLA-DP molecules could mediate beryllium-stimulated tumor
necrosis factor-alpha (TNF-alpha) messenger RNA (mRNA) and protein
production. Using intracellular cytokine staining, the researchers
found that treatment with an anti-HLA-DP, but not anti-HLA-DR,
monoclonal antibody inhibited beryllium-stimulated TNF-alpha
expression in lung CD3+ CD4+ T cells. This monoclonal antibody
also blocked beryllium-specific T cell proliferation, increased
production of TNF-alpha mature-mRNA transcripts, and increased
TNF-alpha protein production by beryllium-stimulated CBD peripheral
blood mononuclear cells and bronchoalveolar lavage (BAL) cells.
The beryllium-stimulated upregulation of TNF-alpha mature-mRNA
levels with TNF-alpha protein production was a unique property
of CBD BAL cells, and did not occur in BAL cells from beryllium-sensitized
patients without CBD, or sarcoidosis BAL cells. This study identifies
HLA-DP as a regulatory component in the activation of T cell
receptors on beryllium-specific CD4+ T cells from CBD patients
resulting in proliferation and proinflammatory cytokine production.
Welch L., Ringen K., Bingham E., Dement J., Takaro T., McGowan
W., Chen A., and Quinn P. Screening for beryllium disease among
construction trade workers at Department of Energy nuclear sites.
American Journal of Industrial Medicine, 46: 207-218, 2004.
Screening programs for construction workers were undertaken
at the Hanford Site, Oak Ridge, and Savannah River Site. Of
the 3,842 workers screened at and included in this study, 34%
reported exposure to beryllium. Overall, 2.2% of workers had
at least one abnormal beryllium lymphocyte proliferation test
(BeLPT), and 1.4% were also abnormal on a second test. Regression
analyses demonstrated increased risk of having at least one
abnormal BeLPT to be associated with ever working in a site
building where beryllium activities had taken place. The findings
demonstrate that some of these workers had significant exposure,
most likely during maintenance, repair, renovation, or demolition
in facilities where beryllium was used.
Dement J., Welch L., Bingham E., Cameron B., Rice C., Quinn
P., Ringen K. Surveillance of respiratory diseases among construction
and trade workers at Department of Energy nuclear sites. American
Journal of Industrial Medicine, 43:559-573, 2003.
Medical screening programs were begun in 1996 and 1997 at Hanford
Site, Oak Ridge, and Savannah River Site to evaluate whether
current and former construction workers are at significant risk
for occupational illnesses. Of the 2,602 workers examined before
9/30/01, 25.2% showed one or more chest x-ray changes by International
Labour Organization criteria and 42.7% demonstrated one or more
pulmonary function defects. Although the observed respiratory
disease patterns are largely reflective of past exposures, these
findings suggest that DOE needs to continue to review industrial
hygiene control programs for work tasks involving maintenance,
repair, renovation, and demolition.
Stefaniak A.B., Weaver V.M., Cadorette M., Puckett L.G.,
Schwartz B.S., Wiggs L.D., Jankowski M.D., and Breysse P.N.
Summary of historical beryllium uses and airborne concentration
levels at Los Alamos National Laboratory. Applied Occupational
and Environmental Hygiene. 18(9):708-15, 2003.
Beryllium operations and accompanying medical screening of
workers at Los Alamos National Laboratory began in the 1940s.
In 1999, a Former Worker Medical Screening Program (FWP) that
includes screening for chronic beryllium disease was initiated.
As part of this program, historical beryllium exposure conditions
were reconstructed from archived paper and electronic industrial
hygiene data sources to improve understanding of past beryllium
uses and airborne concentration levels. A total of 4,528 personal
breathing zone and area air samples for beryllium, combined
for purposes of calculating summary statistics, were identified
during the records review phase. The geometric mean airborne
beryllium concentration for the period 1949-1989 for all technical
areas was 0.04 µg Be/m3 with 97 % of all samples below the 2.0
µg Be/m3 occupational exposure limit. These data can be used
to more effectively identify former worker populations at potential
risk for chronic beryllium disease and to offer these workers
screening as part of the FWP, and, in the event that a case
is diagnosed, help to understand historical exposure conditions.
Breysse P., Weaver V., Cadorette M., Wiggs L., Curbow B.,
Stefaniak A., Melius J., Newman L., Smith H., and Schwartz B.
Development of a medical examination program for former workers
at a Department of Energy national laboratory. American Journal
of Industrial Medicine, 42:443-454, 2002.
A needs assessment was conducted at Los Alamos National Laboratory
(LANL) in order to identify former LANL employees who may be
at significant risk for occupational disease and to determine
whether a medical examination program could reduce morbidity
or mortality. The algorithm approach that was developed documented
that six chemical and physical agents should be included in
the medical examination program.
Miller A., Markowitz S., Dahlgren J., Levin S., Swarcberg
J., and Warshaw R. Early lung cancer detection using low dose
high resolution CT in high risk workers occupationally exposed
to asbestos: An overview of 3 studies. European Journal of Oncology,
Lung cancer is the main cause of cancer mortality in both sexes,
and its incidence continues to increase. Mortality is high due
to the diffusion of disease at the time of diagnosis. Low-dose
high-resolution computed tomography allowing the diagnosis of
lesions <10 mm in diameter may bring about improvement of results.
The authors present some studies and the results available with
the use of this new technique.
Program Manager: Mary