Since 2000, the WHPP Early Lung Cancer Detection (ELCD) Program has provided low-dose chest CT scans to U.S. Department of Energy (DOE) workers, with the primary purpose of detecting lung cancers early. The WHPP ELCD Program serves DOE workers from nine sites in the DOE complex: Idaho National Laboratory (INL); the K-25, Paducah and Portsmouth gaseous diffusion plants (GDPs); the Mound and Fernald closure sites; the Nevada National Security Site (formerly the Nevada Test Site); Oak Ridge National Laboratory; and Y-12. As of September 2015, over 13,000 DOE workers have received low-dose screening CT scans through the ELCD Program; 136 lung cancers have been detected, with the majority (71%) found in early stages.
WHPP participants with an elevated risk of lung cancer based on age, smoking and work history are currently offered annual screening, as well as interim follow-up CT scans, if needed.
A low-dose screening CT scan of the chest uses much less radiation than a standard, full-dose CT scan and yet provides a clear enough image to detect very small, early cancers. In the absence of screening, most lung cancers are diagnosed at a late stage when survival is unlikely. Currently, only 15 out of every 100 (15%) of those diagnosed live five years or more, and this statistic has remained unchanged over the last thirty years [See ELCD Program factsheets].
Fortunately, the landscape of lung cancer mortality is likely changing, due to several important developments over the last few years. In August 2011, the National Cancer Institute (NCI) published the results from the National Lung Screening Trial in the New England Journal of Medicine, which showed that low-dose CT scanning reduced the number of deaths from lung cancer in high-risk individuals by at least 20% compared to a control group screened using chest X-rays. Based on the large number of lung cancer deaths each year, this could translate to 30,000 or more lives saved each year in the U.S. alone. Although research has been conducted on the benefit of CT screening for early lung cancer detection since the early 1990s, this was the first randomized control trial to study the mortality benefit from low-dose CT screening for lung cancer.
Following the NCI publication, recognition of lung cancer screening as a safe and effective way to reduce lung cancer deaths has grown. In 2013, the U.S. Preventive Services Task Force (USPSTF) gave low-dose CT lung screening a ("Grade B") recommendation and low-dose CT screening is now available to high risk current or former smokers, at no cost, under the Affordable Care Act. In February 2015, the Centers for Medicare and Medicaid Services (CMS), a government agency, announced it will also provide full reimbursement for low-dose CT lung screening to Medicare patients with a high risk smoking history. As a result of the NCI study and these significant decisions at the federal level, many hospitals and radiology facilities throughout the country are now offering low-dose CT lung cancer screening.
Whereas the NCI study and the new USPSTF and Medicare guidelines focus only on smokers, the WHPP ELCD Program has adopted screening guidelines similar to those of the National Comprehensive Cancer Network (NCCN), which address the combined risk of smoking and occupational exposures to lung carcinogens (such as asbestos, uranium, plutonium and beryllium). Although smoking is the most potent risk factor for lung cancer, work-related lung cancer is the leading occupational cancer in the U.S. (Steeland K et al. Am J Ind Med 2003;43:461-482).
Henschke CI, Yip R, Boffetta p , Markowitz S, Miller A, Hanaoka T, Wu N, Zulueta JJ, Yankelevitz DF; I-ELCAP Investigators. CT screening for lung cancer: Importance of emphysema for never smokers and smokers. Lung Cancer. 2015 Apr;88(1):42-7.
Farooqi AO, Cham M, Zhang L, Beasley MB, Austin JH, Miller A, Zulueta JJ, Roberts H, Enser C, Kao SJ, Thorsen MK, Smith JP, Libby DM, Yip R, Yankelevitz DF, Henschke CI; International Early Lung Cancer Action Program Investigators. Lung cancer associated with cystic airspaces. AJR Am J Roentgenol. 2012 Oct;199(4):781-6.