Lung cancer screening by low-dose CT among asbestos-exposed workers in Germany

INTRODUCTION: The German Social Accident Insurance (DGUV) has introduced lung cancer screening (LCS) by means of annual low-dose CT. Eligibility criteria for the main cohort are age ≥55 years, smoking history of ≥ 30 pack years and occupational asbestos exposure (OAE) of ≥ 10 years with onset before 1985. Medical counselling prior to CT scan is mandatory and supports shared decision-making. After being launched in pilot regions, LCS has been rolled out nationwide since 2017. As guidelines recommend a systematic evaluation for LCS, the research project EVALUNG has been implemented since 2022. METHODS: EVALUNG was designed to evaluate process and outcome of LCS combining quantitative and qualitative elements. The quantitative part is based exclusively on routine administrative and medical data. So far, anonymised data with selected items were used to assess availability of data and potential quality indicators, and to perform initial descriptive analyses in terms of participation rates, suspicious findings and detected lung cancer in first round screening. RESULTS: By end of 2021, 22,794 eligible persons were offered participation in LCS at least once. Based on first round screening, 12,808 pre-screening medical consultations were carried out and resulted in 9,277 initial CT scans, corresponding to a participation rate of 40.7 % of invited persons, and 72.4 % after medical consultation, respectively. Overall, 931 CT findings (10.0%) required control scans within a shortened interval. A total of 103 persons (1.1 %) were diagnosed with lung cancer, of which almost half (n = 54) were legally recognised as occupational disease. CONCLUSIONS: EVALUNG shows feasibility of a screening evaluation of an occupational cohort based on routine data. However, not all quality indicators for LCS can be covered yet and outcome parameters need to be investigated in more detail in this cohort. Linkage with cancer registry data is an option to enhance data and will be explored further in the project. KEY MESSAGES: • Routine administrative data can be used to assess basic outcomes from LCS in an occupational cohort from Germany. Linkage with registry data is desirable to investigate detailed LCS indicators. • Detection rate in first round LCS in an occupational cohort from Germany was 1.1% and half of detected cases were legally recognised as occupational disease.