Early Diagnosis of Lung Cancer and Mesothelioma in Prior Asbestos Workers

Titre officiel

Early Diagnosis of Mesothelioma and Lung Cancer Following Asbestos Exposure Using Low-dose Computed Tomography


L’exposition professionnelle à l’amiante augmente le risque de cancer du poumon (cancer bronchopulmonaire) et de la plèvre (mésothéliome). Les symptômes sont subtils et non spécifiques, le diagnostic est souvent tardif et le pronostic est en conséquence défavorable. Il n’existe actuellement aucun outil non effractif accepté pour diagnostiquer de façon précoce le mésothéliome ou le cancer du poumon chez les sujets exposés à l’amiante. Au cours de la dernière décennie, une technique de tomodensitométrie (TMD) à faible dose a été mise au point et validée pour le diagnostic précoce du cancer du poumon chez les fumeurs à haut risque. Le mésothéliome malin peut, à un stade précoce, ressembler à une plaque pleurale bénigne, qui est fréquemment observée après une exposition à l’amiante. Nous visons à mettre au point une technique de TMD à faible dose comme outil pour obtenir des images en série des plaques pleurales, mesurer leur volume individuel et global, calculer leur taux de croissance avec le temps et, ainsi, déceler de façon précoce la présence d’un mésothéliome, avant même que les symptômes ne se manifestent.

Description de l'essai

Background and Purpose: Asbestos exposure may result in several different diseases to the lung and to the lining of the lung, the so-called pleura. Mostly they are benign, but there are two common malignant diseases in people with prior asbestos exposure, the so-called mesothelioma

  • which originates from the pleura
  • and cancer of the lung. Symptoms of any of these malignant diseases generally do not appear for 10-35 years after the first asbestos exposure, and include shortness of breath, chronic or new cough, coughing of blood, chest pain or weight loss. Unfortunately, these symptoms are most often causes by very advanced diseases, when patients can no longer be cured. Currently there is no accepted tool for the early diagnosis of mesothelioma or lung cancer in asbestos-exposed subjects available. Standard of care includes regular chest radiographs, which are not sufficient to show mesothelioma or lung cancer in an early stage. A screening CT examination, also called CAT scan, of the lungs will be performed without intravenous contrast. The CT examination as such is not an experimental procedure, CAT scans are performed routinely since decades. However, in this particular case, this albeit standard examination is performed for the purposes of research only, it is not part of standard of care. The screening CT examination of the lungs takes less than 10-20 minutes to perform. If no abnormalities are found on the initial examinations, you will be examined with one repeat screening CT of the chest after one year. If pleural plaques or a nodule in the lungs is seen on your baseline CT, this will lead to further testing. Quite likely (approximately 1 in 3 chance), you will be invited for a follow-up CT 3 or 6 months. Further investigations will be chosen according to standard of care and will be explained to you at the time. These will be coordinated by your physician with Dr. Marc de Perrot, Department of Thoracic Surgery. Secondly, there is evidence in other types of cancers such as cancers of the prostate and ovary, that analysis of blood may reveal protein markers that indicate the presence of cancer in the body. A companion blood analysis study is being undertaken in an effort to discover such markers for lung cancer and mesothelioma, so that the accuracy of CT-scan diagnosis for lung cancer may be further improved. Both at the time of your baseline screening CT and at your annual follow-up screening CT, you will be asked to provide 5 ml (approximately 2 teaspoons full) blood sample through a needle stick. A blood-taking technician employed by the University Health Network or a certified nurse will carry out this procedure. Purpose of this study is to search in the blood for so-called "markers", substances in the blood which indicate that there is a cancer in the lungs or pleura. Most of these markers are still in development, thus your blood will be stored and analyzed at a future date.

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