Trends in Stage I Lung Cancer.

INTRODUCTION: The American Cancer Society has recently reported an increase in the percentage of patients with localized lung cancer from 2004 to 2018, coinciding with the initial lung cancer screening guidelines issued in 2013. We conducted a National Cancer Database (NCDB) study to further evaluate the trends in stage I according to patient and tumor characteristics. METHODS: We selected patients with lung cancer from the NCDB Public Benchmark Report diagnosed between 2010 and 2017. Patients with stages I to IV according to the AJCC seventh edition were evaluated according to the year of diagnosis, histology, age, sex, race, and insurance. RESULTS: Among the 1,447,470 patients identified in the database, 56,382 (3.9%) were excluded due to stage 0 or unknown, or incorrect histology, leaving 1,391,088 patients eligible. The percentage of patients with stage I increased from 23.5% in 2010 to 29.1% in 2017 for all lung cancers, from 25.9% to 31.8% in non-small-cell lung cancer (NSCLC), and from 5.0% to 5.4% in small-cell lung cancer (SCLC). Patients younger than 70 years, males and blacks had lower percentages of stage I compared to older patients, females, and nonblacks respectively. Patients with no insurance had the lowest percentage of stage I. CONCLUSIONS: There has been a significant increase in the percentage of stage I lung cancer at diagnosis from 2010 to 2017, which occurred mostly in NSCLC. Although the staging shift was observed in all subsets of patients, there were noticeable imbalances according to demographic factors.

Silica exposure on construction sites: results of an exposure monitoring data compilation project.

To expand on the limited size and scope of construction silica exposure studies, a silica monitoring data compilation project was initiated through the American Conference of Governmental Industrial Hygienists Construction Committee. Personal silica exposure monitoring data was collected and analyzed from 13 private, research, and regulatory groups. An effort was made to collect as much detail as possible about task, tool, and environmental and control conditions so as much information as possible could be garnered. There were considerable data gaps, particularly with regulatory agency data, that represented over half of the data set. There were 1374 personal quartz samples reported with a geometric mean of 0.13 mg/m(3) and a GSD of 5.9. Descriptive statistics are reported by trade, task, tool, and data source type. Highest exposures were for abrasive blasters, surface and tuckpoint grinders, jackhammers, and rock drills. The sample period was important, with short-term samples (up to 2 hours) having considerably higher levels than midterm (2-6 hours) or longer (over 6 hours) samples. For nearly all exposure variables, a large portion of variable categories were at or over the quartz occupational exposure limit of 0.05 mg/m(3), including 8 of 8 trade, 13 of 16 task, and 12 of 16 tool categories. The respiratory protection commonly used on construction sites is often inadequate for the exposures encountered. The data variability within task and tool was very large, with some very high exposures reported for a broad spectrum of tools. Further understanding of the conditions leading to high exposures will require more detailed documentation of the sample characteristics following database design recommendations or systematic surveys of exposure in this complex industry.

The effect of local exhaust ventilation controls on dust exposures during concrete cutting and grinding activities.

This study assessed the effectiveness of commercially available local exhaust ventilation (LEV) systems for controlling respirable dust and crystalline silica exposures during concrete cutting and grinding activities. Work activities were performed by union-sponsored apprentices and included tuck-point grinding, surface grinding, paver block and brick cutting (masonry saw), and concrete block cutting (hand-held saw). In a randomized block design, implemented under controlled field conditions, three ventilation rates (0, 30, and 75 cfm) were tested for each tool. Each ventilation treatment was replicated three times in random order for a total of nine 15-min work sessions per study subject. With the exception of the hand-held saw, the use of LEV resulted in a significant (p < 0.05) reduction in respirable dust exposure. Mean exposure levels for the 75 cfm treatments were less than that of the 30 cfm treatments; however, differences between these two treatments were only significant for paver block cutting (p < 0.01). Although exposure reduction was significant (70-90% at the low ventilation rate and 80-95% reduction at the high ventilation rate), personal respirable dust [corrected] exposures remained very high: 1.4-2.8 x PEL (permissible exposure limit) at the low ventilation rate and 0.9-1.7 x PEL at the high ventilation rate. Exposure levels found under actual field conditions would likely be lower due to the intermittent nature of most job tasks. Despite incomplete control LEV has merit, as it would reduce the risk of workers developing disease, allow workers to use a lower level of respiratory protection, protect workers during short duration work episodes reduce exposure to nearby workers, and reduce clean-up associated dust exposures.

Silica dust exposures during selected construction activities.

This study characterized exposure for dust-producing construction tasks. Eight common construction tasks were evaluated for quartz and respirable dust exposure by collecting 113 personal task period samples for cleanup; demolition with handheld tools; concrete cutting; concrete mixing; tuck-point grinding; surface grinding; sacking and patching concrete; and concrete floor sanding using both time-integrating filter samples and direct-reading respirable dust monitors. The geometric mean quartz concentration was 0.10 mg/m(3) (geometric standard deviation [GSD]=4.88) for all run time samples, with 71% exceeding the threshold limit value. Activities with the highest exposures were surface grinding, tuck-point grinding, and concrete demolition (GM[GSD] of 0.63[4.12], 0.22[1.94], and 0.10[2.60], respectively). Factors recorded each minute were task, tool, work area, respiratory protection and controls used, estimated cross draft, and whether anyone nearby was making dust. Factors important to exposure included tool used, work area configuration, controls employed, cross draft, and in some cases nearby dust. More protective respirators were employed as quartz concentration increased, although respiratory protection was found to be inadequate for 42% of exposures. Controls were employed for only 12% of samples. Exposures were reduced with three controls: box fan for surface grinding and floor sanding, and vacuum/shroud for surface grinding, with reductions of 57, 50, and 71%, respectively. Exposures were higher for sweeping compound, box fan for cleanup, ducted fan dilution, and wetted substrate. Construction masons and laborers are frequently overexposed to silica. The usual protection method, respirators, was not always adequate, and engineering control use was infrequent and often ineffective.

The efficacy of local exhaust ventilation for controlling dust exposures during concrete surface grinding.

This study assessed the effectiveness of a commercially available local exhaust ventilation (LEV) system for controlling respirable dust and crystalline silica exposures during concrete grinding activities. Surface grinding was conducted at six commercial building construction sites in Seattle, WA, by cement masons. Time-integrated filter samples and direct reading respirable dust concentrations were collected using a cyclone in line with a direct reading respirable dust monitor. Personal exposure levels were determined with and without LEV, one sample directly after the other. A total of 28 paired samples were collected in which three different dust collection shroud configurations were tested. Data obtained with a direct reading respirable dust monitor were adjusted to remove non-work task-associated dust exposures and was subsequently used to calculate the exposure reduction achieved. The application of LEV resulted in a reduction in the overall geometric mean respirable dust exposure from 4.5 to 0.14 mg/m(3), a mean exposure reduction of 92%. Despite the effective control of dust generated during surface grinding, 22 and 26% of the samples collected while LEV was being used were greater than the 8 h time-weighted average permissible exposure limit (Occupational Safety and Health Administration) and threshold limit value (American Congress of Governmental Industrial Hygienists) for respirable crystalline silica, respectively.