Lung cancer screening in occupational settings: a scoping review

Abstract

Background Lung cancer is the leading cause of cancer-related mortality worldwide. It is often asymptomatic until advanced stages, resulting in delayed diagnosis and poor survival. Screening enables early detection and reduces mortality. Multiple occupational and environmental exposures have been linked to lung cancer, and some guidelines recommend their inclusion in risk assessment. This review aims to map the existing evidence on lung cancer screening (LCS) in occupational settings. Methods This review followed JBI methodology and employed a three-step search strategy across six databases: PubMed, Web of Science, Scopus, CINAHL (via EBSCO), ScienceDirect and Cochrane Library. Eligible studies were those reporting on LCS conducted in any occupational setting, published in English or German between 2013 and November 2024. Two reviewers independently screened studies for inclusion. Data were synthesized thematically, and findings were reported according to PRISMA-ScR guidelines. Results Twenty-one studies from 12 countries were included, conducted across diverse occupational populations. Low-dose computed tomography (LDCT) was used for screening in 18 studies (15 as a standalone modality, 3 combined with biomarkers, sputum cytology, or chest ultrasonography respectively), while 3 studies employed alternative approaches. Eligibility criteria varied substantially, and intervention durations ranged from 3 months to 13 years. Individual and combined recruitment strategies were identified, including emails, invitation letters, face-to-face interactions, direct outreach by department heads or supervisors, and referrals from primary care or specialty clinics. Thematic synthesis yielded five overarching themes: (1) occupational exposures as lung cancer risk factors and limitations of current LCS guidelines; (2) lung cancer burden across occupational groups; (3) benefits and performance of LDCT in occupational cohorts; (4) tools and multimodal strategies to enhance LDCT; and (5) implementation, participation, and program feasibility. Conclusion Occupational settings present significant opportunities for early lung cancer detection among high-risk workers, while offering potential benefits for those with low or uncharacterized exposures. However, the evidence base remains limited, with significant gaps in implementation protocols and reporting standards. Addressing these deficiencies requires robust prospective studies and standardized frameworks to ensure the translation of occupational LCS into a reproducible, scalable public health intervention. Systematic review registration https://doi.org/10.17605/OSF.IO/UHS8D