The Royal Australian and New Zealand College of Radiologists have released a statement recommending that screening of workers for occupational lung disease such as silicosis should be carried out using CT scans, rather than X-rays that are widely used currently.
X-rays, including portable X-ray screening carried out by icare, is “failing to reliably detect” lung disease in workers, and the RANZCR cited a study where more than 40 per cent of workers with silicosis were overlooked during X-ray testing.
Silicosis has been called Australia’s next “public health crisis”. It is a group of lung diseases that have a particularly high prevalence among workers who are exposed to engineered stone products, like kitchen benchtops and tiles.
Lung diseases, including silicosis, are considered such a danger to Australian’s health that the Morrison Government has committed $5 million to address them, under the National Dust Diseases Taskforce, launched in April.
The Australian Cancer Council has reported that more than 580,000 Australian workers have been exposed to silicosis since 2011. Of those, the charity estimates that “5758 of these will develop lung cancer over the course of their life as a result of that exposure”.
In NSW, workers considered at risk from diseases from silica dust can undertake free or subsidised testing via the icare Lung Bus and NSW screening clinic. However, the testing provided by icare doesn’t currently extend to CT scanning, and those utilising the service are tested via X-rays.
Under the service, more than 6500 workers have been screened since it was launched in 2017.
Following the RANZCR statement, icare’s practises will be reviewed. The college stated that X-ray testing for workers was “failing to reliably detect disease”, while CT scans were endorsed for the testing as having greater “sensitivity” and accuracy.
“Silicosis is much more readily detected in a low-dose CT, a more sensitive test. That’s what you would want for your family. You want the best test,” college president Lance Lawler said.
While Dr Lawler has praised the government’s screening program and explained that they were effective at detecting some diseases, and utilised the available resources, “but we could do better” he said.
One study of workers in Queensland exposed to silica dust showed that 43 per cent of tested workers produced normal or healthy chest X-rays, only to have CT scans reveal disease.
“We now have the clearest possible evidence that lung screening needs to move immediately from X-rays to low-dose CT scans to ensure not a single case is undiagnosed,” said Greens MP David Shoebridge.
Mr Shoebridge, who manages the Industrial Relations (including Compensation) portfolio for the NSW Greens, said the numbers of workers who had been screened with X-rays instead of low-dose CT scans was concerning.
Mr Shoebridge is part of the enquiry into the Dust Diseases scheme, focused on the response to the emerging crisis of seriously ill workers in the manufactured stone industry, as well as investigating the current compensation scheme available.
Mr Shoebridge is pushing for the government to invest in CT technology for icare’s Lung Bus, pushing for a “comprehensive effort to retest the thousands of workers already on the system … free of charge”.
icare has said that is working with industry bodies and regulators to consider the college’s findings.
“SafeWork Australia is currently reviewing the national guides for health monitoring, and we will follow this work closely and adjust practices if there are recommendations from this research.”
President of the NSW branch of the CFMEU, Rita Mallia, said that the union would continue to advocate for workers and has called on icare to “do whatever is necessary to update technology”.