WHPP Early Lung Cancer Detection Program (ELCD)

Since 2000, the WHPP Early Lung Cancer Detection (ELCD) Program has provided low-dose chest CT scans to U.S. Department of Energy (DOE) workers, with the primary purpose of detecting lung cancers early. The ELCD Program serves seven sites in the DOE complex: the K-25, Paducah and Portsmouth gaseous diffusion plants (GDPs), Y-12, Oak Ridge National Laboratory, and the Mound and Fernald closure sites. In 2012, we plan to expand the program to include the Idaho National Laboratory and the Nevada Test Site. Over 10,500 DOE workers have received low-dose chest CT scans through the WHPP ELCD Program, and as of August 2011, the Program has detected 71 lung cancers, with the majority (72%) found in early stages. 

Many DOE workers are at increased risk for lung cancer as a result of their occupational exposure to lung carcinogens such as asbestos, beryllium, radioactive materials, nickel, and chromium. Participants with an elevated risk of lung cancer based on age, smoking and work history are currently offered a baseline low-dose CT scan and one annual, as well as follow-up CT scans for either, if needed. 

A low-dose screening CT scan of the chest uses much less radiation than a standard, full-dose CT scan and yet provides a clear enough image to detect very small, early cancers. In the absence of screening, most lung cancers are determined at a late stage when survival is unlikely. Currently, only 15 out of every 100 (15%) of those diagnosed live five years or more, and this statistic has remained unchanged over the last thirty years [See ELCD Program factsheets].  

The landscape of lung cancer mortality may very well be changing, however, with the release of an important new study of lung cancer screening. In August 2011, the National Cancer Institute (NCI) published the results from the National Lung Screening Trial in the New England Journal of Medicine, which showed that low-dose CT scanning reduced the number of deaths from lung cancer in high-risk individuals by at least 20% compared to the comparison population screened using chest X-rays. Based on the large number of lung cancer deaths each year, this could translate to 30,000 or more lives saved each year in the US alone. Although research has been conducted on the benefit of CT screening for early lung cancer detection since the early 1990s, this was the first randomized control trial to study the mortality benefit from low-dose CT screening for lung cancer. 

Although the NCI study focused on smokers, workers who are exposed to lung carcinogens such as asbestos, uranium, plutonium and beryllium are also at risk and can benefit from early detection. Work-related lung cancer, in fact, is the leading occupational cancer in the US. (Steeland K et al. Am J Ind Med 2003;43:461-482.) 

Steven Markowitz
Steven Markowitz

Steven Markowitz, M.D. is a physician specializing in occupational and environmental medicine. Dr. Markowitz is currently Director of the Center for the Biology of Natural Systems (CBNS) and Professor of Environmental Sciences at Queens College, City University of New York. He is also Adjunct Professor of Community and Preventive Medicine at Mount Sinai School of Medicine, where he was on the full-time faculty from 1986 to 1998. He received his undergraduate education at Yale University and his medical degree from Columbia University. Dr. Markowitz is board-certified in occupational and environmental medicine and internal medicine. 

Dr. Markowitz currently directs the Worker Health Protection Program, a medical screening program for former Department of Energy workers who built the nuclear weapon arsenal of the United States. This program is co-sponsored by the United Steelworkers International Union and the Atomic Trades & Labor Council. This program conducts the largest early lung cancer detection project in occupational health in the country through the application of low-dose helical CAT scanning. To date, over 10,000 workers who were exposed to asbestos, uranium, and other lung carcinogens have been screened for lung cancer in this program. 

Dr. Markowitz co-directs the North Shore-LIJ/Queens College World Trade Center Clinical Center of Excellence and monitors the health of over 2,000 WTC workers and provides treatment services to WTC workers with 9/11-related health conditions. 

Dr. Markowitz' research interests center on occupational and environmental disease surveillance; occupational cancer; asbestos-related diseases; and the burden and costs of occupational diseases and injuries. Dr. Markowitz is Editor-in-Chief of the American Journal of Industrial Medicine. He is Associate Editor with William Rom MD of a major textbook, Environmental and Occupational Medicine, (4nd Edition, Lippincott William and Wilkens, New York, 2007, 1884 pp.). In 2000, he co-authored a landmark book, Costs of Occupational Injuries and Illnesses (University of Michigan Press). He has additionally served as a consultant to the World Health Organization, the Pan American Health Organization, and the Department of Energy. 

Amy Manowitz

Amy Manowitz, MPH is a highly respected program administrator in the field of occupational safety and health. In the mid-1980's, she coordinated large-scale medical screening programs at the noted Environmental Sciences Laboratory at Mount Sinai Medical Center under the direction of Dr. Irving Selikoff, the renowned asbestos researcher. After obtaining her master's degree in Public Health with a concentration on occupational health, Ms. Manowitz joined the Center for Occupational and Environmental Health at Hunter College. For fifteen years, she directed national and state-wide training programs in occupational safety and health for various groups, primarily union workers. During her tenure at Hunter College, Ms. Manowitz gained technical expertise in program planning and administration and curriculum development. 

Since April 2000, Ms. Manowitz has served as administrative director of the WHPP Early Lung Cancer Detection Project of the Workers Health Protection Program, the largest lung cancer screening program in occupational health in the country. Her outstanding program planning and coordination skills have made her an extraordinary asset to Queens College in developing and implementing this complex national medical screening program. 

Albert Miller
Albert Miller

Dr. Miller is Medical Director of the Early Lung Cancer Detection (ELCD) Project of the Worker Health Protection Program. He is a Senior Attending Physician in Pulmonary Medicine at Beth Israel Medical Center and director of the pulmonary function laboratory. He is Professor of Clinical Medicine at New York Medical College of Medicine and Adjunct Clinical Professor of Occupational Medicine at Mount Sinai School of Medicine. He is a recognized authority in lung disease, especially occupational lung disease and in disability caused by lung disease. He has contributed to the Surgeon General's Annual Report on the Health Effects of Smoking, has advised N.A.S.A. in the medical effects of space travel and has served on American Thoracic Society Committees to establish standards for pulmonary function tests, asbestos-related diseases and air pollution. He has edited two textbooks on pulmonary medicine, contributed chapters to seven other textbooks, and published more than 110 articles in peer-reviewed medical journals. 

As Medical Director of the ELCD Project, he oversees the screening and most importantly, the follow-up of the suspect findings, advising, and working closely with the workers' physicians and specialists in their communities.  

Marija Sedlar