Table 4.

Mapping the evidence.

Theme	Description	Key evidence	Representative studies
Occupational exposures as lung cancer risk factors and limitations in current LCS guidelines	To identify how specific occupational exposures contribute to lung cancer risk	• Firefighting exposure independently increases lung cancer risk • Cooking–oil fumes are associated with higher Lung–RADS categories • Wood–dust exposure linked to increased radiologic abnormalities and cancer markers • Heavy exposure to welding fumes, chromium, and nickel is independently associated with higher prevalence of positive screening findings • Smoking–based criteria fail to capture many high–risk asbestos–exposed workers • Combined smoking + occupational exposures dramatically elevate risk	Shah et al. (29); Kato et al. (44); Kim et al. (31); Chung et al. (37); Gaballah et al. (46); Abtahi et al. (43); Welch et al. (40); Brims et al. (33); Markowitz et al. (41)
Lung–cancer burden in diverse occupational groups	To assess incidence and prevalence rates of lung cancer	• Hospital employees show higher lung cancer incidence than general population • Employer–driven screening detects more early lung cancers than expected	Chen et al. (35); Zhang et al. (38); Anzai et al. (36); Okereke et al. (47)
Benefits and performance of LDCT screening in occupational cohorts	To evaluate early–detection performance and mortality outcomes of LDCT in occupational groups	• LDCT detects cancers at earlier stages in high–risk workers • Mortality reductions reported in asbestos cohorts undergoing LDCT • LDCT more effective for early detection than traditional surveillance methods	Cabral et al. (32); Zhang et al. (38); Brims et al. (33); Barbone et al. (42); Mastrangelo et al. (49)
Tools and multimodal strategies to enhance LDCT	To assess whether biomarkers, cytology, or imaging adjuncts improve screening performance	• DECAMP integrates biomarkers + LDCT to enhance early detection • Glass wool workers show elevated tumor markers indicating added risk stratification utility • Chest ultrasonography feasible for monitoring asbestos–related pleural disease • Sputum cytology has low sensitivity but marginally improves detection when added to LDCT	Billatos et al. (39); Abtahi et al. (43); Smargiassi et al. (45); Felten et al. (48)
Implementation, participation and program feasibility	Understanding barriers and facilitators to screening uptake among workers	• Studies highlight the need to explore more measures to improve participation of workers in a LCS program • Tailored communication and centralized scheduling improve participation • Clinical reminders in electronic health records are valuable for monitoring participation	Grolleau et al. (30); Heidrich et al. (34); Zhang et al. (38); Cabral et al. (32); Okereke et al. (47)