© 2005 American Thoracic Society
Screening for Chronic Beryllium DiseaseTo the Editor:For practitioners treating and preventing chronic beryllium disease (CBD), the recent publication from the Environmental and Occupational Health Sciences Division at National Jewish Medical and Research Center (NJMRC) of their longitudinal experience with beryllium sensitization (BeS) progressing to CBD is a welcome validation of growing efforts to control this epidemic in beryllium workers (1). The total number of workers in the United States with potential for current exposure was recently estimated to be 134,000 (2), and an even larger number of former workers are at risk. The DOE nuclear weapons program has screened over 40,000 production and cleanup workers with the beryllium lymphocyte proliferation test (BeLPT), the largest cohort where the test has been deployed (3). Over 230 cases of CBD have been diagnosed in this cohort with over 750 additional workers sensitized.
CBD, which is preceded by BeS, is a slowly progressive disease. We would therefore expect BeS workers who are closely followed with the BeLPT and invasive diagnostic testing to have disease detection at its earliest stage. In his accompanying commentary, Dr. Cullen suggests that recently diagnosed cases of CBD do not have the "associated clinical manifestations of CBD" (4). However, after follow-up of 4.7 yr (1.6–10) over half showed an average 15.5% decline in DLCO and/or similar decline in Even in the absence of these data, Newman and coworkers have made a convincing argument for ongoing screening and surveillance of beryllium-exposed workers. Detecting a disease in its early stages before large reductions occur in function is beneficial as identified by Cullen and coworkers, in a previous paper (5). The experience with DOE workers shows that LPT testing provides the benefit of early detection. Longer follow-up in the DOE group, as with the NJMRC cohort, is likely to yield an increase in those with significant physiologic impairment. Considering the recent confirmation of the risk to workers in industries using low percentage beryllium alloys (6), even workers with relatively low exposures should be tested.
a University of Washington, Seattle, Washington FOOTNOTES Conflict of Interest Statement: T.K.T. is a medical consultant to the Dept. of Labor Energy Employees Occupational Illness Compensation Program and advises on medical aspects of workers' beryllium claims. He was also paid as an expert on a panel evaluating the use of the beryllium lymphocyte proliferation test convened by Exponent and paid for by Brush Wellman, Inc. L.P. was the Chair of the Current Worker Beryllium Surveillance Program for Rocky Flats Workers. The program was managed by the Occupational and Environmental Health Program at National Jewish Medical Center. He received approximately $500–$1,000 per year for 3.5 years as the Panel Chair. He also received travel expenses, and food and lodging. He was a Visiting Professor and Lecturer at National Jewish Medical Center in 1999 and received $500. REFERENCES
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O2max. Nevertheless, the article by Newman and coworkers (