Is the US Coal Miner Chest X-Ray Surveillance Program Succeeding in Controlling Lung Disease?
NIOSH 1990 Sep:803-806
The question of whether the NIOSH surveillance and screening program was functioning adequately to contribute significantly to controlling lung diseases in United States (US) underground coal miners was discussed. The program which involved obtaining a series of periodic chest X-rays was originally mandated by the 1969 Federal Coal Mine Health and Safety Act. It was continued and expanded to utilize medical screening as a preventive strategy under the Federal Mine Safety and Health Act of 1977 (MSHA). MSHA provides for transferring miners from dusty to less dusty jobs if they show signs of developing coal worker's pneumoconiosis (CWP) on the basis of their chest X-rays or other medical examinations. Reducing dust exposures in the miner's current job by applying appropriate engineering controls was an alternative to job transfer. Selecting appropriate tests for the program was discussed. The success of the program was discussed in terms of miner participation, job transfer acceptance, and development of respiratory impairment. The program has been plagued by low and progressively decreasing participation of miners. The participation of miners who have worked for at least 20 years underground has also decreased. The number of working miners who have exercised their right to transfer to a less dusty job has progressively declined. Miners were continuing to show radiographic signs of CWP despite the fact that the program has been in operation for nearly 20 years. The number of miners who have applied for disability benefits under the Black Lung Program exceeded the number of those who have chosen to transfer from a dusty to less dusty job. The authors conclude that the surveillance and screening program has developed a valuable data base, but it has been marred by poor participation. Many miners who are at great risk for developing asymptomatic lung disease are not being screened. The authors encouraging greater participation, tying the surveillance component to dust control, separating the screening component from the surveillance component, and broadening the X-ray screening to include conditions other than CWP.
Coal-miners; Legislation; Surveillance-programs; Occupational-health-programs; Chest-X-rays; Coal-workers-pneumoconiosis; Coal-dust; Occupational-respiratory-disease;
DHHS (NIOSH) Publication No. 90-108
Proceedings of the VIIth International Pneumoconioses Conference