Evaluating the QEAS-7 questionnaire as a predictor of asbestos burden in lung tissue in lung cancer patients: insights from the AMCANES Study

Abstract

Summary: This multicenter study assessed the QEAS-7 questionnaire's ability to identify asbestos exposure by comparing responses with histologically measured asbestos bodies in lung tissue. Among lung cancer patients, combining occupational and domestic exposure domains yielded 100% sensitivity for detecting high asbestos burden. QEAS-7 offers a practical screening tool in clinical settings lacking histological or occupational hygiene resources. ABSTRACT Objectives: Asbestos exposure is a known risk factor for lung cancer, and quantifying asbestos bodies (ABs) in lung tissue remains the gold standard for assessing cumulative exposure. However, histological analysis is not routinely available in many clinical settings. The validated QEAS-7 questionnaire was developed to evaluate occupational, domestic, and environmental asbestos exposure. This study examined the association between QEAS-7 exposure classifications and the asbestos burden in lung cancer patients. Methods: A cross-sectional multicenter study was conducted across nine Spanish hospitals. Patients with histologically confirmed lung cancer undergoing surgical resection completed the QEAS-7 questionnaire. Non-tumoral lung tissue samples were analyzed for Abs and asbestos burden was categorized according to AB concentration (with elevated burden defined as >1000 AB/g). Diagnostic performance metrics were evaluated. Results: Among 133 patients (median age 67 years; 77% male), ABs were detected in 61% of samples, with 5% showing an elevated asbestos burden (>1000 AB/g). Occupational exposure was reported by 36% of patients and accounted for 71.4% of cases with elevated burden. Domestic exposure was reported by 9% of patients and detected in 28.6% of elevated-burden cases. The combined occupational and domestic exposure domain achieved 100% sensitivity for detecting elevated asbestos burden, while occupational and domestic domains alone showed sensitivities of 71.4% and 28.6%, respectively. Specificity and positive predictive values remained modest. Notably, 29% of patients classified as 'non-exposed' by QEAS-7 had measurable ABs. Conclusion: The QEAS-7 questionnaire demonstrated high sensitivity for detecting elevated asbestos burden when combining occupational and domestic exposures. While histological analysis remains the definitive method, QEAS-7 offers a practical screening alternative, when lacking access to tissue-based diagnostics or occupational hygiene expertise.