Medical screening is a strategy used to identify diseases or conditions in a select population at an early stage, often before signs and symptoms develop, and to refer individuals with suspicious findings to their personal physician or a specialist for further testing, diagnosis, and treatment. The program is not intended to serve as a substitute for routine medical exams through an individual's personal physician.

The medical screening exam offered by the FWP evaluates an employee's health as it relates to their potential occupational exposures to hazardous agents. The FWP uses a customized medical screening protocol that was developed by a team of independent physicians specializing in occupational medicine and disease in partnership with subject matter experts from HSS. The protocol is periodically updated, as necessary, based on new research findings within the scientific/medical community. The health conditions targeted in the exams include chronic lung and pleural diseases, beryllium-related disorders, hearing loss, and damage to other selected major organ systems that may be associated with occupational exposures. A listing of exposures and medical examinations offered through the FWP is available in the medical protocol posted on the FWP website.

Prior to participating in the medical screening program, former workers must complete a medical history questionnaire and an occupational history questionnaire, either on their own or via an interviewer-conducted session. The interviews are conducted by the local outreach coordinators employed by the FWP projects who, in many cases, are former workers with knowledge of DOE sites and exposures.

The initial medical screening examination includes a physical examination and may consist of the following based on the individual's occupational exposure history as reported in the questionnaire/interview:

• Chest x-ray with interpretation for occupational lung disease (B reading)
• Spirometry (breathing test)
• Beryllium Lymphocyte Proliferation Test (BeLPT)
• Blood chemistry test
• Urinalysis
• Audiometry (hearing test)

Participation in the FWP is completely voluntary, and participants can refuse any portion of the screening examination.

The original legislation for the FWP also called for the program to provide ongoing medical examinations; therefore, former workers are entitled to a re-screen examination three years after their initial medical screening and every three years thereafter. A number of the work materials and processes at DOE sites that have an established association of a particular disease risk with a particular exposure often have a period of latency (the time between the exposure and the potential onset of the disease). The re-screening improves the detection of latent occupational disease, which may not show signs or symptoms for decades after exposure. It should also be noted that certain tests may be recommended only during the initial screening exam and, therefore, excluded from the re-screen exam. For example, audiometry (hearing test) is not offered on the re-screen exam, since occupational hearing loss would typically be detected during the initial screening exam of retired workers.

The medical screening examinations, while focusing on the detection of occupational disease, also provide an overall picture of the "general health" of DOE former workers. In addition to its core function of identifying conditions that may have been related to workplace exposures, the program also provides some general health screening services at little additional cost to the Department.

Participants are screened for some common non-occupational health conditions, such as blood sugar (diabetes), cholesterol (coronary artery disease), blood pressure (cardiovascular disease/hypertension), obesity, and elevated creatinine levels (a blood test used to assess kidney function). While not intended to be a comprehensive examination, these tests provide for the early detection of these conditions without significantly impacting on the overall focus and cost of the program

The standard medical screening protocol used by the FWP is known to detect incidental findings. An incidental finding, or unanticipated abnormal finding, is information discovered during routine medical checks that, in many cases, ends up saving lives. Some of these include:

• Chest x-ray: pneumonia, abdominal aortic aneurysm
• Audiogram (hearing test): age-related hearing changes
• Complete blood count: anemia
• Physical exam: non-cancerous skin conditions

Another value-added benefit to the FWP physical exam is the opportunity for health practitioners to provide wellness counseling. Studies have shown that individuals are more likely to stop smoking, for example, when a health care provider counsels them to do so. Similarly, the re-screening examination is an opportunity to educate former workers about behavior changes to improve their overall health status for improved quality of life and also affords the opportunity to look for any changes in the individual's overall health condition from the previous exam, making early referral and treatment more effective for a positive outcome.

The results of general health screening tests, as well as incidental findings picked up on examination, can be of great benefit to a participant. Many of the conditions that fall into this category can be readily treated by the participant's personal physician and can significantly improve one's longevity and quality of life. EHSS and the FWP projects are committed to ensuring that the overall wellbeing of our workers is evaluated within the program.

Program Elements:

Chest X-Rays
Spirometry (breathing test)
Beryllium testing
Audiometry (hearing test)

Mary Fields, Program Manager