Published in May 2006 American Longwall Magazine
The new project – the Enhanced Coal Workers’ Health Surveillance Program – is a spin-off program from one that has been around since the late 1960s. The original NIOSH program is a medical monitoring plan specifically designed to detect coal workers pneumoconiosis (CWP), commonly called black lung, and chronic obstructive pulmonary disease – both lung diseases that can be caused by inhaling coal mine dust.
Although some miners never develop disease, others may develop early signs of disease after less than 10 years of mining experience. In early stages, these lung diseases typically do not prevent the individual from working or carrying on most normal activities. In some miners, the disease progresses extremely slowly and never interferes with a generally normal life. In other miners, disease may progress to complicated pneumoconiosis, also called progressive massive fibrosis (PMF), and result in disabling impairment.
Unfortunately, there is no cure for the damage that the dust does to the lungs. However, such damage can be prevented and may be diagnosed by chest X-rays.
During the early 1970s, one out of every three miners examined under NIOSH’s program, who had worked at least 25 years underground, had radiographic evidence of coal workers pneumoconiosis.
A recent analysis of over 25,000 underground coal miners examined from 1996 to 2002 indicated that the proportion affected has greatly decreased, to about one in 20. However, that same analysis also suggested that certain groups of miners were still at elevated risk for developing disease.
While there has been a rapid decline in the proportion of active underground coal miners with radiographic evidence of CWP, NIOSH said that each week during reviews of X-rays, new cases of this disabling and potentially lethal disease are still seen, despite the mandated reductions in permissible dust exposures.
Pneumoconiosis is associated with work in certain mining jobs, in smaller mines, in several geographic areas, and among contract miners. However, results have many variables. Under the new enhanced program NIOSH and MSHA hope to secure comprehensive data to gain a more accurate picture of the distribution and prevalence of black lung in the US.
The Enhanced Coal Workers’ Health Surveillance Program will use digital radiographic imaging – a digital approach for data acquisition, transmission, storage, display and interpretation of patient data. NIOSH plans to request miners who participate in the Enhanced Program to undergo an additional digitally acquired chest radiograph, so that independent classifications of the images from the digital system can be compared to those obtained using the traditional film screen system.
Part of the funding from MSHA and NIOSH for the new project has gone into a new $US500,000 mobile examination unit, which will be used to provide many underground coal miners with a convenient way to receive a chest X-ray in close proximity to where they work, live or shop.
NIOSH plans to initiate the enhanced testing in coal mining regions where it has noted rapidly progressive disease among a high proportion of previously examined miners, and also in coal mining areas with particularly low participation in the existing health monitoring program.
The initial group of miners to be surveyed in 2006 will be those working at mines located in counties in which at least 40% of previously examined miners demonstrated rapidly progressive pneumoconiosis.
First priority will be given to those mines that are due (within one to two years) for examinations under the original program. Within those targeted counties, second priority will be given to those mines with less than 50% participation rate in the program. NIOSH said the objective of this group of surveys was to identify individual miners who were experiencing rapidly progressive pneumoconiosis, to enable intervention.
Underground miners and mines will be recruited based upon stratified sampling, including participation by county, contract miners, mine size, and face versus non-face work.
Examinations will be paid for solely by NIOSH, and NIOSH will maintain a confidential file of the individual results. The results of each examination will be reported directly to the examined miner.
No one else, not even a personal physician, will be notified of the results without the written permission of the participating miners. Coal mine operators are not involved in this program and will not receive a report of the X-ray.
