As exposure limits for beryllium have decreased, so has the incidence and severity of chronic beryllium disease.
There are however an emerging number of cases of subclinical disease and beryllium sensitization (BeS) that are being detected with new immunological tests, namely the beryllium lymphocyte proliferation test (BeLPT). Almost all the recent data on screening beryllium workers relates to the BeLPT, and more traditional screening programmes such as spirometry and chest x-rays that have been in use since the 1950s have only been evaluated as secondary endpoints.
Whilst the BeLPT has revolutionised the diagnosis of chronic beryllium disease (CBD), concerns have been raised about its inter- and intra-laboratory variability, possible reversibility in patients and uncertain sensitivity and specificity. There is also debate about the natural history of BeS and subclinical CBD and the ethical aspects of identifying disease early when there is no treatment, and subsequent employment implications. Another issue for the UK is the fact that only one laboratory offers BeLPT testing, although certain evidence supports double sampling of tests across laboratories to improve sensitivity and specificity. All these factors have led to certain US based groups advocating the use of BeLPT for screening and others not.
Therefore, in the US, a definitive stance on the content of a health surveillance programme has not been possible from the current evidence base. This is supported by the fact, for example, that the National Institute for Occupational Safety and Health (NIOSH), whilst citing many articles on beryllium on its website, does not offer any specific advice on health surveillance in beryllium workers, as it does for other industries.
This report and the work it describes were funded by the Health and Safety Executive (HSE). Its contents, including any opinions and/or conclusions expressed, are those of the authors alone and do not necessarily reflect HSE policy.
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