Justification for screening for chronic beryllium disease: closer to reality.

C hronic beryllium disease (CBD) appeared to be waning 30 yrs ago [1]. In 1980, less than one case per year was reported and the incidence rate per ton of beryllium produced had declined from between five and 10, to less than 0.001. CBD appeared to be heading toward the medical archives as a success story of environmental control in the absence of understanding of the pathogenesis of the disease. However, in 1982, an immunological test performed on lymphocytes recovered from the bronchoalveolar lavage fluid demonstrated a marked increased in the number of berylliumsensitive cells in the lung compared to the blood, strongly suggesting that CBD was a hypersensitivity to beryllium [2]. The findings of that initial study were confirmed in larger studies [3] and by different investigators [4, 5]. Around 10 yrs later, an immunological test (the beryllium lymphocyte proliferation test (BeLPT)) was initially used in cross-sectional studies and later in the surveillance and screening of current and former beryllium workers [6–8]. Those studies demonstrated that CBD was not heading for the medical archives, but that the disease was present in much greater numbers than previously reported due to misdiagnosis of overt cases and the detection of early and asymptomatic cases through immunological testing.