[Occupational cancer. The role of the occupational physician in systematic search and aetiological diagnosis of lung cancer. Analysis of a case list].
BACKGROUND
About 15% of lung cancers (LC) might be attributable to occupation. However, clinical practice shows that LC percentage for which occupational aetiology is recognized is lower than expected.


OBJECTIVE
To address the role of Occupational Physicians (OP) in systematic search and aetiological diagnosis of LC.


METHODS
The search was carried out at a university hospital in Brescia, northern Italy, a highly industrialized area with many workers potentially exposed to occupational lung carcinogens. Through short occupational history forms, physicians of various departments refer all new cases of primary LC to OP When occupational exposure to lung carcinogens is presumed, the OP evaluates the case at the occupational health clinic and sends clinical reports to notifying physicians, containing aetiological diagnosis and indications for medico-legal obligations.


RESULTS
Before 1998, few cases were referred to the OP and even less were compensated. The search yielded 1502 LC; after screening, full occupational health evaluation was performed in 693 cases: occupational aetiology was recognized in 182 (26%). Risk factors were silica, asbestos, polycyclic aromatic hydrocarbons, truck driving, painting, road paving; many workers were exposed to multiple carcinogens. 48 cases were compensated, many others are under litigation.


CONCLUSIONS
A systematic LC search made it possible to: reach an aetiological diagnosis and reduce the gap between expected LC and those reported/compensated; inform health authorities and undertake preventive action in workplaces; detect sentinel events; provide epidemiological data at community level; promote cooperation among health professionals (oncologists, surgeons, pneumologists, general practitioners, plant OP); increase teaching opportunities for medical students, those taking a specialisation course in occupational health; provide counselling and expert opinions for individual subjects, trade unions, employers, law courts.
Porru
S
S
Cattedra di Medicina del Lavoro, Università degli Studi di Brescia. porru@med.unibs.it
di Carlo
A Scotto
AS
Placidi
Donatella
D
Arici
Cecilia
C
Tassi
G
G
Alessio
L
L
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases; D009787:Occupational Medicine; D010819:Physician's Role