[Factors associated with physicians' under-reporting of asbestos-related bronchopulmonary cancers. Telephone survey conducted among general practitioners and pulmonologists randomly selected in the French region of Provence-Alpes-Côte-d'Azur].
OBJECTIVE
To study the difficulties faced by general practitioners to detect and report asbestos-related cancers, focusing on the influence of patients' tobacco use, physicians' training and role perception.


METHODS
Telephone survey conducted among 486 general practitioners and pulmonologists randomly selected in the French region of Provence-Alpes-Côte d'Azur, with: 1) a standardized questionnaire on their behaviors, attitudes and practices in the field of occupational health; 2) a clinical case (case vignette) about a lung cancer patient with occupational asbestos exposure. Two alternative versions of the clinical case varying only in the patient's smoking status were presented randomly to two subgroups of general practitioners and pulmonologists. The primary variable examined was the physician recommendation that the patient described in the vignette file an occupational disease claim.


RESULTS
The response rate was 64.4% among general practitioners and 62.5% among pulmonologists. In multiple logistic regressions, the recommendation to file an occupational disease claim was significantly associated with specialty (OR = 4,46; 95% CI: 2.38-8.37 for pulmonologists versus general practitioners), patient's smoking status (OR = 3.15; 95% CI: 2.11-4.70, for non-smokers versus smokers), physician's workload (OR =1,8; 95% CI:1.17-2.88, for physicians examining less than 25 patients per day versus those examining more than 25) and role perception (OR = 2.00; 95% CI:1.22-3.27, for those who considered completing occupational disease medical certificates to be part of their role versus those who did not).


CONCLUSIONS
For a certain number of physicians, tobacco use often over-shadows the role of environmental carcinogens in the development of cancers. Those responsible for initial and continuing medical education should give occupational health higher priority in their programs. Tools designed to help physicians detecting and managing occupational diseases should be developed and disseminated.
Viau
Alain
A
Observatoire régional de la santé Provence-Alpes-Côte d'Azur, 13006 Marseille. alain.viau@inserm.fr
Arnaud
Sandrine
S
Ferrer
Stéphanie
S
Iarmacovai
Gwenaëlle
G
Saliba
Marie-Laure
ML
Souville
Marc
M
Verger
Pierre
P
D001195:Asbestosis / Q000150:complications*; D001291:Attitude of Health Personnel; D001984:Bronchial Neoplasms / Q000209:etiology*; D004781:Environmental Exposure / Q000009:adverse effects; D005194:Family Practice / Q000592:standards*; D005260:Female; D005602:France; D006306:Health Surveys; D006801:Humans; D016014:Linear Models; D008175:Lung Neoplasms / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010819:Physician's Role; D015272:Pulmonary Medicine / Q000592:standards*; D012044:Regression Analysis; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D011795:Surveys and Questionnaires; D013689:Telephone; D014942:Workers' Compensation