title: Reducing the underreporting of lung cancer attributable to occupation: outcomes from a hospital-based systematic search in Northern Italy.
abstract: OBJECTIVE
  Occupational exposure to lung carcinogens is and was common in workplaces. 5-25 % of lung cancers (LCs) could be causally attributable to occupation; however, LC underreporting and undercompensation are widespread, with remarkable tolls paid by individuals and society. This work aims to: describe an ongoing hospital-based systematic search (SS) of occupational LC; improve aetiological diagnosis; increase number and quality of LC notifications.
  
  
  METHODS
  Through a short form, physicians at a public hospital referred incident LC to the Occupational Health Unit (OHU). Only patients selected through the form were interviewed; a personal, occupational and clinical history was collected; reports were sent to the ward and Local Health Authority, with aetiological diagnosis criteria and probability of causation.
  
  
  RESULTS
  From 1998 to 2013, 3274 cases of LC were notified to the OHU; prior to the system, just couple of dozens were assessed. A total of 1522 patients were fully interviewed; in 395 cases, causation was attributed to occupation (26 % of interviewed patients); all were notified to authorities, as compared to the handful reported before the system was adopted. Main aetiological agents were silica, asbestos, polycyclic aromatic hydrocarbons, truck driving, painting, multiple exposures. Compensation rate was remarkable (39 %).
  
  
  CONCLUSIONS
  Through SS, many occupational LCs were found that otherwise would have been lost. Aetiological diagnosis proved to be rich of scientific advantages and practical implications, with attention to equity and social aspects. SS was easy, accountable and fostered multidisciplinary collaboration among medical specialties, significantly reducing underreporting and undercompensation of occupational LC.
authors.affiliation: Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy. stefano.porru@unibs.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Porru
authors.affiliation: Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Carta
authors.affiliation: Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Toninelli
authors.affiliation: Division of Pneumology, Spedali Civili of Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy.
authors.forename: Giordano
authors.initials: G
authors.lastname: Bozzola
authors.affiliation: Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Arici
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006779:Hospitals, Public; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008175:Lung Neoplasms / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D019221:Mandatory Reporting; D008875:Middle Aged; D009784:Occupational Diseases / Q000453:epidemiology / Q000209:etiology*; D016273:Occupational Exposure / Q000009:adverse effects*; D009787:Occupational Medicine / Q000379:methods*; D009790:Occupations; D011795:Surveys and Questionnaires
keywords: Occupational health physician; Occupational lung cancer; Systematic search; Undercompensation; Underreporting