A 7-Year Active Surveillance Experience for Occupational Lung Cancer in Bologna, Italy (2017-2023)
Main Article Content
Keywords
occupational lung cancer, occupational carcinogens, active systematic search
Abstract
Background: In Italy, lung cancer is the second most frequent neoplasm in men and the third in women. Exposure to carcinogens in workplaces plays a significant role. Still, cases attributable to occupational exposure are currently under-reported as occupational diseases: the current National Prevention Plan also encourages active research projects for the detection of cancers attributable to occupational exposure. Methods: The Unit of Prevention and Safety in the Workplace of Bologna Local Health Authority (Azienda Unità Sanitaria Locale-AUSL-)created a network for active surveillance of occupational lung cancer cases with the dedicated Diagnostic and Therapeutic Care Pathways(PDTA). Possible occupational exposure cases were selected within all incident PDTA cases using a self-completed patient filter form. Only patients selected through the form were interviewed; occupational physicians collected personal, occupational, and clinical history. Definition of a cooperation system with the local office of the National Institute for Insurance(INAIL)for monitoring the process during the medico-legal assessments conducted by the insurance institute up to resolution. Results: 453 cases completed the filter form, 177 had a potential occupational exposure. Of these, 140 accepted the direct interview with occupational physicians. One hundred eleven cases interviewed were assessed with sure or suspect occupational origin: for 82, a claim for recognition was sent to the INAIL, while for the other 29 was sent to INAIL a report for epidemiological purposes. Out of 82 compensation claims, 18 individuals (4 females and 14 males) received compensation, while 4 cases remain under investigation. A total of 53 claims were rejected: 54.7% for lack of exposure to risk factors, 24.5% for insufficient exposure, 9.4% due to inadequate administrative documentation, 7.5% because of insufficient clinical documentation, and 3.8% for the absence of causal association. Conclusions: Several occupational lung cancers were found that otherwise would have been unrecognized. Asbestos was the most frequent agent occurring in the most widespread work sectors—construction and manufacture of metalworking products—and in the period of exposure from 1970 to 1980. Other relevant agents were welding fumes and polycyclic aromatic hydrocarbons. Active surveillance, direct patient interviews, and claims for recognition integrated by a complementary report are essential to increase the INAIL compensation rate.
References
2. Bray J, Ferlay J, SoerjomataramI, Siegel R, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries Ca Cancer J Clin. 2018;0:1–31.
3. Doll R, Peto R. The causes of cancer: quantitative estimates of avoidable risks of cancer in the United States today. J Natl Cancer Inst. 1981 Jun;66(6):1191-1308.
4. Binazzi A, Scarselli A, Marinaccio A. The burden of mortality with costs in productivity loss from occupational cancer in Italy. Am J Ind Med. 2013;56(11):1272-1279.
5. Rushton L, Hutchings Brown TP. The burden of cancer at work: Estimation as the first step to prevention. Occup Environ Med. 2008, 65, 789–800.
6. De Matteis S, Consonni D, Bertazzi PA. Exposure to occupational carcinogens and lung cancer risk. Evolution of epidemiological estimates of attributable fraction. Acta Biomed. 2008; 79 Suppl. 1:34-42.
7. De Matteis S, Consonni D, Lubin JH, et al. Impact of occupational carcinogens on lung cancer risk in a general population. Int J Epidemiol. 2012 Jun;41(3):711-21.
8. Collatuzzo G, Turati F, Malvezzi M, et al. Attributable fraction of cancer related to occupational exposure in Italy. Cancers. 2023, 15, 2234-2249.
9. Boffetta P, Autier P, Boniol M, et al. An Estimate of Cancers Attributable to Occupational Exposures in France. J Occup Environ Med. 2010, 52, 399–406.
10. Steenland K, Burnett C, Lalich N, et al. Dying for work: The magnitude of US mortality from selected causes of death associated with occupation. Am J Ind Med. 2003, 43, 461–482.
11. De Matteis S, Heederik D, Burdorf A, et al. Current and new challenges in occupational lung diseases. Eur Respir Rev. 2017;26:170080.
12. Loomis D, Guha N, Hall AL, Straif K. Identifying occupational carcinogens: an update from the IARC monographs. Occup Environ Med. 2018,0;1–11.
13. Rushton L. Occupational cancer: recent developments in research and legislation. Occ Med. 2017; 67:248-250.
14. Merler E. Estimates of attributable fraction of occupational cancers in the recent epidemiological literature Epidemiol Prev. 2009; 33 Suppl.2:17-27.
15. Counil E, Henry E. Is it time to rethink the way we assess the burden of work-related cancer? Curr Epidemiol Rep. 2019; 6:138-147.
16. Driscoll T, Nelson DI, Steendland K, et al. The global burden of diseases due to occupational carcinogens. Am J Ind Med. 2005 48 419-431.
17. Rushton L, Bagga S, Bevan R, et al. Occupation and cancer in Britain. Br J Cancer. 2010;102(9):1428-37.
18. INAIL Tumori professionali: analisi per comparti di attività economica – Mal Prof 2019.
19. Shankar A, Dubey A, Saini D et al. Environmental and occupational determinants of lung cancer. Transl Lung Cancer Res. 2019 8(Suppl1) S31-S49.
20. Porru S, Carta A, Toninelli E, et al.Reducing the underreporting of lung cancer attributable to occupation: outcomes from a hospital-based systematic search in Northern Italy. Int Arch Occup Environ Health. 2016 Aug;89(6):981-989.
21. Global Burden of Disease (GBD) 2017, Risk Factor Collaborator. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392: 1923–94.
22. Gobba F, Modenese A, John SM. Skin cancer in outdoor workers exposed to solar radiation: a largely underreported occupational disease in Italy. J Eur Acad Dermatol Venereol. 2019;33(11): 2068-2074.
23. Scarselli S, Scano P, Marinaccio A, Iavicoli S. Occupational cancer in Italy: Evaluating the extent of compensated cases in the period 1994 – 2006. Am J Ind Med 2009; 52: 859 – 867
24. Perol O, Lepage N, Noelle H, et al. A multicenter study to assess a systematic screening of occupational exposure in lung cancer patients. Int J Environ Res Public Health. 2023; 20:5068
25. Report_Declaration MP_EUROGIP_102: Study report Reporting of Occupational diseases: issues and good practices in Five European countries. Chapter 3 Combact against under-reporting of occupational diseases in Denmark, Spain, France and Italy
26. Crosignani P, Scaburri A, Audisio R, et al. The Italian Occupational Cancer Monitoring System (the OCCAM project). Eur J Oncol. 2005. vol. 10, n. 3: 181-184
27. Crosignani P, Massari S, Audisio R et al. The Italian surveillance system for occupational cancers: characteristics, initial results, and future prospects. Am J Ind Med. 2006; 49:791-798.
28. Crosignani P, Audisio A, Amendola P, et al. The active search for occupational cancers. Epidemiol Prev. 2009; 33(4-5) Suppl 2:71-73.
29. Curti S, Sauni R, Spreeuers D, et al. Interventions to increase the reporting of occupational diseases by physicians: a Cochrane systematic review. Occup Environ Med. 2016;73:353–354.
30. ISS studio Passianni 2021-2022 available on line: https://www.epicentro.iss.it/passi/dati/fumo
31. Yeager DS, Krosnick JA The validity of self-reported nicotine product use in the 2001-2008 National Health and Nutrition Examination Survey. Med Care. 2010; 48(12):1128-32.
32. Schabath MB, Cote ML. Cancer progress and priorities: lung cancer. Cancer Epidemiol Biomarkers Prev. 2019 28(10):1563-1579.
33. Pizzato M, Martinens JI, Heikkinen S., et al. Socioeconomics stats and risk of lung cancer by histological subtype in the nordic countries. Cancer Medicine. 2022 11:1850-1859.
34. Olsson A, Bouaoun L, Shuz J, et al. Lung cancer risk associated with occupational exposure to pairs of five lung cancer carcinogens: results of a pooled analysis of case-control studies (SYNERGY). Environ Health Perspect. 2024;132(1):17005-1-17005-10.
35. International Agency for Research on Cancern (IARC)List of classifications by cancer sites with sufficient or limited evidence in humans, monographs volumes 1‐135. 2023.Accessed September 2024https://monographs.iarc.who.int/wp-content/uploads/2019/07/classifications_by_cancer_site.pdf
36. Markowitz S, Ringen K, Dement JM, et al. Occupational lung cancer screening. A Collegium Ramazzini statement. Am J Ind Med. 2024;67:289–303
Article Sidebar
Article Details
How to Cite
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All Journal's articles are Open Access papers distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Reproductions with commercial intent will require written permission and payment of royalties.
This work is licensed under a CC BY-NC 4.0 Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
