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Reducing the underreporting of lung cancer attributable to occupation: outcomes from a hospital-based systematic search in Northern Italy

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Abstract

Purpose

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.

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Acknowledgments

The Authors wish to thank the colleagues of the Divisions of Pneumology and Radiology of the Spedali Civili of Brescia, the residents of the School of Occupational Health of the University of Brescia and their clinical tutors for their significant contribution. The Authors are also grateful to the local Health Authority and to the INCA patronage, for their cooperation. Special thanks go to Dr. Gianfranco Tassi, former head of the Division of Pneumology.

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Authors and Affiliations

  1. Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy

    Stefano Porru, Angela Carta, Elena Toninelli & Cecilia Arici

  2. Division of Pneumology, Spedali Civili of Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy

    Giordano Bozzola

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  1. Stefano Porru
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  2. Angela Carta
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  3. Elena Toninelli
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Correspondence to Stefano Porru.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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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 89, 981–989 (2016). https://doi.org/10.1007/s00420-016-1135-5

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