Screening for Occupational Cancer

  • Douglas B. TroutEmail author
  • David N. Weissman


Many known and potential human carcinogens are related to workplace exposures. Primary prevention is the optimal prevention strategy for occupational cancer control through activities intended to eliminate harmful exposure(s) in the workplace. Secondary prevention provided by medical screening remains an important component of sound occupational health practice in many instances. One of the aims of secondary prevention is to reduce morbidity and mortality through detection of illness at an early stage when treatment may succeed in altering progression of disease. Medical screening data, ideally collected in a standardized manner, aggregated, and evaluated over time, can also be evaluated as a part of a surveillance program and play an important role in primary prevention.


Medical screening Medical surveillance Lung cancer screening Bladder cancer screening Skin cancer screening Biomonitoring 


  1. 1.
    Boffetta P. Epidemiology of environmental and occupational cancer. Oncogene. 2004;23:6392–403.PubMedPubMedCentralCrossRefGoogle Scholar
  2. 2.
    Landrigan PJ. The prevention of occupational cancer. CA Cancer J Clin. 1996;46:67–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Siemiatycki J, Richardson L, Straif K, et al. Listing occupational carcinogens. Environ Health Perspect. 2004;112(15):1447–59.PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Cone JE, Rosenberg J. Medical surveillance and biomonitoring for occupational cancer endpoints. Occup Med. 1990;5(3):563–81.PubMedGoogle Scholar
  5. 5.
    Ward E. Cancer. In: Levy BS, Wegman DH, Baron SL, Sokas RK, editors. Occupational and environmental health: recognizing and preventing disease and injury. 6th ed. Oxford: University Press; 2011. p. 366–97.Google Scholar
  6. 6.
    Bode AM, Dong Z. Cancer prevention research – then and now. Nat Rev Cancer. 2009;9(7):508–16.PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Gochfeld M. Medical surveillance and screening in the workplace: complementary preventive strategies. Environ Res. 1992;59:67–80.PubMedCrossRefGoogle Scholar
  8. 8.
    Silverstein MA. Medical screening, surveillance, and the prevention of occupational disease. J Occup Med. 1990;32(10):1032–6.PubMedGoogle Scholar
  9. 9.
    Baker E, Matte T. Occupational health surveillance. In: Rosenstock L, Cullen MR, Brodkin CA, Redlich CA, editors. Textbook of clinical occupational and environmental medicine. 2nd ed. Philadelphia: Elsevier Saunders Company; 2005. p. 76–82.Google Scholar
  10. 10.
    Halperin WE, Ratcliffe J, Frazier TM, Wilson L, Becker SP, Schulte PA. Medical screening in the workplace: proposed principles. J Occup Med. 1986;28(8):547–52.PubMedCrossRefGoogle Scholar
  11. 11.
    Millar JD. Screening and monitoring: tools for prevention. J Occup Med. 1986;28(8):544–6.PubMedCrossRefGoogle Scholar
  12. 12.
    Matte TD, Fine L, Meinhardt TJ, Baker EL. Guidelines for medical screening in the workplace. Occup Med. 1990;5(3):439–56.PubMedGoogle Scholar
  13. 13.
    Atkinson AJ Jr, Colburn WA, DeGruttola VG, et al. Biomarkers and surrogate endpoints: preferred definitions and conceptual framework. Clin Pharmacol Ther. 2001;69:89–95.CrossRefGoogle Scholar
  14. 14.
    Schulte PA. Opportunities for the development and use of biomarkers. Toxicol Lett. 1995;77:25–9.PubMedCrossRefGoogle Scholar
  15. 15.
    National Research Council Committee on Biological Markers. Biological markers in environmental health research. Environ Health Perspect. 1987;74:3–9.Google Scholar
  16. 16.
    Schulte PA. Problems in notification and screening of workers at high-risk of disease. J Occup Environ Med. 1986;28(10):951–7.CrossRefGoogle Scholar
  17. 17.
    Schulte PA. The use of biomarkers in surveillance, medical screening, and intervention. Mutat Res Fundam Mol Mech Mutagen. 2005;592(1–2):155–63.CrossRefGoogle Scholar
  18. 18.
    Gallo V, Khan A, Gonzales C, et al. Validation of biomarkers for the study of environmental carcinogens: a review. Biomarkers. 2008;13(5):505–34.PubMedCrossRefGoogle Scholar
  19. 19.
    Vineis P, Perera F. Molecular epidemiology and biomarkers in etiologic cancer research: the new in light of the old. Cancer Epidemiol Biomark Prev. 2007;16(10):1954–65.CrossRefGoogle Scholar
  20. 20.
    Jacobs IJ, Menon U, Ryan A, et al. Ovarian cancer screening and mortality in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): a randomized controlled trial. Lancet. 2016;387(10022):945–56.PubMedPubMedCentralCrossRefGoogle Scholar
  21. 21.
    Schorge JO. What is new in prevention of ovarian cancer? Obstet Gynecol. 2016;4:795–6.CrossRefGoogle Scholar
  22. 22.
    Smith RA, Andrews KS, Brooks D, et al. Cancer screening in the United States, 2017: a review of current American Cancer Society guidelines and current issues in cancer screening. CA Cancer J Clin. 2017;67:100–21.PubMedCrossRefGoogle Scholar
  23. 23.
    Swenberg JA, Fryar-Tita E, Jeong YC. Biomarkers in toxicology and risk assessment: informing critical dose-response relationships. Chem Res Toxicol. 2008;21(1):253–65.PubMedCrossRefGoogle Scholar
  24. 24.
    Gyorffy E, Anna L, Kovács K, Rudnai P, Schoket B. Correlation between biomarkers of human exposure to genotoxins with focus on carcinogen-DNA adducts. Mutagenesis. 2008;23(1):1–18.PubMedCrossRefGoogle Scholar
  25. 25.
    Lai Y, Yu R, Hartwell HJ, et al. Measurement of endogenous versus exogenous formaldehyde–induced DNA–protein crosslinks in animal tissues by stable isotope labeling and ultrasensitive mass spectrometry. Cancer Res. 2016;76(9):2652–61.PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    Kirschner MB, Pulford E, Hoda MA, et al. Fibulin-3 levels in malignant pleural mesothelioma are associated with prognosis but not diagnosis. Br J Cancer. 2015;113:963–9.PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    Napolitano A, Antoine DJ, Pellegrini L, et al. HMGB1 and its hyperacetylated isoform are sensitive and specific serum biomarkers to detect asbestos exposure and to identify mesothelioma patients. Clin Cancer Res. 2016;22(12):3087–96.PubMedPubMedCentralCrossRefGoogle Scholar
  28. 28.
    Valverde M, Rojas E. Environmental and occupational biomonitoring using the comet assay. Mutat Res Rev Mutat Res. 2009;681:93–109.CrossRefGoogle Scholar
  29. 29.
    Chang CM, Edwards SH, Arab A, et al. Biomarkers of tobacco exposure: summary of an FDA-sponsored public workshop. Cancer Epidemiol Biomark Prev. 2016;26(3):1–12.Google Scholar
  30. 30.
    Christiani D, Mehta A, Yu CL. Genetic susceptibility to occupational exposures. Occup Environ Med. 2008;65:430–6.PubMedCrossRefPubMedCentralGoogle Scholar
  31. 31.
    Collins FS, Varmus H. A new initiative on precision medicine. N Engl J Med. 2015;372(9):793–5.PubMedPubMedCentralCrossRefGoogle Scholar
  32. 32.
    Brandt-Rauf P, Borak J, Deubner DC. Genetic screening in the workplace. J Occup Environ Med. 2015;57(3):e17.PubMedCrossRefGoogle Scholar
  33. 33.
    Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65:87–108.PubMedCrossRefGoogle Scholar
  34. 34.
    National Toxicology Program. Report on carcinogens. 12th ed. Research Triangle Park: U.S. Department of Health and Human Services, Public Health Service, National Toxicology Program; 2011.Google Scholar
  35. 35.
    Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016;66:7–30.PubMedCrossRefGoogle Scholar
  36. 36.
    Rushton L, Hutchings S, Fortunato L, et al. Occupational cancer burden in Great Britain. Br J Cancer. 2012;107:S3–7.PubMedPubMedCentralCrossRefGoogle Scholar
  37. 37.
    Straif K. The burden of occupational cancer. Occup Environ Med. 2008;65(12):787–8.PubMedCrossRefPubMedCentralGoogle Scholar
  38. 38.
    Viera AJ. Predisease: when does it make sense? Epidemiol Rev. 2011;33:122–34.PubMedCrossRefPubMedCentralGoogle Scholar
  39. 39.
    Cancer Prevention and Control. Accessed 1 Mar 2017.
  40. 40.
    U.S. Preventive Services Task Force. Accessed 1 Mar 2017.
  41. 41.
    Smith RA, Mettlin CJ. Cancer detection. In: Lenhard Jr RE, Osteen RT, Gansler T, editors. Clinical oncology. Atlanta: American Cancer Society; 2001. p. 75–122.Google Scholar
  42. 42.
    Levin B, Prorok PC. Principles of screening. In: Schottenfeld D, Fraumeni JF, editors. Cancer epidemiology and prevention. Oxford: University Press; 2006. p. 1310–7.CrossRefGoogle Scholar
  43. 43.
    Smith RA, Mettlin CJ, Davis KJ, Eyre H. American Cancer Society guidelines for the early detection of cancer. CA Cancer J Clin. 2000;50:34–49.PubMedCrossRefGoogle Scholar
  44. 44.
    Stojanovica J, Milovanovica S, Pastorinoa R, Iavicolic I, Boccia S. Occupational exposures and genetic susceptibility to urinary tract cancers: a systematic review and meta-analysis. Eur J Cancer Prev. 2018;27(5):468–76. Scholar
  45. 45.
    Schulte PA. Some implications of genetic biomarkers in occupational epidemiology and practice. Scand J Work Environ Health. 2004;30(1):71–9.PubMedCrossRefGoogle Scholar
  46. 46.
    Samuels SW. Medical surveillance-biological, social, and ethical parameters. J Occup Environ Med. 1986;28(8):572–7.CrossRefGoogle Scholar
  47. 47.
    Samuels SW. The Selikoff agenda and the human genome project: ethics and social issues. In: Samuels SW, Upton AC, editors. Genes, cancer, and ethics in the work environment. Beverly Farms: OEM Press; 1998. p. 3–9.Google Scholar
  48. 48.
    Screening and surveillance: a guide to OSHA standards. Accessed 1 Mar 2017.
  49. 49.
    Herbert R, Szeinuk J. Integrating clinical care with prevention of occupational illness and injury. In: Rosenstock L, Cullen MR, Brodkin CA, Redlich CA, editors. Textbook of clinical occupational and environmental medicine. 2nd ed. Philadelphia: Elsevier Saunders Company; 2005. p. 1263–74.CrossRefGoogle Scholar
  50. 50.
    Occupational Safety and Health Administration. OSHA’s final rule to protect workers from exposure to respirable crystalline silica. Accessed 1 May 2017.
  51. 51.
    Rutstein D, Mullan RJ, Frazier TM, et al. Sentinel health events (occupational): a basis for physician recognition and public health surveillance. Am J Public Health. 1983;73:1054–62.PubMedPubMedCentralCrossRefGoogle Scholar
  52. 52.
    Schulte PA, Ehrenberg RL, Singal M. Investigation of occupational cancer clusters: theory and practice. Am J Public Health. 1987;77(1):52–6.PubMedPubMedCentralCrossRefGoogle Scholar
  53. 53.
    Moyer VA, on behalf of the U.S. Preventive Services Task Force. Screening for lung cancer: U.S. preventive services task force recommendation statement. Ann Intern Med. 2014;160:330–8.PubMedGoogle Scholar
  54. 54.
    The National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365(5):395–409.PubMedCentralCrossRefPubMedGoogle Scholar
  55. 55.
    Wender R, Fontham ETH, Barrera E Jr, et al. American Cancer Society lung cancer screening guidelines. CA Cancer J Clin. 2013;63:106–17.CrossRefGoogle Scholar
  56. 56.
    U.S. Preventive Services Task Force. Lung cancer: screening. Accessed 4 May 2017.
  57. 57.
    Patz EF Jr, Greco E, Gatsonis C, Pinsky P, Kramer BS, Aberle DR. Lung cancer incidence and mortality in National Lung Screening Trial participants who underwent low-dose CT prevalence screening: a retrospective cohort analysis of a randomised, multicentre, diagnostic screening trial. Lancet Oncol. 2016;17:590–9.PubMedPubMedCentralCrossRefGoogle Scholar
  58. 58.
    Wolff H, Vehmas T, Oksa P, Rantanen J, Vainio H. Asbestos, asbestosis, and cancer: the Helsinki criteria for diagnosis and attribution 2014: recommendations. Scand J Work Environ Health. 2015;41(1):5–15.PubMedPubMedCentralCrossRefGoogle Scholar
  59. 59.
    Markowitz SB, Levin SM, Miller A, Morabia A. Asbestos, asbestosis, smoking, and lung cancer: new findings from the North American insulator cohort. Am J Respir Crit Care Med. 2013;188(1):90–6.PubMedCrossRefGoogle Scholar
  60. 60.
    Vehmas T, Sauni R, Miller AB, Straif K, Malila N, Smith RA. Screening for asbestos related lung cancer. In: Oksa P, Wolff H, Vehmas T, Pallasaho P, Frilander H, editors. Asbestos, asbestosis, and cancer—Helsinki criteria for diagnosis and attribution 2014. Helsinki: Finnish Institute of Occupational Health; 2014.
  61. 61.
    Huber A, Landau J, Ebner L, et al. Performance of ultralow-dose CT with iterative reconstruction in lung cancer screening: limiting radiation exposure to the equivalent of conventional chest X-ray imaging. Eur Radiol. 2016;26(10):3643–52.PubMedCrossRefGoogle Scholar
  62. 62.
    Weissman D. Role of chest computed tomography in prevention of occupational respiratory disease: review of recent literature. Semin Respir Crit Care Med. 2015;36:433–48.PubMedPubMedCentralCrossRefGoogle Scholar
  63. 63.
    Ruder AM, Carreon T, Ward EM, Schulte PA, Halperin W. Bladder cancer. In: Rosenstock L, Cullen MR, Brodkin CA, Redlich CA, editors. Textbook of clinical occupational and environmental medicine. 2nd ed. Philadelphia: Elsevier Saunders Company; 2005. p. 757–66.Google Scholar
  64. 64.
    Schulte PA. Screening for bladder cancer in high-risk groups – delineation of the problem. J Occup Environ Med. 1990;32(9):789–92.CrossRefGoogle Scholar
  65. 65.
    Weiderpass E, Vainio H. The need for further preventive measures for occupational bladder cancer. JAMA Oncol. 2015;1(9):1291–2.PubMedCrossRefGoogle Scholar
  66. 66.
    Marsh GM, Leviton LC, Talbott EO, et al. Drake chemical workers health registry study – notification and medical surveillance of a group of workers at high-risk of developing bladder cancer. Am J Ind Med. 1991;19(3):291–301.PubMedCrossRefGoogle Scholar
  67. 67.
    Cumberbatch MG, Windsor-Shellard B, Catto JWF. The contemporary landscape of occupational bladder cancer within the United Kingdom: a meta-analysis fo risks over the last 80 years. BJU Int. 2017;119:100–9.PubMedCrossRefGoogle Scholar
  68. 68.
    Vickers AJ, Bennette C, Kibel AS, et al. Who should be included in a clinical trial of screening for bladder cancer? Cancer. 2013;119:143–9.PubMedCrossRefGoogle Scholar
  69. 69.
    Lotan Y, Roehrborn CG. Sensitivity and specificity of commonly available bladder tumor markers versus cytology: results of a comprehensive literature review and meta-analyses. Urology. 2003;61(1):109–18.PubMedCrossRefGoogle Scholar
  70. 70.
    Chen HI, Liou SH, Loh CH, et al. Bladder cancer screening and monitoring of 4,4′-methylenebis(2-chloroaniline) exposure among workers in Taiwan. Urology. 2005;66(2):305–10.PubMedCrossRefGoogle Scholar
  71. 71.
    Schmitz-Dräger BJ, Droller M, Lokeshwar VB, et al. Molecular markers for bladder cancer screening, early diagnosis, and surveillance: the WHO/ICUD consensus. Urol Int. 2015;94:1–24. Scholar
  72. 72.
    Shariat SF, Karam JA, Lotan Y, Karakiewizc PI. Critical evaluation of urinary markers for bladder cancer detection and monitoring. Rev Urol. 2008;10(2):120–35.PubMedPubMedCentralGoogle Scholar
  73. 73.
    Fradet Y. Screening for bladder cancer: the best opportunity to reduce mortality. Can Urol Assoc J. 2009;3(6 Suppl 4):S180–3.PubMedPubMedCentralGoogle Scholar
  74. 74.
    Katz MH, Steinberg GD. Editorial comment – bladder cancer screening in a high risk asymptomatic population using a point of care urine based protein tumor marker. J Urol. 2009;182(1):58.CrossRefGoogle Scholar
  75. 75.
    Pesch B, Taeger D, Johnen G, et al. Screening for bladder cancer with urinary tumor markers in chemical workers with exposure to aromatic amines. Int Arch Occup Environ Health. 2014;87:715–24.PubMedCrossRefPubMedCentralGoogle Scholar
  76. 76.
    Larre S, Catto JWF, Cookson MS, et al. Screening for bladder cancer: rationale, limitations, whom to target, and perspectives. Eur Urol. 2013;63:1049–58. Scholar
  77. 77.
    Carreon T, Ruder AM, Schulte PA, et al. NAT2 slow acetylation and bladder cancer in workers exposed to benzidine. Int J Cancer. 2006;118(1):161–8.PubMedCrossRefGoogle Scholar
  78. 78.
    Wang YH, Yeh SD, Shen KH, et al. A significantly joint effect between arsenic and occupational exposures and risk genotypes/diplotypes of CYP2E1, GSTO1 and GSTO2 on risk of urothelial carcinoma. Toxicol Appl Pharmacol. 2009;241(1):111–8.PubMedCrossRefGoogle Scholar
  79. 79.
    Lotan Y, Elias K, Svatek RS, et al. Bladder cancer screening in a high risk asymptomatic population using a point of care urine based protein tumor marker. J Urol. 2009;182(1):52–7.PubMedCrossRefGoogle Scholar
  80. 80.
    Taiwo OA, Slade MD, Cantley LF, et al. Bladder cancer screening in aluminum smelter workers. J Occup Environ Med. 2015;57(4):421–7.PubMedPubMedCentralCrossRefGoogle Scholar
  81. 81.
    Chou R, Dana T. Screening adults for bladder cancer: a review of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2010;153(7):461–8.PubMedCrossRefGoogle Scholar
  82. 82.
    American Cancer Society. Key statistics for basal and squamous cell skin cancers. Accessed 18 Apr 2017.
  83. 83.
    John SM, Trakatelli M, Gehring R, et al. Consensus report: recognizing non-melanoma skin cancer, including actinic keratosis, as an occupational disease – a call to action. J Eur Acad Dermatol Venereol. 2016;30(Suppl 3):38–45.PubMedCrossRefGoogle Scholar
  84. 84.
    Shellenberger RA, Kakaraparthi S, Tawagi K. Melanoma screening: thinking beyond the guidelines. Mayo Clin Proc. 2017;92(5):693–8.PubMedCrossRefGoogle Scholar
  85. 85.
    Tripp MK, Watson M, Balk SJ, Swetter SM, Gershenwald JE. State of the science on prevention and screening to reduce melanoma incidence and mortality: the time is now. CA Cancer J Clin. 2016;66:460–80.PubMedPubMedCentralCrossRefGoogle Scholar
  86. 86.
    Terushkin V, Halpern AC. Melanoma early detection. Hematol Oncol Clin North Am. 2009;23:481–500.PubMedCrossRefGoogle Scholar
  87. 87.
    Cohen DE, Bassiri S, Forrester BG, Nethercott J. Skin cancers. In: Rosenstock L, Cullen MR, Brodkin CA, Redlich CA, editors. Textbook of clinical occupational and environmental medicine. 2nd ed. Philadelphia: Elsevier Saunders Company; 2005. p. 811–24.Google Scholar
  88. 88.
    Trautmann F, Meier F, Seidler A, Schmitt J. Effects of the German skin cancer screening programme on melanoma incidence and indicators of disease severity. Br J Dermatol. 2016;175:912–9.PubMedCrossRefGoogle Scholar
  89. 89.
    Stang A, Garbe C, Autier P, Jockel KH. The many unanswered questions related to the German skin cancer screening programme. Eur J Cancer. 2016;64:83–8.PubMedCrossRefGoogle Scholar
  90. 90.
    Wernli KJ, Henrikson NB, Morrison CC, et al. Screening for skin cancer in adults updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2016;316(4):436–47. Scholar
  91. 91.
    Hue L, Makhloufi S, Sall N’Diaye P, et al. Real-time mobile teledermoscopy for skin cancer screening targeting an agricultural population: an experiment on 289 patients in France. J Eur Acad Dermatol Venereol. 2016;30:20–4.PubMedCrossRefGoogle Scholar
  92. 92.
    Landow SM, Oh DH, Weinstock MA. Teledermatology within the Veterans Health Administration, 2002–2014. Telemed J E Health. 2015;21:769–73.PubMedCrossRefGoogle Scholar
  93. 93.
    Kipen HM, Wartenberg D. Lymphohematopoietic malignancies. In: Rosenstock L, Cullen MR, Brodkin CA, Redlich CA, editors. Textbook of clinical occupational and environmental medicine. 2nd ed. Philadelphia: Elsevier Saunders Company; 2005. p. 744–56.Google Scholar
  94. 94.
    McHale CM, Smith MT, Zhang L. Application of toxicogenomic profiling to evaluate effects of benzene and formaldehyde: from yeast to human. Ann N Y Acad Sci. 2014;1310:74–83.PubMedPubMedCentralCrossRefGoogle Scholar
  95. 95.
    Gao A, Yang J, Yang G, Niu P, Tian N. Differential gene expression profiling analysis in workers occupationally exposed to benzene. Sci Total Environ. 2014;472:872–9.PubMedCrossRefGoogle Scholar
  96. 96.
    Creaney J, Robinson BWS. Malignant mesothelioma biomarkers – from discovery to use in clinical practise for diagnosis, monitoring, screening and treatment. Chest. 2017;152(1):143–9. Scholar
  97. 97.
    Hirohashi T, Igarashi K, Abe M, Maeda M, Hino O. Retorspective analysis of large-scale research screening of construction workers for the early diagnosis of mesothelioma. Mol Clin Oncol. 2014;2:26–30.PubMedCrossRefGoogle Scholar
  98. 98.
    Breysse PN, Weaver V, Cadorette M, et al. Development of a medical examination program for former workers at a Department of Energy National Laboratory. Am J Ind Med. 2002;42(5):443–54.PubMedCrossRefGoogle Scholar
  99. 99.
    Dasaro CR, Holden WL, Berman KD, et al. Cohort profile: world trade center health program general responder cohort. Int J Epidemiol. 2017;46(2):e9. Scholar
  100. 100.
    Moir W, Zeig-Owens R, Daniels RD, et al. Post-9/11 cancer incidence in world trade center-exposed New York City firefighters as compared to a pooled cohort of firefighters from San Francisco, Chicago, and Philadelphia (9/11/2001–2009). 2016. Am J Ind Med; 59:722–730.PubMedPubMedCentralCrossRefGoogle Scholar
  101. 101.
    Boffetta P, Zeig-Owens R, Wallenstein S, et al. Cancer in world trade center responders: findings from multiple cohorts and options for future study. Am J Ind Med. 2016;59:96–105.PubMedCrossRefGoogle Scholar
  102. 102.
    Schulte PA, Roth G, Hodson LL, et al. Taking stock of the occupational safety and health challenges of nanotechnology: 2000–2015. J Nanopart Res. 2016;18:159. Scholar
  103. 103.
    Nasterlack M, Zober A, Oberlinner C. Considerations on occupational medical surveillance in employees handling nanoparticles. Int Arch Occup Environ Health. 2008;81(6):721–6.PubMedCrossRefGoogle Scholar
  104. 104.
    Murashov V, Howard J. Risks to health care workers from nano-enabled medical products. J Occup Environ Hyg. 2015;12(6):D75–85. Scholar
  105. 105.
    Department of Health and Human Services (DHHS). Occupational Exposure to Carbon Nanotubes and Nanofibers. DHHS (NIOSH) Publication No. 2013-145. 2013.Google Scholar

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Division of Surveillance, Hazard Evaluations and Field StudiesNational Institute for Occupational Safety and HealthCincinnatiUSA
  2. 2.Respiratory Health DivisionNational Institute for Occupational Safety and HealthMorgantownUSA

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