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

Our plain-English summary of Reducing the underreporting of lung cancer attributable to occupation: outcomes from a hospital-based systematic search in Northern Italy, by S. Porru, A. Carta, E. Toninelli, et al (International Archives of Occupational and Environmental Health, 2016).

The study

• Authors: S. Porru, A. Carta, E. Toninelli, G. Bozzola, C. Arici
• Journal: International Archives of Occupational and Environmental Health
• Published: 2016;89(6):981-9
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

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.

In plain English

This article described a programme begun in 1998 at a Northern Italian public hospital to find work-caused lung cancers. Physicians in four wards completed a one-page form when a primary lung cancer was histologically diagnosed; referrals to the occupational health unit covered over 85% of Pneumology Unit patients. There an occupational physician decided whether to interview. From 1998 to 2013, 3274 lung cancer cases were referred and 1522 patients were fully interviewed. Work was judged a cause in 395 cases. That was 26% of those interviewed and 12% of all referred, versus a couple of dozen reported before the programme. Among the 395, the largest groups were truck drivers (117), silica (83), multiple exposures (59) and painters (48). Asbestos accounted for 23 (5.8%). The search also found 4 cases of asbestosis and 21 benign pleural asbestos lesions. Compensation authority data up to May 2010 showed 91 of 234 concluded claims (39%) compensated, including 10 asbestos workers. The authors concluded the search appeared effective and efficient. They noted it missed cancers treated elsewhere and that work histories could be misclassified.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Description of an ongoing hospital-based systematic search programme for occupational lung cancer (a descriptive case series of referred patients)
• Who was studied: 3274 patients with histologically diagnosed primary lung cancer referred to the Occupational Health Unit of a public general hospital in Northern Italy from 1998 to 2013. About 81% lived in Brescia Province, and referrals covered more than 85% of patients assessed at the Pneumology Unit. Of the 3274, 1522 were fully interviewed.
• Exposure: Lifetime occupational exposure to known or suspected lung carcinogens. Examples given included asbestos, crystalline silica, diesel exhausts, polycyclic aromatic hydrocarbons and certain metals, and jobs such as foundry work, electroplating, truck driving, welding, painting and rubber work. Each was assessed by an occupational physician through interview.
• Main results:
  • Physicians in Pneumology, Thoracic Surgery, Internal Medicine and Radiotherapy wards completed a referral form when a primary lung cancer was histologically diagnosed
  • About 200 patients per year were referred, accounting for more than 85% of patients assessed at the Pneumology Unit
  • Of the 1522 fully interviewed patients, causation was attributed to occupation in 395 (26% of interviewed patients; 12% of all 3274 referred cases)
  • Before the systematic search, only a couple of dozen lung cancer cases had been reported; all 395 cases attributed to occupation were reported to the Local Health Authority
  • Among the 395 occupational lung cancers, the largest groups were truck drivers 117 (29.6%), silica 83 (21.0%), multiple exposures 59 (14.9%) and painters 48 (12.2%)
  • Asbestos was the exposure for 23 (5.8%) of the 395 occupational lung cancers
  • Other occupational disorders identified during the search included 4 cases of asbestosis
  • Other occupational disorders identified during the search included 21 benign pleural asbestos lesions
  • According to Italian Workers' Compensation Authority (INAIL) data updated only until May 2010, 240 occupational disease claims were filed. Of the 234 concluded claims, 91 (39%) were compensated and 143 (61%) rejected.
  • The compensated cases included 15 painters and 10 asbestos workers
  • Of 18 rejected cases fully evaluated after patients sought patronage counselling, occupational aetiology was confirmed and compensated through judicial trial in 12 (67%)
  • Most of the lung cancer patients were smokers or former smokers (among the 395 attributed to occupation: 130 current, 235 former, 30 non-smokers)
• The authors' conclusion: The authors concluded that systematic search of occupational lung cancer cases in a hospital setting in Northern Italy appeared effective and efficient. They also concluded that it found many occupational lung cancers that would otherwise have been lost.
• Limitations the authors state:
  • The search could not reach all lung cancers diagnosed in the area, because some cases were admitted to other hospitals
  • Lung cancer cases assessed at the Pneumology Unit were estimated at about 35 to 40% of those expected from local epidemiological data
  • Some patients did not request patronage counselling, and some physicians did not report cases to authorities
  • Occupational histories could be misclassified, because exposures, technologies and materials could have changed over decades
  • Patient recall could be difficult, especially given their clinical conditions
  • Most lung cancer patients were current or former smokers, a potential confounding factor
  • Compensation follow-up was incomplete: 116 cases attributed to occupation were not followed up, and further information could not be obtained from INAIL

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer.

Medical terms in this study, explained in our Lexicon: Lung Cancer, Occupational Exposure, Causation.

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