Methods to recognize work-related cancer in workplaces, the general population, and by experts in the clinic, a Norwegian experience

<p>Abstract</p> <p>Background</p> <p>In most countries, the numbers of work-related cancer identified are much lower than are the estimated total burden of cancer caused by exposure at work. Therefore, there is a great need to use all available practical as well as epidemiological methods for identification as well as to develop new methods of recognizing cases of work-related cancers.</p> <p>Methods</p> <p>Primarily based on practical experiences from Norway, methods to identify cases of possible work-related cancers in the general population and at workplaces as well as methods to recognize more specific cases after referral to specialized clinics are reviewed in this publication.</p> <p>Results</p> <p>Countries applying a number of the available methods to detect work-related cancer reach a reporting rate of 60 such cases per million, while other countries that do not employ such methods hardly identify any cases. As most subjects previously exposed to cancer causing agents and substances at work are gradually recruited out of work, methods should be versatile for identification of cases in the general population, as well as at work.</p> <p>Conclusions</p> <p>Even in countries using a number of the available methods for identification, only a limited fraction of the real number of work-related cancer are notified to the labour inspectorate. Clinicians should be familiar with the methods and do the best to identify work-related cancer to serve prevention.</p

Comparison of the Quality of Life between Patients with Non-Small-Cell Lung Cancer and Healthy Controls

We explored covariates of the quality of life (QOL) in non- small-cell lung cancer (NSCLC) patients and made a comparison with healthy controls. We assessed the QOL of 220 consecutive NSCLC patients at a university hospital. The QOL data were measured by the brief version of the World Health Organization's Quality of Life and by utility using the standard gamble method. We selected demographically matched healthy controls from the 2001 National Health Interview Survey for comparison. Multiple linear regression models were constructed to explore significant factors of QOL after controlling for covariates. Patients with more advanced stages of NSCLC had poorer scores than did the healthy controls in the physical and psychological domains. Patients with disease duration of longer than 1 year tended to report higher physical and environment QOL than did those with NSCLC diagnosed for less than 1 year. Insight into one 's own illness was associated with a higher utility, better social support, and improved financial resources. QOL was significantly associated with staging and duration of NSCLC. Disease insight appears to be a positive factor for operable NSCLC patients of the Taiwanese culture, which implies that clinicians should respect patient autonomy in diagnosis disclosure

An estimation of the health impact of groundwater pollution caused by dumping of chlorinated solvents

Hazardous waste sites are major environmental concerns, but few studies have quantified their expected utility loss on health. Objectives: To evaluate the health impact of groundwater pollution by an electronics manufacturing factory, we conducted a health risk assessment based on expected utility loss from liver cancer. Methods: Based on measurements of major pollutants, we estimated the likelihood of developing liver cancer after exposure to groundwater contamination. All patients with liver cancer between 1990 and 2005 in the Taiwan Cancer Registry were followed through 2007 using the National Mortality Registry to obtain survival function. Quality of life was assessed with two cross-sectional surveys, one employing the standard gamble method, and the other using the EQ-5D instrument. Quality-adjusted life expectancy (QALE) was estimated by multiplying the utility values with survival function under the unit of quality-adjusted life year (QALY). The difference of QALE between the cancer cohort and the age- and gender-matched reference population was calculated to represent the utility loss due to liver cancer. Results: A total of 94,144 patients with liver cancer were identified. The average utility loss to development of liver cancer was 17.5 QALYs. Based on toxicological approach, we estimated that groundwater pollution caused 1.7 extra cases of liver cancer, with an overall loss of 29.8 QALYs. Based on epidemiological approach, the expected annual excess number of liver cancer would be 3.65, which would have been accumulated through the years, had the pollution not mitigated. Conclusions: We demonstrated a practical approach for comparative health risk assessment using QALY as the common unit. This approach can be used for policy decisions based on possible health risks

Impact of malignant mesothelioma in Taiwan: A 27-year review of population-based cancer registry data

To describe the epidemiologic characteristics of malignant mesothelioma (MM) in Taiwan; to evaluate the impact of the condition. Methods: The Taiwan Cancer Registry Database was used to retrieve the cases of MM registered from 1979 to 2005. Only cases of histopathologically verified MM were included. For evaluating the impact of MM, the cancer sites of the pleura and peritoneum (ICD-O codes 163 and 158, respectively) were used for statistical analysis and estimation of the expected years of life lost (EYLL). Their survival was calculated by Kaplan-Meier analysis and extrapolated to obtain the EYLL using the Monte Carlo simulation by borrowing information from gender- and age- matched populations in Taiwan. Results: A total of 423 cases of MM were included; MM of the pleura and peritoneum accounted for 91% of all cases (387/423). The median survival of pleural and peritoneal MM was 7.6 and 13.5 months for males and females, respectively. The incidence of MM increased during the observation period. A total of 232 males and 155 females diagnosed with MM were used for estimation of EYLL: 14.8 [95% Confidence Interval: 13.1-16.6 ] life years for males and 13.7 [11.2-16.2] life years for females. Conclusion: The increasing incidence and significant EYLL for MM were observed for both males and females during 1979-2005 in Taiwan, although under-diagnosis and under-estimation were likely