[How do we reduce the under-reporting of occupational primary lung cancer]

The under-reporting of occupational lung cancer is due to insufficient recognition of occupational exposure and inadequate medico-legal action.

All cases of primary bronchial carcinoma seen at the University Hospital of Grenoble between October 1996 and December 1998 completed a standardised questionnaire set by a physician in occupational medicine. When evidence of exposure to occupational carcinogens was established a claim for occupational disease was made and the outcomes of these claims were obtained from the Department of Social Security at the end of 2000.

Asbestos was the most common carcinogenic agent found, followed by crystalline silica, diesel fumes, metals, paints and ionising radiation. Among the 305 patients in the study with primary bronchial carcinoma 20% were able to make a claim for occupational disease whereas only 2% would have claimed otherwise. The Department of Social Security accepted 77% of the 39 claims for occupational disease submitted, thus giving a 12% incidence of occupational bronchial carcinoma in this group.

It is important to inform and instruct doctors of the environmental risks that are additional to those of tobacco smoking and of the need of inquire into any exposure to carcinogenic agents in order to ensure that the victims receive the appropriate medico-legal benefits. Improved primary prevention alone might eventually avoid the development of up to 3 500 cases of occupation bronchial carcinoma per year in France.