Prostate cancer as an occupational disease: the actual impact in a high-incidence area

In Guadeloupe, prostate cancer (PCa) shows very high incidence rates. This over-incidence is associated with the historical use of chlordecone in banana plantations. Since December 2021, PCa has been recognized as an occupational disease for agricultural workers exposed to this pesticide. However, patient identification and referral to compensation mechanisms remain limited. The aim of this study was to estimate the proportion of PCa patients in Guadeloupe eligible for occupational disease recognition.

We conducted a retrospective study based on the prospective KP Caraïbes cohort, including patients newly diagnosed at the University Hospital of Pointe-à-Pitre between June 2022 and December 2024. Clinical, geographical, and occupational data were collected through medical records and structured telephone interviews. Eligibility for occupational disease recognition was assessed according to current regulatory criteria.

Among the 267 patients in the cohort, 59 (22.1%) were identified as potentially eligible, of whom 18 (30.5%) met the official criteria. By extrapolation, this would represent nearly 140 cases per year in Guadeloupe, more than three times the number of cases actually submitted for compensation over the same period (n=44). Employment in the agriculture/fishing/livestock sectors was significantly associated with occupational exposure (P=0.001).

This study reveals a major discrepancy between the number of eligible patients and those actually recognized. A decision-support algorithm has been proposed to enhance systematic screening and referral of exposed patients.