Occupational cancer: clinical interpretation and application of scientific evidence

Maintaining an awareness that workplace factors may contribute to occupational cancer is one of the most formidable obstacles in early clinical recognition. This early recognition provides an opportunity for a practicing physician to make an important contribution to new knowledge in the field. Another important reason for the physician to have a high index of suspicion of cancers being related to workplace exposures has to do with compensation benefits which may accrue to the injured worker. The physician's role in the compensation system is critical both in providing medical opinion, which is material to the final decision, and because in many states it is the physician who starts the time clock for the statute of limitations. Three case examples are used to illustrate the importance of clinical recognition by an alert physician: 1) mesothelioma and labor; 2) lung cancer in a plumber who smokes and one who does not smoke; 3) leukemia in a rubber industry worker. Given the inherent preventable nature of occupational cancers, it is hoped that society will assist in searching for these important links.