Occupational cancer in the practice of occupational medicine

Evidence-based risk assessment is needed to develop effective strategies for the prevention of occupational cancer. Cancer risk assessment is based on valid estimates of the dose-risk relationship, and on realistic estimates of exposure levels in different occupational settings. One example of classification that includes the possibility of nonlinear dose-risk relationships with a threshold is that developed by the European Commission. Occupational tumors do not differ clinically or pathologically from those of other origins and can be divided into two categories: neoplasms with a clearly identified cause linked to employment, and the larger group of tumors for which both occupational and nonoccupational causes are known. The diagnosis of occupational cancer, which is important not only from the clinical perspective, but also from a legal and compensation point of view, is complex and may satisfy specific diagnostic criteria, as illustrated by the example of malignant mesothelioma. Prevention of occupational cancer comprises primary interventions aimed at the elimination or containment of risk, as well as secondary and tertiary interventions aimed at the early identification of conditions that could result in illnesses or, if the disease is established, to contain its effects with early interventions that limit its progression and improve prognosis. The role of the occupational physician is crucial in these interventions.