[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-371526-105":3,"detail-sidebar-cat-0-en-105":73,"doc-detail-371526-en":122},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":66,"head_meta":68,"extra_data":70,"updated_unix":72},105,"en","when-occupational-cancer-recognition-falters","When Occupational Cancer Recognition Falters","","The commentary contrasts epidemiology and legal medicine approaches to under-reporting occupational cancers. It argues that epidemiology can map patterns without ethical dilemmas, while legal medicine must evaluate individual cases under legal standards, creating more complex ethical burdens. It highlights workers’ physical and emotional distress when occupational diseases remain unrecognized and compensation becomes difficult. It then summarizes comparative study outcomes using occupational history, showing different compensation proportions across countries and discussing why recognition criteria and asbestos prevalence may drive disparities. Finally, it reviews alternative data-driven approaches such as OCCAM and registry linkage.",{"@graph":14,"@context":65},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/when-occupational-cancer-recognition-falters/371526/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/when-occupational-cancer-recognition-falters/371526.png","ImageObject",300,407,{"name":42,"@type":43},"Riley West","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-31","2026-09-23",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",7,{"@type":57,"mainEntity":58},"FAQPage",[59],{"name":60,"@type":61,"acceptedAnswer":62},"What explanations are proposed for the large difference in compensation rates between studies?","Question",{"text":63,"@type":64},"The text suggests stricter criteria in Italian INAIL or differing prevalence of asbestos exposure between study areas. 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Lav. 2025; 116 (2): 16997 DOI: 10.23749/mdl.v116i2 .16997  \nWhen Occupational Cancer Recognition Falters  \nGiorgio Assennato1,*, Chiara de Giampaulis2 1Medico del Lavoro ed Epidemiologo, Bari  \n2INAIL, Direzione territoriale di Taranto  \nSummary  \nThere are differences between epidemiology and legal medicine in addressing the problem of under-reporting occupational cancers. Epidemiology focuses on systematically gathering data and identifying patterns of under-reporting, which is not deemed to pose ethical dilemmas, as its goal is to improve public health outcomes. Conversely, legal medicine investigates individual cases and ensures compliance with legal standards, presenting more complex ethical challenges. Considering workers’frustrations when dealing with unrecognized occupational diseases is essential. These workers experience significant physical and emotional distress and should not have to face a complicated compensation claims process. There is a needfor ethical approaches that support workers in navigating their rightful claims for compensation, not challenging their mental and emotional well-being.  \nUnder-reporting and under-compensation of occupational cancers are well-known issues in occupational medicine, which could be partly due to the lack of expertise of physicians in the assessment of occupational exposures and the long latency period between exposure and cancer occurrence, resulting in very scanty knowledge of past exposures.  \nIn this journal issue, two articles, one in France and the other in Italy, aim to address the problem. They are both based on the advanced use of occupational history in cancer cases.The French study deals with hematopoietic neoplasms, while the Italian one deals with lung cancer. There are remarkable differences in the outcomes ofthe studies. The Italian research resulted in compensation by the responsible authority (INAIL) for 18 out of 82 cases identified in the surveillance evaluation (21.9%) [1]. The proportion of compensated cases was much higher in the French paper (14 out of 18 cases, or 77.8%) [2] . However, a direct comparison between the two studies is impossible because of the different cancers being evaluated. To overcome such a problem, we compared the Italian research with a French paper published in 2023 by the same authors dealing with underreporting occupational lung cancers using the  \nsame methodology [3] . In the study, 1251 patients were asked to complete a validated questionnaire on occupational exposure to carcinogens. The response rate was 33.5% . Out of the 462 respondents, occupational physicians interviewed 150, 88 of them received a certificate of occupational disease. Of the 65 patients who had forwarded it to the responsible authority, 38 were compensated (57%), a proportion much more significant than the one shown in the Italian study. It should be mentioned that 36 out of the 38 compensated cases in the French study were attributed to asbestos exposure, compared to the 7 (possibly 8) cases reported in the Italian study.  \nResults were not dissimilar in another, more extensive Italian study on 1522 thoroughly interviewed patients; in 395 cases, causation was attributed to their occupation (26% of interviewed patients). The main etiological agents were silica, asbestos, polycyclic aromatic hydrocarbons, truck driving, painting, and multiple exposures, with a compensation rate of 39%[4] .  \nThe compensation rate (No. of compensated cases/ No. of study participants x 100) was 8.2%(38/462) in the French study compared to 3.9%(18/453) in the Italian study, more than 2-fold. A possible  \nReceived 20.03.2025 – Accepted 27.03.2025  \n*Corresponding Author: Giorgio Assennato; E-mail: [assennatogiorgio@gmail.com](assennatogiorgio@gmail.com)  \n2 Assennato and De Giampaulis  \nexplanation of such striking difference could be due to more stringent criteria adopted by the Italian INAIL or, considering that 36 out of 38 compensated cases in the French","cbCaiv08XF1a5MiT","https://ap.wps.com/l/cbCaiv08XF1a5MiT","pdf",75274,"English","# Summary\n## Differences between epidemiology and legal medicine\n## Evidence from French and Italian occupational history studies\n## Causes of under-compensation and recognition barriers\n## OCCAM and registry linkage approaches","[{\"question\":\"What explanations are proposed for the large difference in compensation rates between studies?\",\"answer\":\"The text suggests stricter criteria in Italian INAIL or differing prevalence of asbestos exposure between study areas. It also notes that causation proof is easier for asbestos (included in an official list) and harder for carcinogens not listed, due to limited exposure information.\"}]","When Occupational Cancer Recognition Falters | PDF",1790192262]