Occupational Medicine Advance Access published online on June 4, 2007
Occupational Medicine, doi:10.1093/occmed/kqm031
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Evaluating causality for occupational cancers: the example of firefighters
Department of Environmental and Occupational Health, School of Public Health and Health Services and Division of Occupational Medicine and Toxicology, Department of Medicine, School of Medicine and Health Sciences, The George Washington University Medical Center, Washington, DC, USA
Background The evaluation of causality in cancers associated with firefighting presents problems common to other applications of occupational epidemiology in adjudication of individual claims for workers' compensation. A trend in Canada to establish legislated presumptions for compensation of firefighters created an opportunity to re-evaluate the literature applying medicolegal standards of certainty.
Objective To evaluate causality in selected cancer categories for firefighters using the criteria applied in tort litigation and workers' compensation, which is based on the weight of evidence and which is required to take into account individual factors.
Methods The epidemiological literature on cancer risk among firefighters was reviewed based on the weight of evidence rather than scientific certainty. Generalizable frameworks were formulated to define recurrent issues in assessing the evidence from epidemiological studies. The evidence for latency and for a threshold effect with duration of employment was also examined in order to provide practical guidelines.
Results Presumption is justified for the following cancers: bladder, kidney, testicular and brain, and lung cancer among non-smokers. Non-Hodgkin lymphoma, leukaemia and myeloma (each as a class) not only present particular problems in assessment but also merit an assumption of presumption. Four analytical frameworks describe the problems in analysis encountered.
Discussion The preponderance of evidence supports the presumption of causation for certain cancer, mostly rare. These frameworks are applicable to other problems of adjudication that rest on interpretation of epidemiological data. The named cancers, taking into account the special assessment issues described by each framework, are supported by sufficient evidence to conclude that a presumption is warranted but not necessarily sufficient evidence to accept as proof by a scientific standard.
Keywords Adjudication; bladder cancer; brain cancer; epidemiology; firefighters; kidney cancer; leukaemia; lung cancer; lymphoma; myeloma; occupational cancer; presumption; testicular cancer; weight of evidence; workers'; compensation
Correspondence to: Tee L. Guidotti, The George Washington University Medical Center, 2100 M Street, NW, Suite 203, Washington, DC 20052, USA. Tel: +1 202 994 1734; fax: +1 202 994 0011; e-mail: eohtlg{at}gwumc.edu
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