A 7-Year Active Surveillance Experience for Occupational Lung Cancer in Bologna, Italy (2017-2023)

Our plain-English summary of A 7-Year Active Surveillance Experience for Occupational Lung Cancer in Bologna, Italy (2017-2023), by M. Bogni, D. Cervino, M.R. Rossi, et al (La Medicina del Lavoro, 2025).

The study

• Authors: M. Bogni, D. Cervino, M.R. Rossi, P. Galli
• Journal: La Medicina del Lavoro
• Published: 2025;116(2):16173
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: In Italy, lung cancer is the second most frequent neoplasm in men and the third in women. Exposure to carcinogens in workplaces plays a significant role. Still, cases attributable to occupational exposure are currently under-reported as occupational diseases: the current National Prevention Plan also encourages active research projects for the detection of cancers attributable to occupational exposure.

Methods: The Unit of Prevention and Safety in the Workplace of Bologna Local Health Authority (Azienda Unità Sanitaria Locale-AUSL-)created a network for active surveillance of occupational lung cancer cases with the dedicated Diagnostic and Therapeutic Care Pathways(PDTA). Possible occupational exposure cases were selected within all incident PDTA cases using a self-completed patient filter form. Only patients selected through the form were interviewed; occupational physicians collected personal, occupational, and clinical history. Definition of a cooperation system with the local office of the National Institute for Insurance(INAIL)for monitoring the process during the medico-legal assessments conducted by the insurance institute up to resolution.

Results: 453 cases completed the filter form, 177 had a potential occupational exposure. Of these, 140 accepted the direct interview with occupational physicians. One hundred eleven cases interviewed were assessed with sure or suspect occupational origin: for 82, a claim for recognition was sent to the INAIL, while for the other 29 was sent to INAIL a report for epidemiological purposes. Out of 82 compensation claims, 18 individuals (4 females and 14 males) received compensation, while 4 cases remain under investigation. A total of 53 claims were rejected: 54.7% for lack of exposure to risk factors, 24.5% for insufficient exposure, 9.4% due to inadequate administrative documentation, 7.5% because of insufficient clinical documentation, and 3.8% for the absence of causal association.

Conclusions: Several occupational lung cancers were found that otherwise would have been unrecognized. Asbestos was the most frequent agent occurring in the most widespread work sectors-construction and manufacture of metalworking products-and in the period of exposure from 1970 to 1980. Other relevant agents were welding fumes and polycyclic aromatic hydrocarbons. Active surveillance, direct patient interviews, and claims for recognition integrated by a complementary report are essential to increase the INAIL compensation rate.

In plain English

This article described an active surveillance program run by the workplace prevention unit of the Bologna local health authority, Italy, from 2017 to 2023. Its aim was to find lung cancers that may have been caused by work. Lung cancer patients filled in a short checklist of jobs and agents, and 453 reports (206 women and 247 men) were assessed. Of these, 177 patients had a possible work exposure, and 140 accepted a detailed interview. Occupational physicians judged 111 of the 140 to have been exposed at work to certain or suspected lung cancer risk factors. Compensation claims were sent to INAIL, the national workers' insurance institute, for 82. For the other 29, a report was sent for epidemiological purposes. Of the 82 claims, 18 were compensated and four were still under investigation. Asbestos was the most often identified carcinogen, mainly for work in the 1970-1980 period. Silica, welding fumes and polycyclic aromatic hydrocarbons were other frequent agents. The main reason INAIL gave for rejecting claims was lack of reliable documentation of exposure. The authors concluded that the program found many cases that would otherwise have been overlooked.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Description of a regional active surveillance program for occupational lung cancer (descriptive case series of patients identified through hospital lung cancer care pathways)
• Who was studied: Primary lung cancer patients living in the Bologna AUSL area and treated within the hospital lung cancer care pathway (PDTA), 2017-2023. There were 507 forms received; 54 were excluded, and 453 reports (206 women, 247 men) were assessed, about 28% of cases treated in the PDTA. Of these, 177 had possible occupational exposure (147 men, 30 women) and 140 were interviewed.
• Exposure: Occupational exposure to known or suspected lung carcinogens, usually several per patient. Agents included asbestos (fiber type not specified), polycyclic aromatic hydrocarbons, silica dust, welding fumes, diesel exhaust, paints, chromium VI compounds and others. Asbestos exposure was established from archive documents or from published evidence for specific work sectors.
• Main results:
  • Of 453 assessed reports, 177 patients had a potential occupational origin (147 men, 30 women). Of these 177, 79% (140 patients) accepted the direct interview.
  • 111 of the 140 interviewed patients (about 80%) were considered occupationally exposed to certain or suspected lung cancer risk factors.
  • Of the 111, 82 had a compensation claim sent to INAIL. For the remaining 29 (one woman), a report was sent for epidemiological purposes.
  • Of the 82 compensation claims, 18 (4 females and 14 males) were compensated and four were still under investigation.
  • Among rejected claims, the main reason was absence of reliable documentation on each worker's exposure (55%). The second reason was exposure judged 'not sufficient' (25%). Two neuroendocrine tumors were not considered by INAIL to be related to asbestos exposure.
  • Among the claimed cases, asbestos was the most represented carcinogen, mainly for the 1970-1980 working period.
  • Silica, the leading agent in construction, followed asbestos in frequency.
  • The exposures concerned mainly the 1970-1980 working period.
  • INAIL-reported and defined lung cancer cases for the Bologna office rose about 3 times during the project period (2018-2022, excluding 2020) compared with 2014-2017. The percentage recognized rose from 31.6% to 33.8%.
  • The authors estimated that 6.2% of lung cancer over 2017-2023 was attributable to occupational exposure.
• The authors' conclusion: The authors concluded that active surveillance identified a significant number of occupational lung cancer cases that would otherwise have been overlooked. They found asbestos was the most common exposure factor, followed by welding fumes and polycyclic aromatic hydrocarbons.
• Limitations the authors state:
  • Reporting of cases by hospital units was inconsistent over the years, partly because of staff shortages and organizational difficulties.
  • Reported cases averaged only about 28% of the lung cancer cases treated, and this percentage varied over the years.
  • The findings on exposing sectors and activities are strongly shaped by the local area's industries.
  • There were too few women to identify a prevalent work sector for them.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer.

Medical terms in this study, explained in our Lexicon: Active Surveillance, Lung Cancer, Neoplasm, Occupational Exposure, Occupational Disease.

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