The purpose of this report is to introduce the occupational cancer surveillance system, implemented in June 2018, and to share the results of our cooperative program.
The cooperative program begins when the patient is diagnosed with acute myeloid leukemia (AML). Newly diagnosed AML patients are admitted to the internal medicine hematology department, then attending hematology physician requests a consultation from the occupational and environmental medicine (OEM) department. The OEM doctor next visits the hospitalized patient and interviews them to take their occupational history, and preliminarily evaluates the likelihood that the condition is associated with occupation. If the patient wants to apply for compensation through the Korea Workers' Compensation & Welfare Service, the patient was informed to visits the outpatient clinic of the OEM department and requests a ‘work-relatedness evaluation report’ for use in applying for compensation.
Among the 103 patients, who received an OEM departmental work history evaluation, 18 patients were considered to have a work-related incidence and 12 patients were registered in the Industrial Accident Compensation Insurance system.
The present report provides data on a sustainable model for identifying occupational disease in a general hospital setting, while also informing patients about their occupational rights.
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We reviewed articles to clarify the current evidence status for 1) types of cancer which related to benzene exposure, and 2) certain benzene exposure level which might cause the hematopoietic cancers. Hematopoietic function of the bone marrow is involved in the production of all blood cells types. The benzene metabolites including benzoquinone and mucoaldehyde affect hematopoietic stem cells as well as differentiation steps of progenitor cells for each blood cell. Hence, we concluded that benzene was associated with all lymphohematic carcinogenesis. First, it is supported by biological plausibility. Second, it is supported by meta-analysis although sing study did not show relationship due to lack of sample size or statistical power. More recent studies show lesser exposed level related to risk of cancer, compare to past studies did. Actually, early studies show the risk of malignancies in workers who exposed more than 200 ppm-years. However, only 0.5 to 1 ppm-year benzene exposed show significant linking to risk of malignancies in recent study. As reviewed research articles, we concluded that the relatively lower exposure level, such as 0.5–1 ppm-year, will be considering at risk of hematopoietic cancer. However, more research needs to be done on dose-response analysis.
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The South Korean criteria for occupational diseases were amended in July 2013. These criteria included formaldehyde as a newly defined occupational carcinogen, based on cases of “leukemia or nasopharyngeal cancer caused by formaldehyde exposure”. This inclusion was based on the Internal Agency for Research on Cancer classification, which classified formaldehyde as definite human carcinogen for nasopharyngeal cancer in 2004 and leukemia in 2012.
We reviewed reports regarding the causal relationship between occupational exposure to formaldehyde in Korea and the development of these cancers, in order to determine whether these cases were work-related.
Previous reports regarding excess mortality from nasopharyngeal cancer caused by formaldehyde exposure seemed to be influenced by excess mortality from a single plant. The recent meta-risk for nasopharyngeal cancer was significantly increased in case-control studies, but was null for cohort studies (excluding unexplained clusters of nasopharyngeal cancers). A recent analysis of the largest industrial cohort revealed elevated risks of both leukemia and Hodgkin lymphoma at the peak formaldehyde exposure, and both cancers exhibited significant dose-response relationships. A nested case-control study of embalmers revealed that mortality from myeloid leukemia increased significantly with increasing numbers of embalms and with increasing formaldehyde exposure. The recent meta-risks for all leukemia and myeloid leukemia increased significantly. In South Korea, a few cases were considered occupational cancers as a result of mixed exposures to various chemicals (e.g., benzene), although no cases were compensated for formaldehyde exposure. The peak formaldehyde exposure levels in Korea were 2.70–14.8 ppm in a small number of specialized studies, which considered anatomy students, endoscopy employees who handled biopsy specimens, and manufacturing workers who were exposed to high temperatures.
Additional evidence is needed to confirm the relationship between formaldehyde exposure and nasopharyngeal cancer. All lymphohematopoietic malignancies, including leukemia, should be considered in cases with occupational formaldehyde exposure.
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Clinicians who perform radiation therapy (RT) are exposed to radiation, which may negatively affect their health. The present study reports a case of acute lymphoblastic leukemia in a healthcare provider who was exposed to radiation at work; we also present a literature review of this topic.
A 45-year-old patient, who had been a radiation oncologist and had been exposed to radiation while performing brachytherapy 10 years ago, complained of chest pain and was suspected of having leukemia based on the results of a blood test in an outpatient clinic. He was diagnosed with acute lymphoblastic leukemia, and subsequently underwent chemotherapy. However, the case died during treatment. Through epidemiological investigation, it was found that the case’s cumulative exposure dose based on personal exposure and spatial dose measured during the work period was in the range of 6.08–12.15 mSv.
Based on the following considerations, acute lymphoblastic leukemia was highly correlated with the level of radiation to which the case was exposed while performing brachytherapy on patients with cancer. Firstly, the latent period of acute lymphoblastic leukemia in the case closely matched the latency time reported in previous published studies (5–10 years). In addition, numerous studies have reported significantly higher relative risks of cancer among clinicians who perform RT compared with the general population. The case was also atypically exposed to radiation through his hands, despite wearing protective equipment. Lastly, the case’s coworkers were also found to have been exposed to high levels of radiation. Investigation into the influence of radiation exposure through atypical routes during RT on the health of clinicians is recommended.
Occupational radiation exposure causes certain types of cancer, specifically hematopoietic diseases like leukemia. In Korea, radiation exposure is monitored and recorded by law, and guidelines for compensation of radiation-related diseases were implemented in 2001. However, thus far, no occupation-related disease was approved for compensation under these guidelines. Here, we report the first case of radiation-related disease approved by the compensation committee of the Korea Workers’ Compensation and Welfare Service, based on the probability of causation.
A 45-year-old man complained of chronic fatigue and myalgia for several days. He was diagnosed with chronic myeloid leukemia. The patient was a diagnostic radiographer at a diagnostic radiation department and was exposed to ionizing radiation for 21 years before chronic myeloid leukemia was diagnosed. His job involved taking simple radiographs, computed tomography scans, and measuring bone marrow density.
To our knowledge, this is the first approved case report using quantitative assessment of radiation. More approved cases are expected based on objective radiation exposure data and the probability of causation. We need to find a resolution to the ongoing demands for appropriate compensation and improvements to the environment at radiation workplaces.
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