Scientific papers from OCCAM project are:

Am J Ind Med. 2013 May 30. doi: 10.1002/ajim.22205. [Epub ahead of print]

Female Breast Cancer in Lombardy, Italy (2002–2009): A Case–Control Study on Occupational Risks

Background: The role of occupational exposures in breast cancer development is still uncertain and to our knowledge, no studies have been recently carried out in Italy to provide a comprehensive estimation of this possible risk.

Methods: Based on administrative data, a case-control study was carried out recruiting all incident cases of female breast cancer in the period 2002–2009, aged between 35 and 69 years, residing in Lombardy, Italy. Controls were randomly sampled from all women residing in Lombardy as of December 31, 2005. Occupational histories, including bluecollar status, were available from 1974 through record linkage with a social security pension database, and were obtained for 11,188 cases and 25,329 controls. Adjusted odds ratios (ORs) and corresponding 90% confidence intervals (CIs) were calculated using multiple unconditional logistic regression models, including terms for sectors of longest employment and for duration of employment. Multiple comparisons were accounted for according to the Benjamini–Hochberg method.

Results: The ORs for female breast cancer were modestly but significantly increased for employment in electrical manufacturing (OR 1.12, 90%CI 1.04–1.21), textile (OR 1.08, 90%CI 1.02–1.15), paper (OR 1.25, 90%CI 1.06–1.46) and rubber (OR 1.26, 90%CI 1.03– 1.54) industries. Analysis by duration of employment within sectors showed significantly increased ORs for electrical manufacturing and rubber industries. After adjustment for multiple comparisons no estimates remained statistically significant.

Conclusions: Although with several limitations, our results point to a possible role of exposures in electrical manufacturing, textile, paper and rubber industries in the process leading to breast cancer. An in-dept study for the electrical manufacturing industry has been already planned.

Key words: breast cancer; occupational exposures; electrical manufacturing; case–control study; OCCAM project

Am J Ind Med 2012; 55(1): 1-4

Lung Cancer Risk in the Electroplating Industry in Lombardy, Italy, Using the Italian Occupational Cancer Monitoring (OCCAM) Information System

Background: Occupational Cancer Monitoring (OCCAM) is an Italian organization that monitors occupational cancers, by area and industrial sector, by retrieving cases and employment history from official databases. OCCAM previously estimated a relative risk (RR) of lung cancer of about 1.32 among ‘‘metal treatment’’ workers in Lombardy, northern Italy, potentially exposed to chrome and nickel. In the present study, lung cancer risk was estimated among electroplating workers only.

Methods: Lombardy electroplating companies were identified from descriptions in Social Security files. Lung cancer risk was evaluated from 2001 to 2008 incident cases identified from hospital discharge records.

Results: The RR for lung cancer among electroplating workers was 2.03 (90% CI 1.33–3.10, 18 cases) for men; 3.00 (90% CI 1.38–9.03, 4 cases) for women.

Conclusions: Electroplaters had higher risks than ‘‘metal treatment’’ workers. Although the risks were due to past exposure, case histories and recent acute effects indicate a present carcinogenic hazard in some Lombardy electroplating factories.

Key words: metal plating, chrome, nickel, lung cancer, Occupational Cancer Monitoring

G Ital Med Lav Ergon 2011; 33(4): 381-6

[From research on occupational tumors to interventional prevention: use of the OCCAM method at the ASL in Como]

In the framework of "Occupational Cancers" project of the Lombardy Region, estimates of cancer risk by site and by economic activity for the incidence period 2001-2004 have been produced in the Local Health Unit of Como. Using these estimates a set of cancer cases with possible occupational origin has been determined. This has been carried out using the OCCAM approach, a case control study where incident cases are identified by hospital discharge records, controls are sampled from health population files and occupational histories are obtained by automatic link with social security archives. This has been integrated with the knowledge of firms and the workers' awareness of other cancer cases in the workforce of the same firms. Among 45 cases with potential occupational origin, 24 were established as due to occupation. These cases were referred for compensation. Moreover, carcinogenic risks still present in some firms were identified and appropriate interventions were carried out.

Key words: occupation, cancer, surveillance, lung cancer, bladder cancer, rubber, plastics, textile.

Am J Ind Med 2010; 53: 1002-5

A Confounders and confusion: dealing with cancer cases of occupational origin

Background: the recognition of occupational cancers is often hampered by confusion between the individual determinants of the disease and effects at the group level.

Methods: here we propose an approach, based on the evaluation of the attributable risk at the group level, that provides quantitative estimates of the roles of multiple causes in individuals affected of cancer within a population exposed to occupational risk.

Results: the estimate of individual probability can be easily obtained computing the attributable risk. This can be often achieved by using the existing information available in the literature.

Conclusions: dismissing the occupation as a cause of a cancer in an exposed subject on the sole basis of potential confounding is erroneous and should be withdrawn from medical practice.

Key words: causes; attributable risk; occupational cancer; confounders

Epidemiol Prev 2009; 33(4-5) Suppl 2: 71-3

[The active search for occupational cancers]

The active search for occupational neoplasms has been implemented only in Italy. This search can be carried out with two modalities: the in-hospital face-to-face interview of selected cancer cases, and the linkage of available information (OCCAM). Both were supported by a special project on occupational carcinogenesis of the Lombardy Region. The active search for occupational neoplasms is a moderate-cost activity and is important for the safeguard of the workforce and of the population as a whole.

Key words: cancer, occupation, active search

G Ital Med Lav Erg 2008; 30(4): 392-5

[Confounding and confusion: recognition of causative relation and identification of victims of occupational carcinogens]

The recognition of occupational cancers is often hampered by the confusion between the individual determinants of the disease and the effect at the group level. Here we propose an approach based on the evaluation of the attributable risk at group level aimed to quantify the respective role of multiple causes, and the individual rebounds of it.

Key words: causes, attributable risk, occupational cancer, confounders

Med Lav 2008; 99(1): 40-8

[In-progress matrix for occupational cancer recognition]

Background: In Italy only a small proportion of all cancers is reported to the national labour insurance board and recognized as having an occupational origin. Cancers with a lower etiological fraction such as lung or bladder cancer have a lower rate of recognition than mesotheliomas or sino-nasal tumours either because of a lack of information obtained via specific occupational anamnesis or because knowledge concerning occupational carcinogens is still uncertain.

Objectives: To interpret findings and advance new working hypotheses, within the framework of an occupational monitoring survey project (OCCAM) we performed an extensive bibliographical search in the scientific literature on occupational cancer.

Methods and Results: We built an on-line “literature matrix” ( containing “positive” results from 685 cohort, case-control and cross-sectional epidemiological studies on occupational cancer, from which 1870 citations were obtained describing risk increases by type of cancer and industry. Production cycles or type of industry (iron foundry, leather and shoe manufacturing, etc.) constitute one axis of the matrix and the other consists of type of cancer by site.

Conclusions: This tool is not only useful for interpretation of evidence arising from occupational cancer surveys but was also intended to be a fast and easy-to-use working tool for occupational physicians, general practitioners and many other specialists to investigate and ascertain the possible occupational origin of a cancer case.

Key words: Cancer, occupation, working tool

G Ital Med Lav Ergon 2007; 29(3 suppl): 307-9

[Active search of work related tumours: preliminari findings]

The OCCAM (Occupational Cancer Monitoring) project enabled the active detection of occupational cancer cases in Lombardy Region.

Methods: OCCAM is based on a record linkage with social security files to obtain occupational histories for all subjects having worked in private firms, since 1974. It provides risks by area, site and job.

Results: 271 incident cancer cases obtained by hospital discharge record in the period 2001-2002 where investigate to assess eventually their occupational origin. Approximately 38% where considered to be occupational cancers.

Conclusions: OCCAM provides name of the firms and their economic activity completed by information coming from OCCAM risks ascertainment and deeper knowledge on productive cycle retained by local occupational health services. Thus this system can lead to detection of many cancer cases of occupational origin suitable for compensation and determine strategies for the improvement of the work environment.

Key words: active detection, cancer, occupational, record linkage

Am J Ind Med 2006; 49(9): 791-8

The Italian surveillance system for occupational cancers: characteristics, initial results, and future prospects

Background: occupational cancer monitoring is important for cancer prevention and public health protection. A surveillance system for identifying occupational cancer risks and cancer cases in Italy that are likely to be of occupational origin using information available in the Italian Social Security archives was created and assessed. Persons employed in the private sector, the employing company, its industrial sector, and years of employment are available in these archives.

Methods: a method to find known occupational hazards was first tested using a case-control approach. Cases were from six Italian cancer registries (CRs) and controls were sampled from source populations and as ‘exposure’ the economic sector of the employing company was used. The potential of using hospital discharge records as case sources was subsequently assessed: these cover larger populations and are available more quickly than CR case series.

Results: in the CR-based study many known occupational cancer risks related to specific industrial sectors were identified. By using cases from hospital discharge records many industries at risk were identified, as well as cases of recent diagnosis likely to be of occupational origin. However, for some industrial sectors (e.g., the chemical industry) the approach was unable to detect any excess risk. Furthermore, information on employees in important areas like agriculture, self-employment, and the public sector is not available in the Social Security archives.

Conclusions: This approach appears to be a promising low-cost method for occupational cancer surveillance, at least for some industries, and can be easily implemented in other countries.

Key words: occupational cancer; surveillance; record linkage; case- control

Epidemiol Prev 2005; 29: 253-58

[The active search of occupational cancers: The cancer of the bladder in the Lombardy Region]

Objective: a study called OCCAM (OCcupational CAncer Monitoring) has been carried out in order to establish a nationwide surveillance system for occupational cancer. This project consists of population-based case control studies where information on past occupations are automatically gathered National Institute for Social Security’s archive, cancer cases are obtained from Cancer Registries (CR) and controls are sampled from population files of the National Health Service. As previous results obtained using CR were encouraging, we tried to use regional hospital discharge records as a source of incident cases.

Design: we have conducted a population based case-control study with 1568 male bladder cancer cases occurred in the years 1999 and 2000 and 18818 controls randomly sampled from resident population in Lombardy region (Italy).

Results: despite the limits of this approach the following industries were found at increased risk of bladder cancer: leather and shoes industry (OR=1.83; CI 90% : 1.01-3.33; observed: 10); transports (OR=1.28; CI 90% : 0.94-1.76; observed: 37), rubber industry (OR=1.22 CI 90% 0.80-1.85; observed: 19) and printing industry (OR=1.5 CI 90% : 1.10-2.05; observed: 38).

Conclusion: the ability of OCCAM surveillance system to find known associations using routinely available data offers new opportunities to detect cancer cases likely to be of occupational origin.

Key words: bladder, cancer, occupation

Eur J Oncol 2005; 10 (3), 181-184

[Il progetto OCCAM (Occupational Cancer Monitoring)]

The OCCAM (Occupational Cancer Monitoring) project has been established to estimate and detect occupational cancer.

It includes several subprojects aimed at estimating the burden of occupational cancers by area, site and job, as well as at detecting cases of possible occupational origin for compensation purposes and improvement of the work environment.

Furthermore a system for the classification of the results of scientific papers has been created and is kept updated, with a view to evaluating the results of the area studies. The same knowledge base is proposed as an instrument for General Practitioners for the detection of cases of possible occupational origin.

Key words: occupation, cancer, surveillance, literature

Med Lav 2005; 96 (1): 33-41

[A monitoring system for occupational Cancer]

Introduction: the Italian Occupation and Safety Act (d.lgs 626/94) provided for the establishment of a nationwide occupational cancer registry, under the National Institute for Occupational Health and Safety (ISPESL), with the aim of detecting cancer cases of occupational origin and estimating the influence of occupation in cancer causation.

Methods: information on cancer cases, drawn from six Italian population-based cancer registries (CRs of Friuli Venezia Giulia Region, Genoa Town and Genoa Province, Macerata Town, Umbria Region, Varese Town, Veneto Region), and on a random sample of population controls selected in each CRs area were linked with data on subjects employed in private enterprises that have been available in electronic form since 1974 at the National Institute for Social Security (INPS). In this way, both for cases and controls, the occupational histories of past employment were collected. A population-based case-control study covering the period 1990–1998 was carried out with the aim of estimating occupational cancer risk in the private sector by site and economic category in each area. Since one of the major drawbacks of this approach is the difficulty in distinguishing true occupational hazards from incidental findings derived from multiple comparisons, an extensive research of occupational literature was carried out, independently of the study results, to compare our results with existing knowledge on occupational risks.

Results: pooled analysis of the most recent incidence data based on 36,379 cases and 29,572 controls was performed; 34 “statistically significant” associations were found for 11 economic categories. Using our literature review, 10 associations were supported by more than 5 published papers, 14 by a number of papers between 1 and 5, and 10 associations had not been previously reported.

Conclusions: this system appears suitable for assessing existing occupational cancer risks and can eventually lead to detecting occupational hazards in many areas of Italy. The system can also provide a list of cases suitable for in-depth search for past occupational exposures.

Key words: cancer, occupation, surveillance