| Government Laboratory Worker with Lung Cancer: Comparing Risks from Beryllium, Asbestos, and Tobacco Smoke Craig Steinmaus, John R. Balmes Division of Occupational and Environmental Medicine, Department of Medicine, University of California, San Francisco Abstract
University of California, San Francisco
Occupational medicine physicians are frequently asked to establish cancer causation in patients with both workplace and non-workplace exposures. This is especially difficult in cases involving beryllium for which the data on human carcinogenicity are limited and controversial. In this report we present the case of a 73-year-old former technician at a government research facility who was recently diagnosed with lung cancer. The patient is a former smoker who has worked with both beryllium and asbestos. He was referred to the University of California, San Francisco, Occupational and Environmental Medicine Clinic at San Francisco General Hospital for an evaluation of whether past workplace exposures may have contributed to his current disease. The goal of this paper is to provide an example of the use of data-based risk estimates to determine causation in patients with multiple exposures. To do this, we review the current knowledge of lung cancer risks in former smokers and asbestos workers, and evaluate the controversies surrounding the epidemiologic data linking beryllium and cancer. Based on this information, we estimated that the patient's risk of lung cancer from asbestos was less than his risk from tobacco smoke, whereas his risk from beryllium was approximately equal to his risk from smoking. Based on these estimates, the patient's workplace was considered a probable contributing factor to his development of lung cancer. Key words: berylliosis, beryllium, lung neoplasms, occupational diseases, smoking. Environ Health Perspect 108:1003-1006 (2000) . [Online 11 September 2000]
http://ehpnet1.niehs.nih.gov/docs/2000/108p1003-1006steinmaus/ abstract.html Please address correspondence to C.M. Steinmaus, Allan Smith Research Office, School of Public Health, 140 Warren Hall, University of California, Berkeley, Berkeley, CA 94720-7360 USA. Telephone: 510 843-1736. Fax: 510 843-5539. E-mail: kingboho@pol.net. This work was supported by the University of California Center for Occupational and Environmental Health. Additional support was provided by grant 1-RO1-ESO7459-01A2 from the National Institute of Environmental Health Sciences and grant 99-00563V-10262 from the California Cancer Research Program. Received 24 March 2000 ; accepted 11 July 2000.
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