https://doi.org/10.33573/ujoh2020.02.104
1 SI “Kundiiev Institute of Occupational Health of Ukraine on the National Academy of Medical Sciences of Ukraine, Kyiv
2 National Medical Academy of Postgraduate Education named after P. L. Shupik, Kyiv
Introduction. Malignant neoplasms (MN) are the second leading cause of death in the world. About 70% of deaths from MN occur in low- and middle-income countries, including Ukraine. Occupational cancer (OC) covers malignant neoplasms, etiologically associated with exposure of workers to carcinogenic agents and / or performing by them of certain types of works in conditions of carcinogenic hazardous production. According to modern data, the part of cancer patients (from 1.0 to 40.0%) was exposed to carcinogenic agents at workplace.
Purpose of the study: to determine clinical and epidemiological regularities of morbidity of OC in workers of Ukraine, based on the data of many-year monitoring (1992 - 2019).
Materials and methods. Since 2004, on the basis of the State Institution “Kundiiev Institute of Occupational Health of the National Academy of Medical Sciences of Ukraine”, a clinical and epidemiological Registry of patients with OC has been maintained, which currently accumulates data of 601 patients, diagnosed with occupational cancer established throughout Ukraine within 1992 – 2019.
A descriptive statistical analysis of the data of this Registry was carried out.
Results. During 1992 - 2019, the number of registered patients with OC in Ukraine made 601 individuals (21.5 ± 7.8 persons per year, on the average). The part of patients with OC in the general structure of primary occupational diseases is 4.9 ‰ (0.2 - 11.9 ‰). A high cumulative level (> 10.0% of all cases) of OC registration is observed in 4 regions of Ukraine - Dnepropetrovsk (30.6%), Kirovograd (21.8%), Donetsk (13.1%), Lugansk (11 3 %), which make 76.9% of all cases of OC in Ukraine.
The main sectors of economic activity, in which cases of OC are mainly recorded, are: mining industry (74.5%), mainly - mining and processing of uranium ores (59.8%) and coal (36.6%); processing industry (17.8%), mainly - production of machinery and equipment (50.5%), chemical production, production of coke, oil products, rubber and plastic products (24.3%), metallurgical production (18.7%) ). The largest number of patients with OC worked in underground conditions (64.2%).
The causes of OC in patients were carcinogenic ones: mineral dust (silicon dioxide (crystalline), asbestos) (55.1%); ionizing (alpha, gamma) radiation (33.6%); chemicals (welding aerosols, Cr, Ni, Be, polycyclic aromatic hydrocarbons, benzene, formaldehyde, etc.) - (11.3%).
Among patients with OC, males prevailed (94.3%). The average age of patients is 58.3 ± 10.1 years (lim: 28.0 - 84.0 years); the average duration of the exposure period is 22.6 ± 9.6 years (lim: 1.0 - 48.0 years); the average duration of the post-exposure period is 19.9 ± 6.9 years (lim: 0.0 - 48.0 years).
The structure of target organ damage is as follows: (I place) - respiratory organs (78.2%), including bronchial and lung cancer (90.4%), pleural mesothelioma (0.5%); (II) lymphoid, hematopoietic tissues (8.5%), including leukemia (58.8%); (III) digestive organs (6.0%), including pharynx (36.1%); (IV) skin (carcinoma) (3.5%); (V) urination organs (2.0%), including bladder (58.3%).
Cases of primary multiple MN were recorded in 4.5% of patients with OC (metachronic - 73.1%, with primary tumor localization in the bronchi and lungs (59.2%)). The distribution of patients with OC by the clinical stages of MN: I - 16 5%, II - 21.4%, III - 32.8%, IV - 29.2%.
Conclusion. The key factors of reducing the detection of patients with OC in Ukraine have been identified. A system of measures has been developed aiming to improve the provision of medical and social assistance to patients, to identify and register OC in workers exposed to carcinogenic risk at workplace.
Key words: occupational carcinogenic hazard, malignant neoplasms, occupational cancer, prevention, medical and social assistance
