Transcript Dias nummer 1 - RightOnCanada.ca

Recognition of asbestos-related lung
cancer
Symposium on asbestos
Bispebjerg Hospital
December 2014
Problematic verdict given by the Appeals Board in a matter of
compensation for asbestos-exposed smokers.
Feature article in Ugeskrift for læger (The Journal of the
Danish Medical Association), May 2014, by Frost, Petersen,
Thomsen, and Mikkelsen.
Lung Cancer in Denmark
• In 2012 2352 men and 2193 women were
diagnosed with lung cancer
Asbestos is part of the
cause of between 4-8 %
of cases of lung cancer in
men
WRITING GROUP
David Sherson (DS) Denmark, Jesper
Bælum (JB) Denmark, Jesper
Rasmussen (JR) Denmark, Karen Ege
Olsen Denmark, Lene Snabe Nielsen
(LSN) Denmark, Maria Albin (MA)
Sweden, Niels Christian Hansen
(NCH) Denmark, Søren Dahl (SD)
Denmark,
INTERNAL EXPERT GROUP Christy
Barlow USA, Dick Heederik the
Netherlands, Johnni Hansen
Denmark, Jørgen Vestbo Denmark
Mercello Lotti Italy, Panu Oksa
Finland, Sverre Langård Norway,
Thomas Kraus Germany
Possible under-reporting of asbestos
related lung cancer (ARCL)
National Board of Industrial Injuries
guidance on occupational diseases
Tobacco consumption in connection with asbestos-related lung cancer
Exposure to asbestos increases the risk of lung cancer by 2-5 times,
depending on the extent of the exposure, but if a person is a smoker
and is also exposed to asbestos, the risk is increased 20-50 times,
depending on the exposure to asbestos and the total tobacco
consumption. In other words, it is much more dangerous to be exposed
to two carcinogenic substances at the same time.
As is also applied to other types of work-related lung cancer, a
substantial tobacco consumption may be included as a competing factor
in the assessment of the asbestos claim. Read more under 21.2.4.
Possible causes of lung cancer in
asbestos exposed smoker
• Neither asbestos nor smoking
• Asbestos alone
• Smoking alone
• Asbestos and smoking
Assessment of cause of an individual case
of lung cancer – a probability assessment
10.000 men in each
group followed for
10 years
Number of lung
cancer cases
Surplus number of
lung cancer cases
Neither asbestos nor
smoking
10
-
Asbestos alone
20
10
Smoking alone
100
90
Asbestos and
smoking
200
190
190 > 10 + 90
Principal verdict concerning
compensation for cases of lung cancer
Lung cancer in a heavy smoker was recognized by the National Board
of Industrial Injuries with an injury compensation of 5%, which was
appealed.
The Appeals Board changed the decision – it refused to recognize the
disorder and it refused to reopen the case. This decision was brought
to trial at the City Court. The medical consultant of the Appeals Board
commented on the matter:
"Asbestos exposure increases the risk by a factor of 2-2.5 and
smoking at least by a factor of 10. The risk from tobacco smoking
therefore far exceeds that of the occupational exposure and the lung
cancer is therefore most likely caused by something else than the
occupational exposure.”
The Medico-Legal Council explained to
the court:
The so-called etiological fraction (EF) indicates the fraction of the disease
that can be eliminated, if an exposure is removed.
In the case of 20 pack-years of smoking, which means a 10-fold increased
risk for lung cancer, the EF is 90%, and by a 2-fold increased
risk of lung cancer due to asbestos the EF for asbestos is 50%.
That is to say that 90% of the cases can be eliminated by eliminating
tobacco, and 50% can be eliminated by removing asbestos. The etiologic
fraction does not add up to 100% because there is a synergistic effect
between tobacco and asbestos.
This also indicates that the most likely cause is tobacco smoking, but
whatever the size of the tobacco smoking, asbestos exposure will double
the risk of lung cancer.
Decision of principle
We recognize your lung cancer from the list of
occupational diseases point K. 4.1. D.
Your total permanent injury was at the time of our
verdict on Oct. 8, 2009 15 %. Your permanent injury
resulting from the industrial injury made up, however, only
10 percent of this and therefore is below 5 %.
We find that the specific risk for development of lung
cancer should be compared with the risk if you had not
smoked. Therefore, smoking formed 90 percent of the total
risk and the industrial injury formed 10 percent.
Problematic verdict handed down by the Appeals Board in a matter of
compensation for asbestos-exposed smokers with lung cancer.
Feature article in Ugeskrift for læger (The Journal of the Danish Medical
Association), May 2014, by Frost, Petersen, Thomsen, and Mikkelsen.
The conclusion of the article in Ugeskrift for Læger
(The Journal of the Danish Medical Association)
• No
scientific basis for different reductions in injurycompensation for asbestos exposed smokers than for
asbestos exposed non-smokers with lung cancer.
The etiologic fraction related to asbestos will be 5060% among both smokers and non-smokers.
• The decision of principle deprives asbestos-exposed
smokers with lung cancer the right to compensation
even though their risk is greatly increased due to their
work with asbestos.
Judgment
The Judgment of 27 June 2014 by the Western High Court 13.
Department of appeal VL B-1516-13:
It is made clear from the Medico-Legal Council reply to
Question 5 that the proportion of lung cancer cases due to
asbestos exposure, is about 50% for both non-smoking and
smoking asbestos workers.
The Judgment of the court:
The Appeals Board is ordered to recognize that XX's permanent
injury percent as a result of the recognized occupational injury in
the form of squamous cell carcinoma at the time of the Board's
decision on the 11th January 2013, was 15%. See: Workers'
Compensation Act 18th.
The Appeals Board is now considering whether
the case is so fundamental that a third instance
should be sought to take the case to the Supreme
Court. Such an application must be sent within
eight weeks of the judgment handed down in the
High Court on June 27, 2014.
January 20, 2015 The Appeals Board got
permission to try the case in the Supreme Court.