Government laboratory worker with lung cancer: Comparing risks from beryllium, asbestos, and tobacco smoke

Occupational medicine physicians are frequently asked to establish cancer c ausation 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 pres ent the case of a 73-year-old former technician at a government research fa cility 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 Environmenta l Medicine Clinic at San Francisco General Hospital for an evacuation of wh ether 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 r isk estimates to determine causation in patients with multiple exposures. T o do this. we review the current knowledge of lung cancer risks in former s mokers 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 les s than his risk from tobacco smoke, whereas his risk from beryllium was app roximately equal to his risk from smoking. Based on these estimates, the pa tient's workplace was considered a probable contributing factor to his deve lopment of lung cancer.