The treatment and medical-insurance evaluation of neoplastic diseases

R. Ucciero | Inail, Sovrintendenza sanitaria regionale Campania, Napoli, Italy

Introduction. Parallel to the momentous changes that have marked the world of production and the labor market in Europe and Italy in recent years, the concept of health and safety at work has evolved and become integrated into the broader context of social security. In this context, INAIL, a key institutional interpreter of these changes, especially in its historic role as an insurance institute, has been engaged for years in a profound review of its strategies and organization in order to provide responses that are increasingly in line with the needs of workers and businesses, a commitment that has earned it widespread social consensus.
Occupational diseases, with particular reference to neoplasms, have become a more widespread and increasingly complex phenomenon in recent years. In particular, it is now absolutely clear that dealing with such cases requires a necessarily interdisciplinary and multidisciplinary approach. For this reason, INAIL, in its constant effort to provide a public service that is increasingly responsive to the needs of citizens and businesses, is asking doctors in particular to make a considerable greater commitment in the field of the assessment and diagnosis of technopathies.
Objectives. The main purpose of this contribution is to show the criteria used by INAIL to provide a response to requests for recognition of occupational neoplastic diseases that is fair in terms of both substance and method, timely, and comprehensive; at the same time, it aims to provide feedback on the prevention activities of the Institute and the relevant local authorities.
Method. The recognition of occupational neoplasia is based on the following criteria for assessing causality:
Scientific plausibility: verification of the general admissibility of the presumed cause in the production of the reported injury based on data derived from scientific literature;
 Epidemiological-statistical probability: verification of a constant relationship between certain antecedents and certain subsequent events based on observational or experimental evidence; Logical probability (personalization) divided into sub-criteria: Chronological: compatibility of the time interval between the harmful action and the appearance of the first manifestations of the disease; Topographical: correspondence between the anatomical region affected by the harmful action and the site of onset of the disease; Phenomenological continuity: uninterrupted succession between the symptoms following the harmful action and those of the disease under examination; Efficiency or suitability: qualitative and quantitative aptitude of the harmful action to cause the damaging event;
Exclusion: elimination of all other possible causes.
The cornerstone of the activities listed remains the continuous updating process aimed not only at the Institute's internal doctors, but also at “certifying” doctors in general, integrating the procedural aspects and methods of treatment within INAIL with the latest scientific findings on the subject of occupational neoplasms.
Results and conclusions. Recognizing the occupational origin of neoplastic pathology is complex from a medical-legal point of view, as it is a pathology that has no threshold and is completely indistinguishable from the same pathology induced by other causes: from a health and social point of view, work-induced cancer does not offer substantial differences compared to “natural” oncological pathology. It is above all this indistinguishability that poses the greatest difficulties from a medical-legal point of view. The difficulty for experts and lawyers in attributing responsibility for a specific effect to occupational exposure is extremely evident when one also considers the large increase in the incidence and mortality of cancer in developed countries. INAIL's objective is to create a “prevention management dashboard” to guide future health prevention strategies in the region.