[Tumor and work: 20 years after "The causes of cancer" by Doll and Peto].

In the last twenty years scientific research in the field of occupational cancer has achieved some outstanding results. The number of substances and work processes classified as carcinogens for man has doubled. New cancer sites have been associated with exposure to known occupational carcinogens. New occupational risk factors for cancer sites already known as targets for occupational exposures have been identified. The agents responsible for the excess cancer risk in some industrial settings have also been identified, as well as the mechanisms by which numerous occupational risk factors play a role in the various steps of the multifactorial carcinogenic process. Experimental studies have provided strong support for this progress but substantial contributions have been made as a result of the increase in the number of studies of occupational cancer epidemiology, the establishment and use of large data-bases, the increasing tendency to planning of multicentric epidemiological studies, and the constant improvement of retrospective exposure assessment methods with the aid of more sophisticated job-exposure matrices and the use of biomarkers, some deriving from the old biological monitoring programs, others only recently introduced. However, in spite of the attention that recent Italian legislation for the prevention of occupational diseases has devoted to the problem of occupational cancer, a gap between scientific research in the field of occupational cancer and the practice of occupational health persists in Italy. Future studies can help to close this gap by integrating multidisciplinary contributions from clinicians, toxicologists, epidemiologists, and industrial hygienists right from the planning stage.