Barbieri P G, Pezzotti Chiara, Bertocchi C, Lombardi Sandra
UO Medicina del Lavoro, Servizio PSAL ASL Brescia, via Cantore 20, 25128 Brescia.
Med Lav. 2007 Jan-Feb;98(1):18-24.
Wood dust exposure is strongly associated with the induction of cancer of the nasal cavity and paranasal sinuses (NSC), mainly among furniture production workers. Only limited information is available on wood dust exposure in other industrial sectors, including agriculture. NSC's are defined as "high occupational aetiology fraction" neoplasms, and are therefore indicated as sentinel tumours in occupational medicine.
The report concerns two cases of NSC that occurred in two poultry breeders and the investigations performed in order to define their occupational exposure.
Epidemiological surveillance of NSC within the framework of routine activity of the Cancer Registry of the Province of Brescia (one million inhabitants) identified the two cases. Initially the first NSC case was considered as "probably exposed to formaldehyde" during shed tile disinfecting operations. After discovery of a similar case and further investigation in the sector formaldehyde exposure was found to be at a very low level. However, the observation that hard and soft wood dust was present, followed by dust monitoring, revealed a high level of exposure. The 23 personal and area air samples, performed in a turkey breeding shed, gave concentrations of between 1.3 and 2.3 mg/mc during low dust exposure jobs and concentrations of between 4 and 43.2 mg/mc during litter replacement (100% exceeded the ACGH TLV limit of 1 mg/cm and 25% were even above the legal limits (5 mg/mc according to Italian D.Lgs. 66/2000)). Since breeders are not aware of this type of risk and the use ofpersonal protection is not scrupulous, the local health and safety unit has started an information campaign for the entire work category as regards the necessity of controlling this cancer risk. The two cases of NSC described here were reported to the National Labour Insurance Institute (INAIL) for compensation.
NSC epidemiological surveillance performed through a population registry proved to be of great use in the identification of cases among employees in similar sectors, and thus the identification of previously unknown wood dust exposures with consequent implementation of preventive measures.
接触木屑与鼻腔和鼻窦癌（NSC）的诱发密切相关，主要发生在家具生产工人中。关于其他工业部门（包括农业）的木屑接触情况，现有信息有限。NSC被定义为“职业病因分数高”的肿瘤，因此在职业医学中被视为哨兵肿瘤。
本报告涉及两名家禽饲养员患NSC的病例以及为确定其职业接触情况而进行的调查。
在布雷西亚省癌症登记处（一百万居民）的日常活动框架内对NSC进行的流行病学监测发现了这两例病例。最初，第一例NSC病例被认为在鸡舍瓷砖消毒作业期间“可能接触甲醛”。在发现类似病例并对该部门进行进一步调查后，发现甲醛接触水平非常低。然而，观察到存在硬木和软木粉尘，随后进行的粉尘监测显示接触水平很高。在一个火鸡饲养棚进行的23次个人和区域空气采样显示，在低粉尘接触工作期间，浓度在1.3至2.3毫克/立方米之间，在更换垫料期间，浓度在4至43.2毫克/立方米之间（100%超过了美国政府工业卫生学家会议（ACGIH）的阈限值1毫克/立方厘米，25%甚至高于法定限值（根据意大利第66/2000号法令为5毫克/立方米））。由于饲养员没有意识到这种风险类型，并且个人防护用品的使用并不严谨，当地的健康与安全部门已针对整个工作类别开展了一场关于控制这种癌症风险必要性的宣传活动。此处描述的这两例NSC病例已报告给国家劳动保险局（INAIL）以申请赔偿。
通过人群登记进行的NSC流行病学监测被证明在识别类似行业员工中的病例方面非常有用，从而识别出以前未知的木屑接触情况，并据此实施预防措施。
