Guidotti Tee L
Department of Environmental and Occupational Health, School of Public Health and Health Services, The George Washington University Medical Center, Washington, DC 20052, USA.
Occup Med (Lond). 2007 Oct;57(7):466-71. doi: 10.1093/occmed/kqm031. Epub 2007 Jun 4.
The evaluation of causality in cancers associated with firefighting presents problems common to other applications of occupational epidemiology in adjudication of individual claims for workers' compensation. A trend in Canada to establish legislated presumptions for compensation of firefighters created an opportunity to re-evaluate the literature applying medicolegal standards of certainty.
To evaluate causality in selected cancer categories for firefighters using the criteria applied in tort litigation and workers' compensation, which is based on the weight of evidence and which is required to take into account individual factors.
The epidemiological literature on cancer risk among firefighters was reviewed based on the weight of evidence rather than scientific certainty. Generalizable frameworks were formulated to define recurrent issues in assessing the evidence from epidemiological studies. The evidence for latency and for a threshold effect with duration of employment was also examined in order to provide practical guidelines.
Presumption is justified for the following cancers: bladder, kidney, testicular and brain, and lung cancer among non-smokers. Non-Hodgkin lymphoma, leukaemia and myeloma (each as a class) not only present particular problems in assessment but also merit an assumption of presumption. Four analytical frameworks describe the problems in analysis encountered.
The preponderance of evidence supports the presumption of causation for certain cancer, mostly rare. These frameworks are applicable to other problems of adjudication that rest on interpretation of epidemiological data. The named cancers, taking into account the special assessment issues described by each framework, are supported by sufficient evidence to conclude that a presumption is warranted but not necessarily sufficient evidence to accept as proof by a scientific standard.
在与消防工作相关的癌症因果关系评估中，存在着职业流行病学在判定个人工伤赔偿申请时的其他应用中常见的问题。加拿大出现了一种为消防员赔偿制定法定推定的趋势，这为重新评估采用法医学确定性标准的文献创造了机会。
使用侵权诉讼和工伤赔偿中所适用的标准（该标准基于证据权重，且需要考虑个体因素）来评估消防员特定癌症类别的因果关系。
基于证据权重而非科学确定性对消防员癌症风险的流行病学文献进行了综述。制定了可推广的框架来界定评估流行病学研究证据时反复出现的问题。还研究了潜伏期证据以及就业时长的阈值效应证据，以提供实用指南。
对于以下癌症有理由进行推定：膀胱癌、肾癌、睾丸癌、脑癌以及非吸烟者中的肺癌。非霍奇金淋巴瘤、白血病和骨髓瘤（各作为一类）不仅在评估中存在特殊问题，而且也值得进行推定假设。四个分析框架描述了分析中遇到的问题。
证据优势支持对某些癌症（大多为罕见癌症）因果关系的推定。这些框架适用于其他依赖于流行病学数据解释的判定问题。考虑到每个框架所描述的特殊评估问题，所列癌症有充分证据支持得出有理由进行推定的结论，但不一定有足够证据按照科学标准被接受为证据。
