Schmid Klaus, Drexler Hans
Institut und Poliklinik für Arbeits-,Sozial- und Umweltmedizin der Friedrich-Alexander Universität Erlangen-Nürnberg.
Dtsch Med Wochenschr. 2015 Jan;140(1):51-5. doi: 10.1055/s-0040-100429. Epub 2015 Jan 12.
Background | Persons suffering from malignant tumors who had been exposed to carcinogens at their workplace must be compensated if occupational exposure probably caused the disease. However, the assessment of the causes of cancers is particularly difficult.Method | For the evaluation the authors analyzed selectively researched literature and considered publications of the German Social Accident Insurance and legal regulations.Result | Often the quantification of the occupational exposure is not possible. Cumulative exposures neglect important factors, e.g. high peak concentrations. Even in the general population exposure to noxious agents occurs. This raises the question what amount of occupational exposure must be considered as sufficient for compensation and how non-occupational factors, such as genetic susceptibility, should influence the expert's opinion. Syncancerogenetic effects are currently not sufficiently considered in the legal ordinance on occupational diseases.Conclusion | At best, only a very rough estimate of the probability of causation can be stated. If there is insufficient scientific evidence then there is a need of "makeshift" recommendations within the social consensus, which occupational exposure is considered to be relevant for occupational disease. If there are no reliable data on occupational exposure due to failure of the employer, this should not be stacked against the insured.
背景 | 在工作场所接触致癌物的恶性肿瘤患者，如果职业暴露可能导致了该疾病，则必须给予赔偿。然而，癌症病因的评估尤为困难。
方法 | 为进行评估，作者有选择地分析了研究文献，并参考了德国社会事故保险的出版物及法律法规。
结果 | 职业暴露的量化往往无法实现。累积暴露忽略了重要因素，例如高浓度峰值。即使在普通人群中也存在接触有害物质的情况。这就引出了一个问题，即何种程度的职业暴露应被视为足以获得赔偿，以及非职业因素，如遗传易感性，应如何影响专家的意见。目前，职业病法定条例中对协同致癌效应的考虑尚不充分。
结论 | 充其量，只能对因果关系的可能性进行非常粗略的估计。如果没有足够的科学证据，那么就需要在社会共识范围内提出“权宜之计”的建议，即何种职业暴露被认为与职业病相关。如果由于雇主的失误而没有关于职业暴露的可靠数据，这不应对被保险人不利。
