Clinical Corner - October 2021

In 1775, Percivall Pott, a surgeon working in London, reported on an unusual cancer involving the skin of the scrotum in chimney sweeps. This was perhaps the first account of a true occupation-related cancer. In 2021, the 20th anniversary of 9/11, a number of articles have appeared supporting the occurrence of several types of cancers in firefighters who survived the World Trade Center attacks.

In the intervening 246 years, there have been many reports attesting to the significant associations of cancer with occupations. Employees in naval shipyards exposed to asbestos have had a significant increase in mesothelioma, painters of radium dials in watches have suffered from head and neck cancer, long-haul airline pilots have had an increase in squamous cell cancer of the face, aniline dye workers have been afflicted with bladder cancer, and the list goes on.

My message today is that collection of data relating to a patient’s occupation is a critical, but frequently absent data point in cancer abstracts. Although there may be areas in the abstract to capture this information, sadly the occupational history is routinely missing from the managing physicians’ clinical notes. 

There is no requirement in the STORE manual and in the NCDB for collection of a patient’s occupation. Obviously, including this requirement as a data point would increase collection and add to a valuable database which could uncover unknown occupational cases of cancer. There is a “free text” area created by NAACCR to use for reporting occupational data to central and state registries, but again, the ability to do so depends heavily on the information that is collected in the clinical arena. 

In order for our cancer registries to be useful in uncovering occupational exposure as a cause of cancer, we first need to assure that the occupational data is collected. I am delighted that our CRStar software includes areas for listing “occupation” and “industry” and provides an area for free text. I would urge all registrars to collect these data points when possible. Who knows - the occupational cancer that is uncovered by your data entry may be as defining as the report by Percivall Pott!