P23-15 The procedure for diagnosing occupational malignant diseases in Serbia

The Serbian Law on Pension Disability Insurance defines that only diseases that are on the list of occupational diseases can be accepted and compensated as occupational diseases. The list of occupational diseases itself is defined by the Rulebook on the Diagnosing of Occupational Diseases. The rulebook defines 66 diseases and the criteria for their diagnosis. Although the rulebook essentially defines a closed list of occupational diseases, in the part related to occupational exposure to biological hazards there is a possibility of diagnosing diseases that are not on the list. Furthermore, in the part of the rulebook defining occupational malignant diseases, the list is essentially open. The criterion for diagnosing occupational malignant diseases is “clinical picture of a malignant disease caused by carcinogenic agents (chemical, physical, biological) from the International Agency for Research on Cancer (IARC) list of definitely proven carcinogens”, certainly, in case the person is employed at a workplace where contact with carcinogenic substances is made (proof of exposure and duration of exposure). The procedure for diagnosing occupational malignant diseases begins with the determination that a person has been exposed to a carcinogen found in Group 1 of the IARC list…. Then it is checked whether the localization of the tumor and the histological type are in accordance with the IARC List of Classifications by cancer site. If the first two requirements are met, it is checked whether the latency period, the length of the period from exposure to the development of cancer, is in accordance with the literature data. The last criterion is that the exposure was adequate, or more precisely, that the level and length of exposure are in accordance with literature data. It should be emphasized that this criterion is interpreted quite broadly, bearing in mind the facts about the absence of a clear relation between dose and response in malignant diseases. The mentioned procedure for diagnosing occupational malignant diseases is extremely flexible and, most importantly, it allows adding newly identified human carcinogens to the list without administrative procedures. Nevertheless, despite such a well-defined procedure for diagnosing occupational malignant diseases, the number of diagnosed occupational malignant diseases in Serbia is negligible.