石綿暴露工作者的職業健康檢查制度與惡性間皮瘤監測機制：國際經驗與台灣現況

Occupational health examination for asbestos-exposed workers and surveillance system for malignant mesothelioma: international experiences and conditions of Taiwan

10.6288/TJPH201736105123

蕭汎如(Fan-Ju Hsiao)；鄭雅文(Yawen Cheng)；李俊賢(Lukas Jyuhn-Hsiarn Lee)

石綿 ； 惡性間皮瘤 ； 職業健康檢查 ； 疾病通報 ； 國際比較 ； asbestos ； malignant mesothelioma ； occupational health examination ； surveillance ； international comparison

台灣公共衛生雜誌

36卷2期（2017 / 04 / 15）

187 - 196

繁體中文

目標：石綿相關疾病潛伏期漫長，自暴露到發病可長達數十年。由於過去石綿被廣泛使用，導致至今石綿疾病仍持續出現，在許多國家，其認定與補償已成為重要職業健康議題。不少國家針對石綿暴露工作者建立離職後健康檢查制度，亦有些國家針對與石綿暴露有明確因果關係的惡性間皮瘤建立監測機制。方法：本文回顧文獻與政府網頁，探討先進國家的石綿工作者職業健檢制度與惡性間皮瘤監測機制。結果：日本、英國、德國、法國以職災保險或公共基金籌措財源，對石綿作業的現職工作者與離職者提供定期健康檢查服務，並對確認罹病者提供醫療照顧與補償。澳洲、法國與南韓對於惡性間皮瘤設有疾病監測機制，並對罹病者進行石綿暴露史調查，蒐集的資料成為政府制訂石綿疾病預防與補償政策的實証依據。結論：台灣應針對石綿作業工作者建立離職後職業健檢機制，並應考慮針對惡性間皮瘤建立監測機制，以全面了解石綿疾病的發生狀況與影響。

Objectives: Asbestos-related diseases (ARDs) occur years or decades after the first exposure to asbestos. Secondary to its widespread use, the prevalence of ARDs continues to increase, making its recognition and compensation a major occupational health issue. Many countries have expanded occupational health examination programs to include workers currently and/ or previously exposed to asbestos. In addition, some countries have established surveillance systems for malignant mesothelioma (MM), a sentinel tumor for asbestos exposure. Methods: We reviewed existing literature and official websites of selected countries to understand the design of asbestos-related occupational health examination programs and MM surveillance systems. Results: In Japan, the United Kingdom, Germany and France, workers with ongoing or past occupational exposure to asbestos are eligible to participate in occupational health examination programs. These programs are financed either through workers' compensation insurance or public funds. Medical care and compensation are provided for individuals with ARDs. Surveillance programs for MM were established in Australia, France and South Korea, and MM cases identified through the programs were investigated on asbestos exposure history. Surveillance programs provide empirical evidence for prevention and compensation policies of ARDs including MM. Conclusions: The government of Taiwan should expand the scope of its occupational health examination program to include individuals with a history of occupational exposure to asbestos, and establish a surveillance mechanism for MM. This will allow Taiwan to understand the scope and impacts of ARDs.

1. 蔡奉真、鄭雅文(2015)。職業健康檢查資料的隱私權保護。台灣衛誌，34，223-6。
   連結：
2. 鍾佩樺、鄭雅文(2010)。我國職業傷病通報制度之現況與問題。台灣衛誌，29，561-74。
   連結：
3. Health and Safety Executive, UK (HSE). Guidance for appointed doctors on the control of asbestos regulations 2012. Available at: http://www.hse.gov.uk/pubns/ms31.htm. Accessed December 14,2016.
4. HSE. Mesothelioma in Great Britain - mesothelioma mortality in Great Britain 1968-2014. Available at: http://www.hse.gov.uk/statistics/causdis/mesothelioma/mesothelioma.pdf. Accessed December 14,2016.
5. ILO/WHO. Outline for the development of national programmes for elimination of asbestos-related diseases. Available at: http://www.ilo.org/safework/info/publications/WCMS_108555/lang-en/index.htm. Accessed December 14,2016.
6. ILO. Asbestos in the workplace: a difficult legacy. Available at: http://vww.ilo.org/global/about-the-ilo/how-the-ilo-works/WCMS_081341/lang--en/index.htm. Accessed December 14, 2016.
7. European Parliament. On asbestos related occupational health threats and prospects for abolishing all existing asbestos. Available at: http://www.europarl.europa.eu/sides/getDoc.do?pubRef=-//EP//TEXT+REPORT+A7-2013-0025+0+DOC+XML+V0//EN. 2012. Accessed December 14,2016.
8. WHO. Chrysotile asbestos. Available at: http://www.who.int/ipcs/assessment/public_health/asbestos/en/. Accessed December 14,2016.
9. Furuya S, Takahashi K, Movahed M, Jiang Y. National asbestos profile of Japan. Based on the national asbestos profile by the ILO and the WHO. Available at: http://envepi.med.uoeh-u.ac.jp/NAPJ.pdf. Accessed December 14,2016.
10. Bundesanstalt für Arbcitsschutz und Arbeitsmedizin=BAuA(2014).National Asbestos Profile for Germany.Dortmund, Germany:Federal Institute for Occupational Safety and Health.
11. Carton, M,Bonnaud, S,Nachtigal, M(2011).Post-retirement surveillance of workers exposed to asbestos or wood dust: first results of the French national SPIRALE Program.Epidemiol Prev,35,315-23.
12. Ferguson, DA,Berry, G,Jelihovsky, T(1987).The Australian mesothelioma surveillance program 1979-1985.Med J Aust,147,166-72.
13. Goldberg, M,Imbernon, E,Rolland, P(2006).The French national mesothelioma surveillance program.Occup Environ Med,63,390-5.
14. International Labour Organization=ILO(1997).Technical and Ethical Guidelines for Workers' Health Surveillance Report.Geneva:ILO.
15. Jung, SH,Kim, HR,Koh, SB(2012).A decade of malignant mesothelioma surveillance in Korea.Am J Ind Med,55,869-75.
16. Lee, LJ,Chang, YY,Wang, JD(2012).Disease burden of malignant pleural mesothelioma: Taiwan experiences.J Policy Sci,6,43-62.
17. Lee, LJ,Chang, YY,Wang, JD(2010).Impact of malignant mesothelioma in Taiwan: a 27-year review of population-based cancer registry data.Lung Cancer,68,16-9.
18. Leigh, J,Davidson, P,Hendrie, L,Berry, D(2002).Malignant mesothelioma in Australia, 1945-2000.Am J Ind Med,41,188-201.
19. Lim, SS,Vos, T,Flaxman, AD(2012).A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010.Lancet,380,2224-60.
20. Lin, CK,Chang, YY,Wang, JD,Lee, LJ(2015).Increased standardised incidence ratio of malignant pleural mesothelioma in Taiwanese asbestos workers: a 29-year retrospective cohort study.Biomed Res Int,2015,678598.
21. Ramazzini Collegium(2016).The 18th Collegium Ramazzini statement: the global health dimensions of asbestos and asbestos-related diseases.Scand J Work Environ Health,42,86-90.
22. Sen, D(2015).Working with asbestos and the possible health risks.Occup Med,65,6-14.
23. Wu, WT,Lin, YJ,Li, CY(2015).Cancer attributable to asbestos exposure in shipbreaking workers: a matched-cohort study.PLoS One,10,e0133128.
24. Wu, WT,Lin, YJ,Shiue, HS(2014).Cancer incidence of Taiwanese shipbreaking workers who have been potentially exposed to asbestos.Environ Res,132,370-8.
25. Wu, WT,Lu, YH,Lin, YJ(2013).Mortality among shipbreaking workers in Taiwan - a retrospective cohort study from 1985 to 2008.Am J Ind Med,56,701-8.
26. 劉紹興(1992)。台灣職業醫學五十年之回顧：化學性職業疾病─職業性肺病。台北=Taipei:三軍總醫院職業病防治中心=Center of Occupational Hazard, Tri-Service General Hospital。

1. 蕭汎如、鄭雅文、陳宗延、李俊賢(2018)。石綿暴露工作者的職業健檢：職業醫學專科醫師的觀點。臺灣公共衛生雜誌，37(1)，24-33。