- Cancer (metastatic tumour)
- Mesothelioma
- Evidence (epidemiological)
- Exposure (asbestos)
- Exposure (polycyclic aromatic hydrocarbons)
- Cancer (kidney)
- Initial entitlement (eligibility)
The issues under appeal were entitlement to benefits for kidney cancer as a result of occupational exposures, and entitlement to mesothelioma as a result of occupational asbestos exposure.
The appeal was allowed in part. The evidence established, on a balance of probabilities, that the worker's occupational exposure made a significant contribution to the development of his kidney cancer.Decision No. 600/97 was referenced as the Tribunal's leading decision on the assessment of epidemiological evidence in determining causation. It supports the proposition that an odds ratio or incidence ratio of two (2.0) or more associated with workplace exposure supports a conclusion that the worker was likely a significant contributing factor in the development of the worker's disease. Where the odds ratio is lower, the Tribunal examines whether there are any special factors in the individual worker's case (see for example, Decision No. 2825/01).The Chair found that the evidence established that the worker's kidney cancer metastasized. Therefore, the worker's entitlement for kidney cancer also included the related metastatic cancer. Additionally, with respect to entitlement for mesothelioma, the appeal was denied on this issue as the evidence showed that mesothelioma was unlikely to be the correct diagnosis. It was considered more likely that the diagnosis was metastatic cancer from the primary kidney cancer. It was noted that malignant pleural mesothelioma is described as a cancer of the pleura characterized by local spread and destructive infiltration. It is strongly associated with exposure to asbestos fibres with a lag time of thirty to forty years prior to development and diagnosis.Dr. Bauman concluded that the clinical symptoms the worker experienced were not inconsistent with that expected from advanced, loco-regionally progressive renal cell carcinoma, and the symptoms documented were not uniquely associated with mesothelioma compared to other advanced metastatic cancers. Similarly, Dr. Bauman noted that the ability for renal cell carcinoma to involve multiple organ systems, including the lung and pleura, is well documented, and the radiographic evidence of an evolving aggressive loco-regional progression would have accounted for the worker's severe back pain. It was opined that loco-regionally progressive metastatic renal cell carcinoma was a sufficient explanation for the clinical symptom trajectory and severity and imaging findings observed in the worker's case. Therefore, it was unlikely that mesothelioma was an accurate diagnosis, and considered much more likely that the diagnosis of metastatic renal cancer was accurate.