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Crystalline silica has been classified as a definite carcinogen (Group 1) causing lung cancer by the International Agency for Research on Cancer (IARC). In Korea, crystalline silica has been the most common causal agent for workers to apply to the Korea Workers’ Compensation and Welfare Service (KWCWS).We used KWCWS data to evaluate workers’ crystalline silica exposure levels according to their occupations and industries, and reviewed research papers describing the dose-response relationship between cumulative exposure levels and lung cancer incidence. In addition, we reviewed lung cancer cases accepted by the KWCWS, and suggest new criteria for defining occupational cancer caused by crystalline silica in Korea.A review of 120 cases of occupational lung cancer confirmed through an epidemiological survey of the KWCWS since 2007 revealed that 45 cases (37.5%) involved miners. Most of the coincidental exposures (72.5%) involved asbestos, diesel exhaust particles, radon, hexavalent chromium, and so on. From the carcinogenic exposure to the onset of the disease, there was no case of less than 10 years, and the lag time was more than 40 years in 40% of the cases. Among the patients whose cases were approved, 19.2% had pneumoconiosis, while many cases were approved without pneumoconiosis. A high level of exposure was found in the construction industry, and significant exposures were also confirmed among miners and foundry workers. Stone quarrying and stone laying were also found to expose workers to high concentrations of crystalline silica.Rather than confining to miners, we propose recognising occupational lung cancer whenever workers with pneumoconiosis develop lung cancer, regardless of their industry. Coincidental exposure and lag time should also be considered in evaluations of work-relatedness.