Conference on medical screening and biological monitoring for the effects of exposure in the workplace, July 1984, part I.
Papers on biological monitoring and medical screening of workers for the effects of occupational exposure were presented at a conference in Cincinnati, Ohio, in July 1984. The success of medical screening and biological monitoring is measured in terms of the degree to which these activities contribute in practice to the prevention of occupational disease and disability. Articles on these techniques as practiced in industry were included. Legal, ethical, and social consequences were covered. The need for adequate evaluation of effectiveness was emphasized. Many new methods, especially in the areas of biological monitoring for the presence of intoxicants or their metabolites and medical screening for early evidence of genetic and somatic damage are being developed. The place of these two techniques in the continuum of methods available for the prevention of occupational disease was considered. Along with the biological aspects of screening tests, aspects of public health policy and economics are dealt with, as well as numerous case studies presenting the actual experience of screening programs. Epidemiological screening for purposes of secondary prevention was considered, and problems were illustrated by case studies on lung cancer screening. Assessment in terms of validity, sensitivity, specificity and positive predictive value was discussed. Complexities, such as elucidating the relationship between multiple causes, the host, and the effect were addressed. The final question, what action to take, was considered. Papers deal with urinalysis, blood analysis, breath analysis, immunoassay, radiodiagnosis, pulmonary function screening, sputum cytology, fecal hemoccult testing, birth weight, and sigmoidoscopy. Papers were included on chlorinated-hydrocarbon solvents, industrial toxicants, volatile organic compounds, heavy metals, pesticides, Legionella, and coal dust. The conference stressed that screening is only effective if there is effective followup with immediate treatment.