Precautions for intestinal cancer in the workplace. An initiative for secondary prevention in the BASF joint-stock company

Abstract

The annual incidence of colorectal cancer in Germany is estimated at 27000 in men and 30000 in women. If the diagnosis is made early the cure rate is over 90%. Against this background the department of occupational medicine and health protection of the BASF Aktiengesellschaft initiated a study on the potential prevention of colorectal cancer among the staff at its Ludwigshafen site. The target group included all 13265 actively working employees aged 45 years or above. Those expressing interest were given a standardized questionnaire concerning risk factors for colorectal cancer and a test for occult fecal blood (FOBT). If the test was positive and/or a positive answer was given to the question on blood in the stool or on a positive family history, coloscopy - to be arranged via the general practitioner - was advised, in line with the recommendations of the German Society of Digestive and Metabolic diseases (Deutsche Gesellschaft für Verdauungs- und Stoffwechselerkrankungen). At the end of the study 3732 employees (337 women, 3395 men, mean age 52 years) had completed the questionnaire and the FOBT results were available. Coloscopy was recommended to 688 employees, 323 of whom (47%) underwent the investigation. Nine of the subjects already had manifest cancer, six of them in the early stage T1 or T2. Adenomatous polyps were found in an additional 61 and subsequently excised. Cost-benefit considerations at the company level or in the area of the health system, respectively, gave favourable ratios of 1:10 and 1:14. It requires considerable expenditure to increase the number of participants in the cancer prevention programme and obtain a consequent clarification of suspicious findings. Health care within a company is a valuable complementation in Germany of medical care provided by general practitioners or specialist, if close cooperation between practitioners in the given region is assured. Initiatives like the one presented here protect people personally affected against pain and distress and are also of economic value.