Documented historical occupational exposure to diesel-engine exhaust (DEE) — typical high...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-OCC-DIESEL-EXHAUST-PREVENTION`
Type	Red flag
Status	reviewed 2026-05-18 \| pending_clinical_signoff
Diseases	`DIS-NSCLC` `DIS-SCLC` `DIS-UROTHELIAL`
Sources	`SRC-NCCN-BCELL-2025` `SRC-NCCN-NSCLC-2025`

Red Flag Origin

Definition	Documented historical occupational exposure to diesel-engine exhaust (DEE) — typical high-risk occupations include long-haul truck drivers, underground / surface miners using diesel equipment, railroad workers (engineers, conductors, yard hostlers), heavy-equipment operators, bus / heavy-vehicle mechanics, dockworkers, and forklift operators in enclosed warehouse settings — in an individual without a current diesel-exhaust-associated malignancy diagnosis. Diesel exhaust is an IARC Group 1 carcinogen (Monograph 105, 2012) — established etiologic driver of lung cancer (primary endpoint; cumulative-exposure-response documented) with limited but suggestive evidence for bladder cancer. Latency from first exposure to lung cancer is 10-30 years and is smoking-modified (synergy not fully multiplicative, but additive-to- multiplicative depending on cumulative dose). There is NO curative interven...
Clinical direction	investigate
Category	other

Trigger Logic

{
  "any_of": [
    {
      "finding": "occupational_diesel_exhaust_exposure_documented",
      "value": true
    },
    {
      "finding": "occupational_diesel_exhaust_exposure_years_ge_10",
      "value": true
    }
  ],
  "type": "lab_value"
}

Notes

Prevention-persona RedFlag — v0.3 occupational batch-2 pilot. Fires when patient profile carries documented prior occupational diesel-exhaust exposure AND no confirmed diesel-attributable malignancy diagnosis. Engine routes to 2-track PreventionPlan: (a) IND-OCC-DIESEL-EXHAUST-PREVENTION-INTENSIFIED-SURVEILLANCE (standard) — risk-adjusted LDCT chest screening (USPSTF-modified criteria for cumulative DEE exposure), smoking-cessation counseling (paramount), urinalysis q1-2y for bladder surveillance. (b) IND-OCC-DIESEL-EXHAUST-PREVENTION-OBSERVATION (surveillance) — routine general-population USPSTF screening only; patient declines DEE-modified intensified imaging surveillance. Trigger findings are computed booleans from occupational-history intake at the patient-profile layer (FHIR Patient + Observation / Condition extensions; computation pipeline downstream of KB and not yet implemented). Evidence base: IARC Monograph 105 (2012); Silverman et al. 2012 (Diesel Exhaust in Miners Study — exposure-response gradient for lung-cancer mortality); Garshick et al. 2012 (trucking-industry cohort). Lung-cancer SMR ~1.3-3x depending on cumulative respirable elemental carbon dose; smoker × DEE i...

Used By

Indications

IND-OCC-DIESEL-EXHAUST-PREVENTION-INTENSIFIED-SURVEILLANCE - IND-OCC-DIESEL-EXHAUST-PREVENTION-INTENSIFIED-SURVEILLANCE
IND-OCC-DIESEL-EXHAUST-PREVENTION-OBSERVATION - IND-OCC-DIESEL-EXHAUST-PREVENTION-OBSERVATION