Documented historical occupational exposure to polycyclic aromatic hydrocarbons (PAHs) —...

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

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

Red Flag Origin

Definition	Documented historical occupational exposure to polycyclic aromatic hydrocarbons (PAHs) — typical high-risk occupations include coke-oven workers (steelmaking), coal-gasification workers, aluminum-smelting workers (Söderberg-process pot rooms), iron / steel founders, roofing / asphalt-paving workers (coal-tar pitch exposure), and chimney sweeps — in an individual without a current PAH-associated malignancy diagnosis. Several PAH-rich occupational exposures are IARC Group 1 (Monograph 100F, 2012): coal-tar pitch (skin + lung + bladder), coke production (lung), coal gasification (lung + skin + bladder), aluminum production (lung + bladder), iron / steel founding (lung). Latency to lung / bladder cancer is typically 20-40 years; latency to skin cancer (squamous-cell carcinoma on hands / face from cutaneous PAH contact) can be shorter (10-30 years). There is NO curative intervention for prio...
Clinical direction	investigate
Category	other

Trigger Logic

{
  "any_of": [
    {
      "finding": "occupational_pah_exposure_documented",
      "value": true
    },
    {
      "finding": "occupational_pah_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 PAH-rich exposure AND no confirmed PAH-attributable malignancy diagnosis. Engine routes to 2-track PreventionPlan: (a) IND-OCC-PAH-PREVENTION-INTENSIFIED-SURVEILLANCE (standard) — risk-adjusted annual LDCT chest (PAH-modified USPSTF); urinalysis q1-2y for bladder surveillance; annual dermatology consultation with full-skin exam (focus on PAH-contact areas: face, neck, hands, forearms, scrotum); smoking-cessation counseling. (b) IND-OCC-PAH-PREVENTION-OBSERVATION (surveillance) — routine general-population USPSTF screening only; patient declines PAH-modified intensified surveillance but receives symptom- triggered evaluation. Trigger findings are computed booleans from occupational-history intake at the patient-profile layer. Evidence base: IARC Monograph 100F (2012); coke-oven worker cohorts (Costantino 1995; Lloyd 1971); aluminum-smelter cohorts (Spinelli 2006). Lung-cancer SMR ~2-4x in heavily-exposed coke-oven workers; bladder-cancer SMR ~1.5-3x in aluminum-smelter cohorts; cutaneous SCC excess well-documented historically (chimney sweeps — Pott 1775, f...

Used By

Indications

IND-OCC-PAH-PREVENTION-INTENSIFIED-SURVEILLANCE - IND-OCC-PAH-PREVENTION-INTENSIFIED-SURVEILLANCE
IND-OCC-PAH-PREVENTION-OBSERVATION - IND-OCC-PAH-PREVENTION-OBSERVATION