Documented history of night-shift work or rotating shift work disrupting the normal circa...

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

ID	`RF-OCC-SHIFTWORK-CIRCADIAN-PREVENTION`
Type	Red flag
Status	reviewed 2026-05-19 \| pending_clinical_signoff
Diseases	`DIS-BREAST`
Sources	`SRC-NCCN-BCELL-2025` `SRC-NCCN-BREAST-2025`

Red Flag Origin

Definition	Documented history of night-shift work or rotating shift work disrupting the normal circadian rhythm — typical high-exposure occupations include nurses (especially ICU / ER night shifts), flight attendants and pilots (long-haul / transmeridian routes), long-haul truck drivers, police / firefighter / EMS personnel, manufacturing and processing-plant night-shift workers, hospitality (24-hour hotel / casino staff) — with cumulative exposure ≥10 years — in an individual without a current shift-work-attributable malignancy diagnosis. IARC Monograph 124 (2020, updated 2019 meeting) classified "night shift work" as Group 2A (probably carcinogenic to humans) — limited evidence in humans (consistent positive associations with breast cancer in long-duration night-shift cohort studies; less consistent / inadequate evidence for prostate, colorectal, and other cancers), sufficient evidence in experi...
Clinical direction	investigate
Category	other

Trigger Logic

{
  "any_of": [
    {
      "finding": "occupational_night_shift_work_years_ge_10",
      "value": true
    },
    {
      "finding": "occupational_rotating_shift_work_circadian_disruption_documented",
      "value": true
    }
  ],
  "type": "lab_value"
}

Notes

Prevention-persona RedFlag — v0.3 IARC 2A probable-carcinogen batch (2026-05-19). IARC Group 2A probable — limited human evidence; clinical recommendation more conservative than Group 1. IARC Monograph 124 (2020) is the canonical evidence anchor and is NOT yet a separate SRC entity in KB; cited in notes only. Anchor scope: breast cancer ONLY. IARC 124 classifies "limited evidence in humans" specifically for breast cancer; other cancers (prostate, colorectal) carry "inadequate evidence" and are deliberately excluded from relevant_diseases. Female breast is the dominant endpoint; male breast cancer in night-shift cohorts is insufficiently powered for meaningful inference. Engine routes to 2-track PreventionPlan: (a) IND-OCC-SHIFTWORK-CIRCADIAN-PREVENTION-INTENSIFIED-SURVEILLANCE (standard) — sleep-hygiene counseling, workplace-scheduling discussion, guideline-baseline mammography adherence with consideration of earlier baseline at age 40 (per NCCN risk- stratified framework) when clustering with other breast-cancer risk factors. (b) IND-OCC-SHIFTWORK-CIRCADIAN-PREVENTION-OBSERVATION (surveillance) — routine USPSTF mammography only; patient declines intensified scheduling. STUB pendi...

Used By

Indications

IND-OCC-SHIFTWORK-CIRCADIAN-PREVENTION-INTENSIFIED-SURVEILLANCE - IND-OCC-SHIFTWORK-CIRCADIAN-PREVENTION-INTENSIFIED-SURVEILLANCE
IND-OCC-SHIFTWORK-CIRCADIAN-PREVENTION-OBSERVATION - IND-OCC-SHIFTWORK-CIRCADIAN-PREVENTION-OBSERVATION