石綿暴露工作者的職業健康檢查制度與惡性間皮瘤監測機制：國際經驗與台灣現況

Occupational health examination for asbestos-exposed workers and surveillance system for malignant mesothelioma: international experiences and conditions of Taiwan

目標：石綿相關疾病潛伏期漫長，自暴露到發病可長達數十年。由於過去石綿被廣泛使用，導致至今石綿疾病仍持續出現，在許多國家，其認定與補償已成為重要職業健康議題。不少國家針對石綿暴露工作者建立離職後健康檢查制度，亦有些國家針對與石綿暴露有明確因果關係的惡性間皮瘤建立監測機制。方法：本文回顧文獻與政府網頁，探討先進國家的石綿工作者職業健檢制度與惡性間皮瘤監測機制。結果：日本、英國、德國、法國以職災保險或公共基金籌措財源，對石綿作業的現職工作者與離職者提供定期健康檢查服務，並對確認罹病者提供醫療照顧與補償。澳洲、法國與南韓對於惡性間皮瘤設有疾病監測機制，並對罹病者進行石綿暴露史調查，蒐集的資料成為政府制訂石綿疾病預防與補償政策的實証依據。結論：台灣應針對石綿作業工作者建立離職後職業健檢機制，並應考慮針對惡性間皮瘤建立監測機制，以全面了解石綿疾病的發生狀況與影響。

Objectives: Asbestos-related diseases (ARDs) occur years or decades after the first exposure to asbestos. Secondary to its widespread use, the prevalence of ARDs continues to increase, making its recognition and compensation a major occupational health issue. Many countries have expanded occupational health examination programs to include workers currently and/or previously exposed to asbestos. In addition, some countries have established surveillance systems for malignant mesothelioma (MM), a sentinel tumor for asbestos exposure. Methods: We reviewed existing literature and official websites of selected countries to understand the design of asbestos-related occupational health examination programs and MM surveillance systems. Results: In Japan, the United Kingdom, Germany and France, workers with ongoing or past occupational exposure to asbestos are eligible to participate in occupational health examination programs. These programs are financed either through workers’ compensation insurance or public funds. Medical care and compensation are provided for individuals with ARDs. Surveillance programs for MM were established in Australia, France and South Korea, and MM cases identified through the programs were investigated on asbestos exposure history. Surveillance programs provide empirical evidence for prevention and compensation policies of ARDs including MM. Conclusions: The government of Taiwan should expand the scope of its occupational health examination program to include individuals with a history of occupational exposure to asbestos, and establish a surveillance mechanism for MM. This will allow Taiwan to understand the scope and impacts of ARDs.