Cancer Risk among Physicians is Different from that among Non-Physicians : An Observational Pilot Study

C l i n M e d International Library Citation: Kim HY (2016) Cancer Risk among Physicians is Different from that among NonPhysicians: An Observational Pilot Study. Int J Cancer Clin Res 3:062 Received: May 31, 2016: Accepted: July 28, 2016: Published: July 29, 2016 Copyright: © 2016 Kim HY. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Kim. Int J Cancer Clin Res 2016, 3:062


Introduction
Cancer is a leading cause of death in Korea [1] and has been a major Korean public health concern since 1983.The overall cancer incidence in Korea increased from 1975 to 1989, with non-significant changes during the period 1989 to 1998, and a significant decline in incidence from 1998 to 2008 [2,3].
The Korean workforce currently includes over 100,000 physicians.Physicians comprise a diverse group of healthcare personnel working under multiple occupational and environmental hazards and various teratogenic or carcinogenic factors contributing to impaired physical and mental health.These factors include physical, chemical, biological, and psychological hazards (chronic fatigue, depression, and burnout) and alcohol/tobacco exposure [4,5].Some controversy has existed concerning the cancer incidence rate among physicians and non-physicians.Some studies reported increased mortality rates for specific tumor types in various health care professions: breast cancer among women physicians, and subjects.In the entire study group, 11 primary clinic physicians (7.5%), 2 tertiary hospital physicians (1.6%), and 24 non-physicians (2.9%) were diagnosed with cancer.The mean ages (± SD) were 45.1 ± 9.2 years in the primary clinic physicians group, 37.1 ± 7.5 years in the tertiary hospital physicians group, and 45.6 ± 11.6 years in the non-physicians group.The mean ages (± SD) of those with cancer were 47.8 ± 9.9 years in the primary clinic physician group, 47.5 ± 6.4 years in the tertiary hospital physician group, and 47.5 ± 10.7 years in the non-physician group.
As shown in table 2, a significant relationship was found between being a primary clinic physician and the risk of cancer in multivariate analysis (control; age-and gender-adjusted relative risk [RR], 2.905; 95% confidence interval [CI], 1.337-6.314;p = 0.007).

Discussion
This retrospective analysis shows that primary clinic physicians have a significantly higher overall risk of cancer than tertiary hospital physicians and the reference non-physicians.This association remained significant even after adjusting for other risk factors, including age and gender.To our knowledge, this is the first study to demonstrate an association between being a primary clinic physician and cancer risk.Some epidemiological reports have suggested that physicians have either an average or low risk of cancer, e.g. in Israel and Taiwan [6,7,9].One editorial offered several explanations for the lower cancer death rate among physicians as compared to the general population [10].This may reflect the combined effects of relatively high socioeconomic status and knowledge of the consequences of healthrelated behaviors such as smoking, alcohol drinking, and drug abuse.
Our study results seemed to contradict previous reports that cancer risk is similar between tertiary hospital physicians and the non-physicians.Physicians have a higher prevalence of work-related stress and mental health problems than the general population [11][12][13][14].A study in the USA suggested that motivational interventions may improve physician lifestyles and that positive personal health behaviors should be encouraged among physicians [15].The study reported that over 53% had severe to moderate stress, 35% reported "no" or "occasional" exercise, 34% slept 6 or fewer hours daily, and 21% worked more than 60 hours per week.In Korea, the environment and health behavior of primary physicians is not optimal, even though physicians should know best how to live healthfully.Korean physicians in primary clinic, particularly those who routinely work on Saturday, when there are fewer severely ill patients, often perform minor surgery.Due to competition to provide low-cost healthcare services, the working hours of primary physicians are relatively long, with Saturday, Sunday, and weekday night hours.Thus, time for exercise is lacking, and there are few opportunities to schedule personal health evaluations.We suspect that enhanced and regular diagnostic evaluations account for the discrepancy in cancer risk between primary clinic and tertiary hospital physicians.Our hospital provides a physician-tailored free-of-charge annual health evaluation program to all physicians, and many have evaluations on a regular basis.
The KMA (Korean Medical Association) Health Policy Institute published a primary medical management survey [16,17] showing that the average weekly hours worked by primary physicians were 56.5, which is 5.5 hours longer than in 2005.Compared to nonphysicians working 40 hours in a 5-day week, primary physicians usually work on average an additional 16.5 hours in a 6-day week.Working in the South Korean healthcare system [18], with universal coverage for all citizens and lower medical fees, threatens physician survival, as more physicians further divide an already decreased share of the market.The strengths of the present study include the following: 1) physicians were evaluated by type of practice (primary clinic vs. tertiary hospital); 2) when cancer was diagnosed, treatment was started immediately, and continued follow-up was performed, suggesting the data were of high quality; and 3) all the physicians continue to provide medical services.A main limitation of this study is its cross-sectional, retrospective design.A second limitation is the small sample size.

Conclusion
In conclusion, our findings show a significant association between being a primary clinic physician and cancer risk.Regular health examinations for primary clinic physicians may helpful to maintain their health status.

Table 3
lists various types of cancer in the physicians group (primary and tertiary) and non-physicians group.Primay physician has 1 brain tumor, 1 thyroid cancer, 3 stomach cancer, 1 gallbladder cancer, 3 prostate cancer, 1 renal cell carcinoma.Tertiary physician has 1 rectal neuroendocrine tumor, 1 prostate cancer, 1 ovary cancer.Cancer numbers are too small to analyze for meaningful analysis.

Table 1 :
Baseline characteristics of physicians vs. control group.

Table 2 :
Multivariate-Adjusted odds ratios and 95% confidence intervals of cancer.

Table 3 :
Cancer types among primary vs. tertiary physicians vs. non-physicians group.