Office of Compensation Analysis and 

Support

Technical Information Bulletin

Document Number: 

OCAS-TIB-003

Effective Date: 4/30/2003

Revision No. 0

IREP REQUIREMENTS FOR MULTIPLE CANCERS Page 1 of 3

Approval: Date: 4/30/2003 

 J.W. Neton, Health Science Administrator

Supersedes:

 None

RECORD OF ISSUE/REVISIONS

ISSUE 

AUTHORIZATION 

DATE

EFFECTIVE

DATE

REV. 

NO.

DESCRIPTION

4/30/2003 4/30/2003 0 New document to establish the requirements for 

cases involving multiple primary cancers. 

1.0 Purpose

This Technical Information Bulletin provides a summary of issues associated with multiple primary 

cancers, and cases in which no primary cancer is provided, including updated dose reconstruction 

(DR) requirements for various claim scenarios. NOTE: The policies outlined below were mutually 

agreed to by the Department of Labor (DOL) and the Office of Compensation Analysis and Support 

(OCAS). DOL is distributing their own version of this information, so please note that DOL staff will 

be expecting OCAS to adhere to these procedures.

2.0 50% Probability of Causation reached with less than the total number of primary 

cancers

If only one primary cancer (or any number less than the total number of primary cancers) is sufficient 

to attain the 50% probability of causation, calculate dose and create IREP input files only for the 

minimum number required to reach compensability. (EXCEPTION: Leukemia – please see Item 3.0.)
Effective Date: 4/30/2003 Revision No. 0 Procedure No.

OCAS-TIB-003

Page 2 of 3

3.0 Leukemia (the exception to Item 2.0)

Dose calculations are required for all of the leukemia models used for a claim, and a separate IREP 

input file must be provided to DOL for each model. (Consult Table 4 in the NIOSH-IREP Technical 

Documentation to see which leukemia models are required for each primary.) DOL makes the final 

probability of causation determination based on the leukemia model that yields the highest PC.

4.0 Claims with multiple primary cancers for which probability of causation is less 

than 50%

If a claim results in a probability of causation of less than 50%, dose must be calculated for every 

primary cancer. IREP input files must be provided to DOL for all primary cancers.

5.0 Secondary cancer(s), unknown primary

Table 7 in the NIOSH-IREP Technical Documentation must be consulted to determine which cancer 

models to run. If any one of the indicated cancer models results in a PC of 50% or greater, then no 

additional DRs or IREP runs are necessary; only the IREP input file for the cancer yielding a 

probability of causation of greater than 50% needs to be provided to DOL. On the other hand, if none 

of the cancer models result in a probability of causation of greater than 50%, then dose calculations 

and corresponding IREP runs are required for every indicated cancer model. DOL will then 

adjudicate the claim based on the cancer model yielding the highest probability of causation.

6.0 Multiple IREP Runs

When more than one IREP input is required for the case, check “Yes” in the “Should alt 

model be run?” Check “No” when only one IREP input is required.

7.0 Multiple skin cancers

Each malignant skin neoplasm will be considered as a separate primary cancer unless it is 

specifically noted as metastatic (secondary.) Thus, for dose calculations, the date of diagnosis and 

the location (e.g., arm, neck, back) of each site are essential. (Some claims, reportedly, may include 

as many as 40 or more separate primary skin cancer sites.)
Effective Date: 4/30/2003 Revision No. 0 Procedure No.

OCAS-TIB-003

Page 4 of 3

8.0 Multiple cancers in an organ other than the skin

Multiple primary malignancies are possible in other organs, not just skin. If more than one primary 

cancer is identified for a single organ, dose calculations must be done for each additional primary 

cancer site in that organ as necessary to determine compensability. (i.e., If compensability is attained 

with less than the total number of primary sites, there is no need to reconstruct doses for the 

remaining primary malignancies associated with that organ.)

9.0 Multiple IREP Entries 

IREP accommodates only 12 entries for the online equation used in multiple primary cancer 

calculations. For claims with more than 12 primary cancers, DOL will first enter the 12 highest 

probability of causation values into the equation. In the unlikely event that the 12 highest values fail 

to produce a combined probability of causation of 50%, DOL will create an Excel spreadsheet, based 

on the equation, for use in calculating the probability of causation. (Note that for most claims with 

more than 12 primary cancers, it is anticipated that less than 12 of those cancers will be sufficient to 

yield a probability of causation of 50% or greater; in those instances, NIOSH will create only the 

number of IREP input files necessary to reach a probability of causation of 50% or greater.)