WORKING FOR A HEALTHY FUTURE

INSTITUTE OF OCCUPATIONAL MEDICINE . Edinburgh . UK www.iom-world.org

How to eliminate occupational cancer from chemicals

John Cherrie

Summary…

•  UK occupational cancer burden •  then and now

•  What do we mean by elimination of the problem

•  What evidence is there to help understand exposure changes over time

•  What are the priority substances •  Who is responsible for getting this done?

Doll and Peto (1981)

Occupational cancer burden in Britain

•  Imperial College, Institute of Occupational Medicine and others are undertaking this work for HSE

•  Basic approach… •  Identify the number of people exposed, by industry, in

1980s •  Review the epidemiological literature to define the

appropriate relative risk •  Consider multiple exposures, male/female split, turnover

rates and some other complications •  Estimate the likely number of cases now from past

exposure

Cancers being considered…

•  Lung cancer, bladder cancer, leukaemia, mesothelioma, non-melanoma skin cancer, sinonasal

•  Pharynx and nasopharynx, oesophagus, pancreas, larynx, cervix, ovary, melanoma, stomach, GI tract (stomach + colorectal), kidney, non-hodgkin’s lymphoma, lymphohematopoietic system, multiple myeloma, soft tissue sarcoma, all sites combined, liver & bilary tract, liver (angiosarcoma), liver (hepatocellular), bone, thyroid, CNS, brain, breast, prostate

Results…

Cancer site Number deaths Attributable fraction bladder 245 5.3%

breast 555 4.6%

larynx 20 2.6%

lung 4749 14.5%

melanoma (eye) 1 1.6%

mesothelioma 1937 95%

nasopharynx 8 8.2%

nhl 57 1.7%

nmsc 23 4.6%

oesophagus 184 2.5%

sinonasal 39 34%

Rushton et al. Occupation and cancer in Britain. British Journal of Cancer (2010) vol. 102 (9) pp. 1428-1437.

Results…

Agent Lung cancer registrations

Total registrations

Asbestos 2223 4216 Shift work (+ flight personnel) - 1969 Mineral oils 470 1730 Solar radiation - 1541 Silica 907 907 Diesel engine exhaust 695 801 PAHs from coal tars + pitch 282 545 Painters 215 359 TCDD (dioxins) 284 316 Environmental tobacco smoke (non-smokers)

209 284

Rushton et al. Occupation and cancer in Britain. British Journal of Cancer (2010) vol. 102 (9) pp. 1428-1437

Time trends in exposure…

Rubber - Crude Materials, Compounding and Mixing

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

mg/

m3

Netherlands United Kingdom Poland Germany Sweden

Time trend per year

UK : -6% NL : -2% PL : -6% SW : -6% GE : -7%

http://exasrub.iras.uu.nl/content.html

Agostini et al. Exposure to rubber process dust and fume since 1970s in the UK; influence of origin of measurement data. J. Environ. Monit. (2010) vol. 12 (5) pp. 1170

Results from a review…

Year

1940 1950 1960 1970 1980 1990 2000 2010

% of 1990 exposure levels

0

1000

2000

3000

4000

5000

Exp

osur

e N

orm

alis

ed to

100

in 1

990

Aerosols

Creely et al. Trends in Inhalation Exposure - A Review of the Data in the Published Scientific Literature. The Annals of Occupational Hygiene (2007) vol. 51 (8) pp. 665-678

Results from a review…

Year

1940 1950 1960 1970 1980 1990 2000 2010

% of 1990 exposure levels

0

1000

2000

3000

4000

5000

Exp

osur

e N

orm

alis

ed to

100

in 1

990 Gases and

vapours

Creely et al. Trends in Inhalation Exposure - A Review of the Data in the Published Scientific Literature. The Annals of Occupational Hygiene (2007) vol. 51 (8) pp. 665-678

Crude projections of future burden…

Cherrie JW, Van Tongeren M, Semple S. Exposure to Occupational Carcinogens in Great Britain. Ann Occup Hyg 2007 51: 653-664.

Elimination of occupational cancer….

•  …elimination of the disease as a public health problem (i.e. reduction of cases below what is considered to be a public health risk)

•  What might be “a public health risk” for occupational cancer?

•  Reduction of incidence to <<1% of all cancers?

Cherrie. We can eliminate occupational cancer from chemicals. Occupational Medicine (2008) vol. 58 (5) pp. 314-315

Possible problem agents…

•  Radon and Crystalline silica •  Work to change attitudes and to follow advice on remediation/controls

•  Diesel exhaust •  Filtered air in cabs •  Air conditioned refuges •  Respirators

•  Welding •  Local ventilation and respirators

•  Painting •  Wear respirator and protective clothing •  Improve general ventilation

Tracking progress…

•  Periodic surveys of exposure by EU and national authorities •  Intensity (including contextual information) •  Prevalence

•  Updates of cancer burden estimates •  Routine reporting by health and safety

professionals through European associations

Who’s going to ensure elimination?

•  H&S professionals •  Government •  Industry •  Trade unions

Slides available via www.OH-world.org