eliminating occupational cancer
DESCRIPTION
My presentation at the IOSH National Safety Symposium, 7th and 8th September 2014. http://www.iosh.co.uk/Key-IOSH-events/National-Safety-Symposium.aspxTRANSCRIPT
INSTITUTE OF OCCUPATIONAL MEDICINE . Edinburgh . UK www.iom-world.org
Eliminating occupational cancer
John Cherrie
IOSH National Safety Symposium 2014
I wantto
ELIMINATE workplace
cancer
Summary…
• Workplace cancer has been a problem for some time
• How many people die from occupational cancer in Britain?
• What are the main causes?• What will the future hold?• Can we really eliminate
occupational cancer?
Europe’s dirtiest factory…
• Malcolm Carhart died from lung cancer
• Fred Richards had bladder cancer and survived
• 300 other men who worked at the Phurnacite plant in South Wales had their health damaged by their work Mr Fred Richards
This was a coal carbonization plant
Mortality in the plant…
• We carried out a mortality study in the plant in 1987• 17 year follow-up• 620 men included
• Increased cancer mortality• Lung – about 1.5x the expected numbers• Stomach – 1.6x• Prostate – 1.5x• Bladder – 2.7x
• Non-melanoma skin cancer commonly reported
Understanding the causes
• In 1981 Richard Doll and Richard Peto were commissioned by the US government to assess the relative importance of the “environment” in causing cancer
• Their aim was to identify the proportion of cancer that is preventable
Sir Richard Doll
Sir Richard Peto
Attributable fractions…
About 4% (2 – 8%)
Cancer burden in the UK…
• Designed to update Doll and Peto’s estimate for occupational cancer burden• Current burden (2010) • Future burden (to 2060+)
• Funded by HSE to inform policy• Method based on:
• Risk of Disease (relative risk from published literature)• Proportion of population exposed
• Estimation for IARC groups 1 (definite) and 2A (probable) carcinogens and occupational circumstances
Rushton L, Hutchings SJ, Fortunato L, et al. Occupational cancer burden in Great Britain. Br J Cancer 2012;107:S3–S7.
Attributable fraction…
5.3% (4.6 – 6.6%)
Men = blueWomen = red
Not all carcinogens are equally important
85% of the cancer cases come from the top ten chemical agents
Some good news…
Creely KS et al. (2007) Trends in inhalation exposure--a review of the data in the published scientific literature. Ann Occup Hyg.; 51(8): 665-678.
Aerosols
Some good news…
Creely KS et al. (2007) Trends in inhalation exposure--a review of the data in the published scientific literature. Ann Occup Hyg.; 51(8): 665-678.
Gases and vapours
Burden should be decreasing…
• If exposure is decreasing then it seems likely that the future burden will also be lower
• Assumes • Risk is related to exposure• Prevalence of exposure is not increasing• The aging population is not
distorting the picture
So what does the future hold?• We have estimated future cancer burden in Britain
for a range of interventions for a number of workplace carcinogens• AFs estimated for forecast years, e.g. 2010, 2020 …
2060• Assume 10-50 years latency for solid tumours e.g.
lung cancer, 0-20 years for leukaemia• Some past and some future exposure until 2060 • Workers at the beginning (2010) assumed to be of all
working ages• Workers recruited through employment turnover are
assumed to be only aged 15-24
Hutchings, S., Cherrie, J., van Tongeren, M., & Rushton, L. (2012). Intervening to Reduce the Future Burden of Occupational Cancer in Britain: What Could Work? Cancer Prevention Research. doi:10.1158/1940-6207.CAPR-12-0070
Crystalline silica…
• Assessed baseline scenario• Introduction of new limit values:• 0.05 mg/m3 and • 0.025 mg/m3
• Improved compliance with limits:• From 33% • to 90%
Silica – Cancer incidenceBaseline, 0.1 mg/m3, 33% compliance OEL = 0.05 mg/m3, 33% complianceOEL = 0.025 mg/m3, 33% compliance
Silica – Cancer incidence
OEL =0.1 mg/m3, 90% compliance OEL = 0.05 mg/m3, 90% complianceOEL = 0.025 mg/m3, 90% compliance
Silica – cancer incidence
Silica – cancer incidence
Successful interventions
Agent Intervention
Solar radiation Reduce time outdoors, wear suitable clothes, use sun screen
Diesel engine exhaust
90% comply with an OEL of 1 mg/m3
Shift work < 5-years night shift work for women
Asbestos 90% comply with an OEL of 0.001 fibres/ml
Welders Improved ventilation, wear respiratory protection
Elimination…
• Focus on the top-ten carcinogens• Encourage more effective controls along
with more stringent enforcement• “Elimination” achieved when future
occupational cancer burden less than 0.1% of all cancer registrations
• Monitor exposure and undertake an assessment of future burden as a leading indicator
Questions…