occupational cancer in europe – working towards solutions john cherrie
TRANSCRIPT
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Occupational cancer in Europe – working towards solutions
John Cherrie
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Summary…
Cancer Occupational cancer burden estimates
highlight priorities The role of legislation and wider initiatives Temporal trends in risk determinants Interventions to reduce risk
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Institute of Occupational Medicine, Edinburgh…
IOM is a not-for-profit research and consulting company
It carries out work for governments, industry, trade unions and charitable foundations
Some of this work relates to carcinogens and occupational cancer
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Cancer…
In the UK there are more than 300,000 cases of cancer diagnosed each year Age standardised rate 4 per 1,000 Just over half will survive 5 or more years
In Australia there are 130,000 cases diagnosed each year Age standardised rate 5.6 per 1,000 Around two thirds survive 5 years or more
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Incidence…
13%
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Mortality…
22%
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Monograph programme started in 1972 Identifies carcinogens as:
Carcinogenic (Group 1), Probably carcinogenic (2a), Possibly carcinogenic (2b), Not classifiable (3) and Probably not carcinogenic (4)
Identifies types of cancer caused IARC does not quantify the impact or degree of
risk
Pearce et al. (2015). IARC Monographs: 40 Years of Evaluating Carcinogenic Hazards to Humans. Environmental Health Perspectives, 1–38.
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9
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
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Attributable fractions…
About 4% (2 – 8%)
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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.
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Attributable fraction…
5.3% (4.6 – 6.6%)
Men = blueWomen = red
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Not all carcinogens are equally important 85% of the
cancer cases come from the top ten chemical agents
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European legislation…
Carcinogens and Mutagens Directive First introduced 1990 Implemented in each country under national
legislation Amended once to revise the binding limit for
benzene
Latest updating efforts Started 2004 Impact assessment published 2012
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But legislation has not worked…
Occupational cancer attributable fraction is still around 5%
It does not include many of the main causes of occupational cancer
Legislation is an ineffective instrument of change
Updating the legislation is a political issue Awareness of the issues are very poor, even
amongst health and safety professionals
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http://www.ishn.com/articles/101241-european-unions-call-for-occupational-cancer-prevention-measures
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Baseline health costs…
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No time to loseandBreathe freely…
Two new campaigns in the UK Run by health and safety professionals
To inform members And instigate change
Both have prioritised action Limited number of carcinogens Construction sector
www.notimetolose.org.ukwww.breathefreely.org.uk
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No time to lose campaign…
Focusing on a ‘top five’: Diesel engine exhaust particulate Solar radiation Silica Shiftwork involving night work Asbestos
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Action plan…
Government to: highlight the cost to society maintain a comprehensive national database on
occupational carcinogen exposure fund more research
Regulator to: Deliver more effective compliance with
existing legislation take a more proactive approach
www.notimetolose.org.uk/About-NTTL/Action-plan-for-the-UK.aspx
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Action plan…
Professions to: raise awareness and engage workers in solutions ‘join the dots’ between employers, health and
safety professionals, GPs and consultants
Industry to: ‘design in’ exposure prevention measures to the
complete work process embed work cancer awareness in
relevant apprenticeships and trade-based training
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THE DAILY NEWSwww.dailynews.com AUSTRALIA’S FAVOURITE NEWSPAPER Today
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1973 1974 19751
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What changed? High pressure water jet
cleaning Removal of VCM residues
by stripping Improved general
ventilation Use of scale inhibitors Extraction on open
reactor vessels Reduce leaks Air monitor Breathing Apparatus
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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.
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Interventions…
Acceleration of technological innovation Application of simple solutions Appropriate use of personal protective
equipment
Improved compliance with existing legislation Tightening up exposure limits
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Crystalline silica…
Assessed baseline scenario: limit 0.1 mg/m3 and 33% compliance
Introduction of new limit values: 0.05 mg/m3 and 0.025 mg/m3
Improved compliance with limits: From 33% to 90%
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Silica – Cancer incidenceBaseline, 0.1 mg/m3, 33% compliance OEL = 0.05 mg/m3, 33% complianceOEL = 0.025 mg/m3, 33% compliance
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Silica – Cancer incidenceOEL =0.1 mg/m3, 90% compliance OEL = 0.05 mg/m3, 90% complianceOEL = 0.025 mg/m3, 90% compliance
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Silica – cancer incidence
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Silica – cancer incidence
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Simple solutions…
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Local extraction…
http://www.cdc.gov/niosh/topics/silica/tuckpointing.html
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Respiratory protection…
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We need to change our beliefs about workplace carcinogens…
The status quo is not good enoughWe need an accelerated process of continuous improvement
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Conclusions…
We need better information about carcinogens in the workplace
Legislation is necessary but not sufficient to solve the problem
We should build coalitions to tackle the problem in a focused way
As time goes on occupational exposure decreases, but we should do much better
There are practical solutions available today
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No Time to Lose…