INSTITUTE OF OCCUPATIONAL MEDICINE . Edinburgh . UK www.iom-world.org
What should we be doing to
prevent occupational dise...
Summary…
• Workplace disease
• The case of workplace cancers
• Two key observations that help us plan
our approach
• Two e...
Accidents and disease around
the world
WHO
regions
AFRO
AMRO
EURO
SEARO
WPRO
EMRO
Fatal workplace
disease/accident rates
Hämäläinen P, Saarela KL, Takala J. Global trend according to estimated number of o...
Ratio disease to accidents
Workplace diseases and their
causes…
Chemicals Diseases Deaths DALYs
Chemicals involved in
acute poisonings
Unintentional
...
Let’s get specific: workplace
cancers
• In 1981 Richard Doll and
Richard Peto were
commissioned by the US
government to as...
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 (20...
Attributable fraction…
5.3% (4.6 – 6.6%)
Men = blue
Women = 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 li...
Some good news…
Creely KS et al. (2007) Trends in inhalation exposure--a review of the data in
the published scientific li...
y = 2E+30e-2.00x
R² = 0.740
1
10
100
1000
1973 1974 1975
VCMconcentration(ppm)VCM levels in a English PVC plant
14
Burden should be decreasing…
• If exposure is decreasing then it
seems likely that the future burden
will also be lower
• ...
So what does the future hold?
• We have estimated current and future cancer
burden in Europe and socioeconomic costs of
in...
Future burden estimates for
VCM…
• Increased risks angiosarcoma of liver and
possible hepatocellular carcinomas
• 19,000 p...
Risk already eliminated for some
substances
• In our assessment of current burden in Europe we
estimate <20 cancers/year f...
Estimates of future burden for
silica…
• Crystalline silica in Europe:
• 720,000 people exposed
• About 40% exposed above ...
Lung cancer registrations -
baseline
Lung cancer registrations -
intervention
The cost and benefits of
intervention…
• Total net health benefits by 2069 from
setting an OEL at 0.05 mg/m3 are
€28,000m ...
However, we could just wait…
We could “eliminate” workplace
cancer
• Elimination of the disease as a public health
problem (i.e. reduction of cases bel...
A challenge…
• Focus on the top ten causes of the occupational
cancer burden (and/or COPD)
• Ensure that exposures continu...
Acknowledgements…
• The work was in part funded by the British
Health and Safety Executive (HSE) and the
European Commissi...
Questions…
• You can contribute to the discussion at
www.OH-world.org
John.Cherrie@iom-world.org
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What should we be doing to prevent occupational diseases from hazardous substances?

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A presentation given at XII International Congress on Occupational Risk Prevention in Zaragoza, Spain.

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  • Stress that this is due to continuous improvement not H&amp;S interventions
  • The mostextreme reduction is from the PVC plants in the early 1970s when the risk of angiosarcoma of the liver was first identified as a consequence of high VCM exposure. Here over a about a year the exposure dropped by more that an order of magnitude. Interestingly, although there was not systematic monitoring data for the period prior to the dramatic change the evidence is that there were improvements taking place before this which would have given a series of modest reductions in exposure and after about 1975 the rate of decline in exposure again dropped to about 6% per annum.
  • What should we be doing to prevent occupational diseases from hazardous substances?

    1. 1. INSTITUTE OF OCCUPATIONAL MEDICINE . Edinburgh . UK www.iom-world.org What should we be doing to prevent occupational diseases from hazardous substances? John Cherrie
    2. 2. Summary… • Workplace disease • The case of workplace cancers • Two key observations that help us plan our approach • Two examples: • Vinyl chloride monomer • Respirable crystalline silica • Let’s be bold in our commitment for the future
    3. 3. Accidents and disease around the world WHO regions AFRO AMRO EURO SEARO WPRO EMRO
    4. 4. Fatal workplace disease/accident rates Hämäläinen P, Saarela KL, Takala J. Global trend according to estimated number of occupational accidents and fatal work-related diseases at region and country level. Journal of Safety Research 2009;40:125–39.
    5. 5. Ratio disease to accidents
    6. 6. Workplace diseases and their causes… Chemicals Diseases Deaths DALYs Chemicals involved in acute poisonings Unintentional poisonings 30,000 650,000 Asbestos Mesothelioma and other cancers 110,000 1,500,000 Occupational lung carcinogens, e.g. arsenic, silica, chromium Lung cancer 110,000 1,000,000 Occupational leukaemogens, e.g. benzene Leukaemia 7,500 110,000 Dust and fumes COPD, asthma 375,000 3,800,000 Prüss-Ustün A, Vickers C, Haefliger P, et al. Knowns and unknowns on burden of disease due to chemicals: a systematic review. Environmental Health 2011;10:9.
    7. 7. Let’s get specific: workplace cancers • 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
    8. 8. Attributable fractions… About 4% (2 – 8%)
    9. 9. Cancer burden in the UK… • Designed to update Doll and Peto’s estimate for occupational cancer burden • Current burden (2010) • Future burden (to 2060) • 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.
    10. 10. Attributable fraction… 5.3% (4.6 – 6.6%) Men = blue Women = red
    11. 11. Not all carcinogens are equally important 85% of the cancer cases come from the top ten chemical agents
    12. 12. Some good news… Creely KS et al. (2007) Trends in inhalation exposure--a review of the data in the published scientific literature. Ann OccupHyg.; 51(8): 665-678. Aerosols
    13. 13. Some good news… Creely KS et al. (2007) Trends in inhalation exposure--a review of the data in the published scientific literature. Ann OccupHyg.; 51(8): 665-678. Gases and vapours
    14. 14. y = 2E+30e-2.00x R² = 0.740 1 10 100 1000 1973 1974 1975 VCMconcentration(ppm)VCM levels in a English PVC plant 14
    15. 15. 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
    16. 16. So what does the future hold? • We have estimated current and future cancer burden in Europe and socioeconomic costs of interventions for a number of workplace carcinogens • Exposure levels reliant on stakeholder data or when unavailable published sources • Risk assessment reliant on epidemiological studies or analogy • Health impact carried out using carefully reviewed methodology developed for British cancer burden study • Socioeconomic assessment based on EC guidance Hutchings S, Cherrie JW, van Tongeren M, et al. Intervening to Reduce the Future Burden of Occupational Cancer in Britain: What Could Work? Cancer Prevention Research Published Online First: 7 September 2012.
    17. 17. Future burden estimates for VCM… • Increased risks angiosarcoma of liver and possible hepatocellular carcinomas • 19,000 people exposed in Europe • Geometric mean exposure level 0.05 ppm, 5% exposed above 3 ppm • Current burden - 14 liver cancers • By 2060 we expect there to be no cancer deaths due to workplace VCM exposure
    18. 18. Risk already eliminated for some substances • In our assessment of current burden in Europe we estimate <20 cancers/year from past exposure for: • Vinyl chloride monomer 14 cases • 1, 3 Butadiene 2 cases • Beryllium 7 cases • Acrylamide 7 cases • MbOCA 8 cases • Ethylene oxide 0 cases • Refractory ceramic fibre 2 cases • 1, 2-Epoxypropane 0 cases • Bromoethylene 0 cases
    19. 19. Estimates of future burden for silica… • Crystalline silica in Europe: • 720,000 people exposed • About 40% exposed above 0.05 mg/m3 • Current burden 7,600 lung cancers • 460,000 cases between 2010 and 2069 • Cost of inaction between €190,000m to €490,000m
    20. 20. Lung cancer registrations - baseline
    21. 21. Lung cancer registrations - intervention
    22. 22. The cost and benefits of intervention… • Total net health benefits by 2069 from setting an OEL at 0.05 mg/m3 are €28,000m to €74,000m • Costs of compliance estimated to be €34,000m • About half of these costs arise in construction • Most costs fall on small companies
    23. 23. However, we could just wait…
    24. 24. We could “eliminate” workplace 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?
    25. 25. A challenge… • Focus on the top ten causes of the occupational cancer burden (and/or COPD) • Ensure that exposures continue to fall by about 10% per annum • We have eliminated the problem when an assessment of future burden from current exposure is <1% of all cancers
    26. 26. Acknowledgements… • The work was in part funded by the British Health and Safety Executive (HSE) and the European Commission (EC) • However, the views presented here are my own • Collaborators include: • M Gorman Ng, A Shafrir, M van Tongeren, A Searl, J Crawford, A Sanchez-Jimenez, J Lamb (IOM) • R Mistry, M Sobey, C Corden, O Warwick and M-H Bouhier (AMEC UK) • L Rushton and S Hutchings (Imperial College) • T Kaupinnen and P Heikkila (Finnish Institute of Occupational Health),HKromhout (IRAS, University of Utrecht), L Levy (IEH, Cranfield University)
    27. 27. Questions… • You can contribute to the discussion at www.OH-world.org John.Cherrie@iom-world.org
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