Minimum requirements – CHECK other countries for benzene and wood dust
Stress that this is due to continuous improvement not H&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.
How do we explain tric, beryllium and rubber fume?
Need to know the suggested OELs
What is 1,2 dibromoethane used for?
WORKING FOR A HEALTHY FUTUREUpdating the EuropeanCarcinogens DirectiveJohn CherrieINSTITUTE OF OCCUPATIONAL MEDICINE . Edinburgh . UK www.iom-world.org
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
Summary…• Workplace cancers are a concern• In Europe the Carcinogens and Mutagens Directive is the key piece of legislation • It has generic requirements with specific targets, e.g. vinyl chloride• The current occupational cancer burden is mostly caused by a small number of agents• Exposures have been decreasing steadily over time• Occupational cancer burden is still high and the Directive really needs updating
Mortality in the plant…• We carried out a mortality study in the plant in 1987 • 17 year follow-up • 620 men included• Increased mortality Lung Stomach Prostate Bladder Pneumonia COPD SMR 146 160 152 270 189 139• Non-melanoma skin cancer commonly reported
The Carcinogens Directive…• DIRECTIVE 2004/37/EC OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL of 29 April 2004• This Directive has as its aim the protection of workers against risks to their health and safety, including the prevention of such risks, arising or likely to arise from exposure to carcinogens or mutagens at work
Carcinogens Directive…• Article 4 Reduction and replacement• Article 5 Prevention and reduction of exposure• Article 6 Information for the competent authority• Article 7 Unforeseen exposure• Article 8 Foreseeable exposure• Article 10 Hygiene and individual protection• Article 11 Information and training of workers• Article 14 Health surveillance
Doll and Peto assessed cancer burden• In 1981, they were commission 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
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
Attributable fraction… Men = blue Women = red 5.3% (4.6 – 6.6%)
Cancer registrations… 85% of the cancer cases come from the top ten chemical agents - excluding ETS, which is already banned
Exposure decreases over time… Aerosols 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.
Exposure decreases over time… Gases and vapours 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.
VCM levels in a English PVC plant 1000 y = 2E+30e-2.00x VCM concentration (ppm) R² = 0.740 100 10 1 1973 1974 1975 16
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 Europe and socioeconomic costs of interventions for a number of 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
Estimates of future burden…• Crystalline silica in Europe as an example: • 720,000 people exposed in Europe • 41% 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• Part of the SHEcan project work programme
The cost and benefits of intervention…• Total net health benefits by 2069 from setting a crystalline silica 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
For some substances there is no problem…• 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
SHEcan considered… In Annex III OELs Suggested by EC Process generated
My priority for action… Respirable crystalline silica Strong case Chrome VI Hardwood dust Diesel engine exhaust A case Rubber fume Benzo[a]pyrene Trichloroethylene A limited case Hydrazine Epichlorohydrin O-Toluidine Mineral oils as used engine oil MDA Uncertainty Diesel engine exhaust Outside project scope!
The updating process…• The European Advisory Committee for Safety and Health at Work (ACSH) adopted an opinion on 5 December supporting the introduction of new occupational exposure limits.• Ten substances identified in the article: crystalline silica, refractory ceramic fibres, chromium VI, trichloroethylene, hydrazine, acrylamide, epichlorohydrin, 1,2-dibromoethane, 4,4’ methylenedianiline (MDA) and an updated limit for hardwood dust.
Should we think of a different tactic?• The Carcinogens Directive is a “traditional” approach to deal with occupational health problems • Responsibility lies with the employer to meet minimum standards • Regulators enforce non-compliance• Alternatively we could do more to encourage steady progress (decrease in exposure) in specific key industries/sectors
A challenge…• Focus on the top ten causes of the occupational cancer burden• Ensure that exposures continue to fall by about 10% per annum• With this approach we could have eliminate the problem when an assessment of future burden from current exposure is <1% of all cancers
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), H Kromhout (IRAS, University of Utrecht) • L Levy (IEH, Cranfield University)
Questions…• You can contribute to the discussion at… www.OH-world.org John.Cherrie@iom-world.org