Hemostasis Physiology and Clinical correlations by Dr Faiza.pdf
Updating the european carcinogens directive
1. WORKING FOR A HEALTHY FUTURE
Updating the European
Carcinogens Directive
John Cherrie
INSTITUTE OF OCCUPATIONAL MEDICINE . Edinburgh . UK www.iom-world.org
2. 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
3. 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
5. 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
6. 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
7. 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
9. 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
11. 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
13. Cancer registrations…
85% of the cancer cases come
from the top ten chemical agents
- excluding ETS, which is already
banned
14. 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.
15. 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.
16. 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
17. 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
18. 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
19. 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
22. 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
23. 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
28. 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!
29. 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.
30. 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
31. 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
32. 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)
33. Questions…
• You can contribute to the discussion at…
www.OH-world.org
John.Cherrie@iom-world.org
Editor's Notes
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?