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Fashion, apparel, textile, merchandising, garments

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8281

  1. 1. Occupational Cancer Tim Morse, Ph.D. University of Connecticut Health Center, Farmington, CT, US Spring 2000
  2. 2. Objectives <ul><li>Theoretic concerns in identifying carcinogens </li></ul><ul><li>Estimates of occupational cancer </li></ul><ul><li>Known exposures and occupations related to occupational cancer </li></ul><ul><li>Asbestos and cancer: case study </li></ul><ul><ul><li>History </li></ul></ul><ul><ul><li>Risks </li></ul></ul><ul><ul><li>Control </li></ul></ul><ul><ul><li>U.S. Regulations </li></ul></ul>
  3. 3. Issues <ul><li>Multiple causation & interaction </li></ul><ul><li>Multiple stages </li></ul><ul><li>Latency period </li></ul><ul><li>Threshold level </li></ul>
  4. 4. Testing for Cancer <ul><li>Analysis of structure-activity relations </li></ul><ul><li>Cell tests </li></ul><ul><li>Animal studies </li></ul><ul><li>Epidemiologic studies </li></ul>
  5. 5. Problems in testing <ul><li>Prolonged high exposure is uncommon </li></ul><ul><li>Usually mix of exposures </li></ul><ul><li>Epi: expensive, long, past exposures, poor exposure data </li></ul><ul><li>Animal: high dose, ? Validity in humans </li></ul><ul><li>In vitro: mutagens, not carcinogens </li></ul>
  6. 6. How much cancer is occupational? <ul><li>Doll & Peto (1981) 2-8% </li></ul><ul><ul><li>Viewed as conservative </li></ul></ul><ul><ul><li>For US, 25,000-100,000 new cases/year </li></ul></ul><ul><ul><li>Higher proportions for exposed workers </li></ul></ul>
  7. 7. NJ Cancer Registry by Industry Excess: <ul><li>Nasopharyngeal: carpenters and other blue collar special trade construction </li></ul><ul><li>Colorectal: machinery manufacturing, printing </li></ul><ul><li>Liver: general construction and rubber and plastics </li></ul><ul><li>Gallbladder: electrical equipment </li></ul><ul><li>Lung: primary metals, shipbuilding, construction, and stone, clay, and glass </li></ul><ul><li>Mesothelioma: shipbuilding and asbestos manufacturing </li></ul>
  8. 8. NJ Cancer Registry by Industry Excess: <ul><li>Breast: (Black females) chemical and pharmaceutical </li></ul><ul><li>Bladder: (white males) apparel and textile industries. </li></ul><ul><li>Non-Hodgkin's lymphoma: </li></ul><ul><ul><li>(white females) printing </li></ul></ul><ul><ul><li>(white male) bakers and motor vehicle manufacturing </li></ul></ul><ul><li>Lymphocytic leukemia: chemical and construction </li></ul>
  9. 9. Lung cancer (Steenland, 1996) <ul><li>silica </li></ul><ul><li>asbestos </li></ul><ul><li>diesel engine exhaust </li></ul><ul><li>radon progeny </li></ul><ul><li>arsenic </li></ul><ul><li>chromium, </li></ul><ul><li>beryllium, </li></ul><ul><li>nickel, and </li></ul><ul><li>cadmium </li></ul><ul><li>acrylonitrile </li></ul>
  10. 10. Lung Cancer Annual Incidence (Steenland, 1996) <ul><li>9,000-10,000 men </li></ul><ul><li>900-1,900 women </li></ul><ul><li>half asbestos </li></ul>
  11. 11. Non-Hodgkins Lymphoma (Figgs, 1995) <ul><li>24 state death certificate study: 47 occupations, and 28 industries. </li></ul><ul><li>firefighters, </li></ul><ul><li>farm managers, </li></ul><ul><li>aircraft mechanics, </li></ul><ul><li>electronic repairers, </li></ul><ul><li>mining machine operators, and </li></ul><ul><li>crane and tower operators </li></ul><ul><li>also white collar </li></ul>
  12. 12. Women <ul><li>25% increase in lung cancer among production workers (9% decrease overall cancer) (Delzell, 1994) </li></ul><ul><li>Breast cancer tissue had 50-60% higher levels of DDT and PCB’s (Wolff, 1993) </li></ul><ul><li>38% Breast cancer increase in electrical workers (217% for telephone installers) (Loomis, 1994) </li></ul>
  13. 13. Review of breast cancer (Goldberg, 1996) <ul><li>Limited evidence: pharmaceutical industry and among cosmetologists and beauticians </li></ul><ul><li>Possible associations: chemists and occupations with potential exposure to extremely low frequency electromagnetic fields. </li></ul><ul><li>Little support: textiles workers, dry cleaning workers, and nuclear industry workers </li></ul>
  14. 14. Roofers & asphalt workers (meta analysis: Partanan, 1994) <ul><li>Stomach cancer </li></ul><ul><li>bladder cancer </li></ul><ul><li>skin cancer </li></ul><ul><li>leukemia </li></ul>
  15. 15. Firefighters review (Golden, 1995) <ul><li>leukemia, </li></ul><ul><li>nonHodgkin's lymphoma, </li></ul><ul><li>multiple myeloma, </li></ul><ul><li>cancers of the brain, urinary bladder, and </li></ul><ul><li>possibly from cancer of the prostate, large intestine, and skin. </li></ul>
  16. 16. Construction workers review (Sullivan, 1995): <ul><li>Lung (70% increase from NHIS, 1988), </li></ul><ul><li>larynx, </li></ul><ul><li>oropharyngeal and nasal cancers, </li></ul><ul><li>mesothelioma, </li></ul>
  17. 17. Dry cleaning using perchloroethane (Ruder, 1994) <ul><li>23% increase among 20-year workers </li></ul><ul><li>esophogeal, intestinal, bladder </li></ul>
  18. 18. Cutting fluid exposure (Eisen, 1992) <ul><li>85% increase of laryngeal cancer (also stomach) </li></ul>
  19. 19. Occupational Cancer <ul><li>IARC: ID carcinogens by worker studies </li></ul><ul><li>21/22 lung carcinogens </li></ul><ul><li>34/62 carcinogens overall </li></ul>
  20. 20. Asbestos and Health
  21. 21. Overview <ul><li>Background on asbestos </li></ul><ul><li>Uses of asbestos </li></ul><ul><li>Health Effects </li></ul><ul><li>Risk factors </li></ul><ul><li>Medical tests </li></ul><ul><li>Proper handling </li></ul><ul><li>Standards/ guidelines </li></ul>
  22. 22. What is Asbestos? <ul><li>Mineral </li></ul><ul><li>Fibrous </li></ul><ul><li>White/grey </li></ul><ul><li>Indestructible </li></ul><ul><li>Fireproof </li></ul>
  23. 23. How Long Has it Been a Problem? <ul><li>Early Greek miners wore face masks from animal bladders </li></ul><ul><li>Insurers stopped selling insurance in 1915 </li></ul><ul><li>Cancer cases in 1930’s </li></ul><ul><li>Asbestos industry withheld information </li></ul><ul><li>Selikoff studies in 1960’s </li></ul><ul><li>Banning of some uses in 1980’s </li></ul>
  24. 24. Uses of Asbestos <ul><li>Fireproofing of buildings </li></ul><ul><li>Heat insulation </li></ul><ul><li>Strengthen building materials </li></ul>
  25. 25. Products that can contain asbestos <ul><li>Spray insulation </li></ul><ul><li>Pipecovering </li></ul><ul><li>Asbestos cloth </li></ul><ul><li>Cements, mastic, sealants </li></ul><ul><li>Roofing materials </li></ul><ul><li>Floor & ceiling tiles </li></ul><ul><li>Plaster & taping compound </li></ul>
  26. 26. Hazards of Asbestos <ul><li>Harmful only when breathed in (maybe when swallowed) </li></ul><ul><li>Fiber shape: long, thin </li></ul><ul><li>Travels in air, gets deep in lungs </li></ul><ul><li>Sharp shape gets stuck in lungs </li></ul><ul><li>Doesn’t break down </li></ul>
  27. 27. Asbestos Diseases <ul><li>Asbestosis </li></ul><ul><li>Pleural Plaques </li></ul><ul><li>Cancer </li></ul><ul><ul><li>Lung </li></ul></ul><ul><ul><li>Mesothelioma </li></ul></ul><ul><ul><li>G-I Tract </li></ul></ul>
  28. 28. Asbestos Diseases <ul><li>No completely safe levels </li></ul><ul><li>Higher the exposure, higher the risk </li></ul><ul><li>Low exposures have low risk </li></ul><ul><li>Everyone exposed to asbestos </li></ul><ul><li>Lag time (latency) of 10-40 years </li></ul><ul><li>No acute effects </li></ul>
  29. 29. Asbestosis <ul><li>Not cancer </li></ul><ul><li>Scarring of lungs </li></ul><ul><li>From high exposures </li></ul><ul><li>Causes shortness of breath </li></ul>
  30. 30. Pleural Plaques <ul><li>Scars on lungs </li></ul><ul><li>Shows up on x-rays </li></ul><ul><li>Marker of asbestos exposure </li></ul><ul><li>Half of heavily exposed will have </li></ul><ul><li>“ Not a disease”: no symptoms </li></ul><ul><li>Does not change into cancer </li></ul><ul><li>Legally considered a disease </li></ul>
  31. 31. Lung cancer <ul><li>Most common problem with asbestos </li></ul><ul><li>Heavily exposed workers have 5-7 times increased risk over lifetime </li></ul><ul><li>About same level of risk as a pack a day cigarette smoking </li></ul><ul><li>Interacts with cigarettes: 50-90 times increased risk for both combined </li></ul><ul><li>Quitting smoking reduces risk </li></ul>
  32. 32. Other Cancers <ul><li>Mesothelioma </li></ul><ul><ul><li>Cancer of lining of the lungs </li></ul></ul><ul><ul><li>Only caused by asbestos </li></ul></ul><ul><ul><li>Smoking not a risk factor </li></ul></ul><ul><li>G-I tract cancer </li></ul><ul><ul><li>2-3 times increased risk for heavily exposed </li></ul></ul>
  33. 33. Medical tests <ul><li>Physical </li></ul><ul><li>History </li></ul><ul><li>X-rays </li></ul><ul><li>Lung function tests </li></ul>
  34. 34. What is Risk? <ul><li>Studies are from heavily exposed asbestos workers </li></ul><ul><li>Construction trades working with asbestos have 1/4 or less risk than asbestos workers </li></ul><ul><li>Chemical plant maintenance has about 1/8 </li></ul><ul><li>Other maintenance workers are much lower </li></ul><ul><li>Asbestos has been phased out & removed in many areas </li></ul>
  35. 35. Safe handling of asbestos <ul><li>Find out where the asbestos is </li></ul><ul><li>Management plan </li></ul><ul><li>Remove if needed by licensed contractors </li></ul><ul><li>Only dangerous if is in the air </li></ul><ul><ul><li>Removal may be more dangerous than leaving </li></ul></ul><ul><ul><li>If is bound in material (tiles, etc) is not a hazard </li></ul></ul><ul><li>Should be labeled if left in place </li></ul>
  36. 36. “ Safe” handling of asbestos <ul><li>No absolutely safe exposure </li></ul><ul><li>Wet methods </li></ul><ul><li>HEPA vacuums and respirators </li></ul><ul><li>Never dry sweep or compressed air </li></ul><ul><li>Stays in air for days </li></ul><ul><li>Small fibers can’t be seen </li></ul><ul><li>“ Friable” asbestos means it can be crumbled </li></ul>
  37. 37. Maintenance & asbestos <ul><li>Do not drill, sand, or saw asbestos materials </li></ul><ul><li>Wet mop rather than dry sweep or dust </li></ul><ul><li>Do not use a regular vacuum: only HEPA </li></ul><ul><li>Do not disturb asbestos materials </li></ul><ul><li>If use a face mask, only HEPA </li></ul><ul><li>If are air filters, use wet methods, do not shake </li></ul>
  38. 38. Training/ removal <ul><li>Removal by certified contractors </li></ul><ul><ul><li>Enclosures, ventilation, wet methods, HEPA </li></ul></ul><ul><ul><li>Glove bags, wetting agents, signs </li></ul></ul><ul><li>Encapsulation </li></ul><ul><li>Training needed based on level of exposure </li></ul><ul><li>Level 4 for clean up of asbestos containing materials </li></ul><ul><li>Proper disposal while still wet; labeled bags </li></ul>
  39. 39. Regulations <ul><li>EPA regulations on removal </li></ul><ul><li>OSHA Standard for general industry or construction </li></ul><ul><li>State licensing for asbestos removal </li></ul><ul><li>Workers’ compensation </li></ul><ul><li>Reporting of suspected occupational diseases </li></ul>
  40. 40. EPA: Control of Asbestos in Buildings <ul><li>Survey to see if asbestos is present </li></ul><ul><li>Operations and Management Program </li></ul><ul><li>Assess the asbestos </li></ul><ul><li>Abatement if needed </li></ul>
  41. 41. Survey <ul><li>Appoint manager & team </li></ul><ul><li>Check building records </li></ul><ul><li>Locate & document all asbestos in records </li></ul><ul><li>Inspect for friable </li></ul><ul><li>Collect & test samples </li></ul><ul><li>Document </li></ul>
  42. 42. Operations and Maintenance <ul><li>Contact building managers & maintainers </li></ul><ul><li>Educate employees and occupants </li></ul><ul><li>Train custodians/ maintainers </li></ul><ul><li>Clean using HEPA & wet methods; regular basis </li></ul><ul><li>Special precautions for construction work </li></ul><ul><li>Inspect twice a year </li></ul><ul><li>Continue program until all asbestos removed </li></ul>
  43. 43. Assess Asbestos <ul><li>Assess current conditions and chances of disturbance </li></ul><ul><li>Determine </li></ul><ul><ul><li>Need for further action </li></ul></ul><ul><ul><li>When it needs to be done </li></ul></ul><ul><ul><li>What abatement methods to use </li></ul></ul>
  44. 44. Conduct Abatement if Needed <ul><li>Hire contractor: </li></ul><ul><ul><li>To select: </li></ul></ul><ul><ul><ul><li>Precise contract </li></ul></ul></ul><ul><ul><ul><li>Check references </li></ul></ul></ul><ul><ul><ul><li>Interview </li></ul></ul></ul><ul><ul><ul><li>Insurance </li></ul></ul></ul><ul><ul><ul><li>Best, not low bid </li></ul></ul></ul>
  45. 45. Managing Abatement <ul><li>Inspect 4 times a day </li></ul><ul><ul><li>Containment barrier </li></ul></ul><ul><ul><li>Coveralls & respirators </li></ul></ul><ul><ul><li>Changing & decontamination facilities </li></ul></ul><ul><li>Stop work if problem </li></ul><ul><li>Release only when </li></ul><ul><ul><li>Cleaned at least twice </li></ul></ul><ul><ul><li>Visual test </li></ul></ul><ul><ul><li>Airborne asbestos test </li></ul></ul>
  46. 46. OSHA Standard <ul><li>Applies if over maximum exposure </li></ul><ul><li>Maximum of 0.2 fibers per cc of air (8 hour) </li></ul><ul><li>Maximum of 1 fiber per cc (30 minute) </li></ul><ul><li>Exposure monitoring if above action level (0.1 fiber per cc) </li></ul><ul><li>Engineering controls where feasible </li></ul><ul><li>Proper respirators </li></ul>
  47. 47. OSHA Standard (2) <ul><li>Regulated areas </li></ul><ul><li>Labels </li></ul><ul><li>Recordkeeping for 30 years </li></ul><ul><li>Protective clothing </li></ul><ul><li>Change rooms & showers </li></ul><ul><li>Medical Exams </li></ul>

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