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Diesel engine exhaust and lung cancer


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Slides from a webinar on lung cancer and diesel engine exhaust

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Diesel engine exhaust and lung cancer

  1. 1. WORKING FOR A HEALTHY FUTUREDiesel engine exhaust emissionsand lung cancerJohn CherrieINSTITUTE OF OCCUPATIONAL MEDICINE . Edinburgh . UK
  2. 2. Summary…• Diesel engines and their emissions• Guidance from HSE• Original concerns about cancer• The epidemiological evidence• The International Agency for Research on Cancer (IARC) classification• The likely impact on the working population• Exposures and how they are changing• Possible changes to the EU Carcinogens Directive
  3. 3. Diesel…• Rudolf Diesel invented the engine in 1893• Uses the heat from compressing the fuel air mixture to initiate ignition• Widely used for heavy duty applications but increasingly in cars• There are probably about 400,000 people occupationally exposed to diesel engine exhaust in Britain
  4. 4. Diesel cars in Europe…
  5. 5. Emissions…• Are a complex mixture: • Soot (carbon) • Water Sulphates • Carbon monoxide Metals Hydrocarbons • Carbon Oxides of nitrogen and sulphur • Polycyclic aromatic hydrocarbons (PAHs) • Various other substances• Elemental carbon commonly used as a marker of exposure
  6. 6. HSE guidance (2008)…• Irritation of the eyes and respiratory tract• Coughing, increasing breathlessness and increased sputum production• Limited evidence for lung cancer• Good source of guidance for control of exposure in fixed workplaces e.g. garages
  7. 7. Toxicological evidence for cancer risk…• In 1988 IARC reviewed animal experimental evidence • Five well conducted studies - chronic exposure of rats to high concentrations of whole diesel exhaust • Most showed tumours in the lungs • Two studies with filtered exhaust showed no effect• Concluded that there was sufficient evidence to conclude diesel exhaust emissions were carcinogenic in animal toxicology • Limited evidence from human epidemiological studies
  8. 8. Epidemiological evidence…• Studies among non-metal miners, railroad workers and workers in the trucking industry • Best studies take account of smoking risks• Many (most) studies show increasing risk of lung cancer with increasing exposure • Overall risks increased by about 50% for prolonged occupational exposure• Some studies also suggest an increased risk for bladder cancer
  9. 9. Lung cancer risk and exposure… Data from a study of non- metal miners in the USA Silverman et al. The Diesel Exhaust in Miners Study: A Nested Case-Control Study of Lung Cancer and Diesel Exhaust. Journal of the National Cancer Institute.
  10. 10. The IARC evaluation…• Latest evaluation June 2012• Concluded diesel engine exhaust is “carcinogenic to humans” (Group 1)• There is “strong evidence” for the ability of whole diesel-engine exhaust to induce cancer in humans through genotoxicity• Recognised that new technology diesel engines have reduced emissions but insufficient information to classify them differently
  11. 11. Occupational cancer in Britain… Men = blue Women = red 5.3% (4.6 – 6.6%)
  12. 12. Cancer registrations… 85% of the cancer cases come from the top ten chemical agents 800 cases of lung and bladder cancer per - excluding ETS, year which is already banned
  13. 13. Exposures and how they are changing… In the future we expect exposure levels to decrease by about 7% per annum because of replacement of old engines with new technology
  14. 14. The European dimension…• The European Commission is considering revising the Carcinogens Directive to include Diesel Exhaust Emissions (as elemental carbon) • Which would result in it being highlighted in COSHH• They may also set an Occupational Exposure Limit (OEL) • Existing limits are around 100 g/m3 • An effective limit would be nearer 10 to 20 g/m3
  15. 15. Exposures and how they are changing… In the future we OEL? expect OEL? exposure levels to decrease by about 7% per OEL? annum because of replacement of old engines with new technology
  16. 16. Greater control of exposure is needed…• Use of local exhaust ventilation and good general ventilation in garages and similar workplaces• Replacement of old engines• Filtration of air into vehicle cabs• Use of respirators for mobile workers, e.g. traffic wardens
  17. 17. Summary…• Diesel engine exhaust particulate causes lung cancer• There are many people exposed at work (and in the urban environment)• Relatively large numbers die as a consequence of their exposure• We need to need to tighten exposure controls