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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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What should we be doing to prevent occupational diseases from hazardous substances?

  1. 1. INSTITUTE OF OCCUPATIONAL MEDICINE . Edinburgh . UK 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