This study estimates the current and future burden of cancer in Great Britain due to occupational exposures. Currently there are about 8,000 cancer deaths and 14,000 new cancer cases attributed to past work. Lung cancer, mesothelioma and breast cancer account for most occupational cancer deaths. The construction industry has the highest attributable cancer burden. Interventions like lowering exposure limits and improving compliance could substantially reduce the future cancer burden from substances like respirable crystalline silica. Monitoring exposure levels over time is key to evaluating the success of interventions in reducing occupational cancer risk.
My presentation at the IOSH National Safety Symposium, 7th and 8th September 2014.
http://www.iosh.co.uk/Key-IOSH-events/National-Safety-Symposium.aspx
Presentation from Manolis Kogevinas, Head of the Cancer Programme at ISGlobal, on occupational cancer.
Epidemiology in Occupational Health Conference - EPICOH 2017
Roel Vermeulen, Professor, Utrecht University, at Europe That Protects - Safeguarding Our Planet, Safeguarding Our Health EU side event, 3-4 Dec 2019, THL, Helsinki
My presentation at the IOSH National Safety Symposium, 7th and 8th September 2014.
http://www.iosh.co.uk/Key-IOSH-events/National-Safety-Symposium.aspx
Presentation from Manolis Kogevinas, Head of the Cancer Programme at ISGlobal, on occupational cancer.
Epidemiology in Occupational Health Conference - EPICOH 2017
Roel Vermeulen, Professor, Utrecht University, at Europe That Protects - Safeguarding Our Planet, Safeguarding Our Health EU side event, 3-4 Dec 2019, THL, Helsinki
Background. Ionizing radiation could cause negative effects on DNA molecules, which leads mutation and tumorigenesis. Thyroid gland is one of the most radiosensitive organ due to the great oxidative process on their physiological condition. Medical workers have been exposed to radiation during medical image acquisition. The relation between radiation and the increase of thyroid cancer incidence have been studied before, the discussion mostly explain the acute effect of radiation. The aim of this study is to describe the incidence of thyroid nodule on radiation-exposed worker.
Methods. The study was performed in 40 radiation-exposed workers with at least has 5 years working period. We examined using thyroid ultrasonography and blood level of T3, fT4 and TSH.
Result. The incidence of thyroid nodule in radiation-exposed worker is 37.5%, which is higher among female (66%) than in male (29%). Based on the age distribution, most of the nodules were find in workers with age more than 35 years old. According to ultrasonography result and TIRADS scoring, 66.7% of the nodules were benign which categorize as TIRADS 1 and only 33% of the nodules were categorize as moderately suspicious or TIRADS 4.
Conclusion. Radiation-exposed workers have high risk to develop thyroid nodules. This study could be used as basic data to do further evaluation. It is important to perform thyroid screening periodically among them.
Medicinal Mushroom Preparations against Lung CancerNeven Jakopovic
In this cohort study, 13 patients with advanced small cell lung carcinoma and 52 with non-small cell lung carcinoma used medicinal mushroom extract (Dr Myko San company) from 2004 to 2007, and their status was assessed in 2009.
Using medicinal mushroom extracts with standard oncological therapy resulted in these significant dose-depended effects:
improved cancer survival and delayed mortality
decreases in tumor size
improved quality of life scores
when compared with standard therapy alone. Significant side effects or decreases in performance status, tolerance to therapy or outcome was not observed.
This work was presented by Dr. Ivan Jakopovic at the 5th International Medicinal Mushroom Conference in Nantong, China, in 2009.
Eurotox sep 2018 takala brussels new v2Jukka Takala
Succesful experiences of toxicology in occupational health. Items covered include classification and labelling of hazardous products, international regulations, global estimates of occupational accidents and work-related diseases, UN Sustainable Development Goals, Human Rights and occupational safety and health. Global asbestos disaster.
Effect of Time of Echo on 1H-magnetic Resonance Spectroscopy Imaging of Metab...submissionclinmedima
The aim of this study is to evaluate the effect of time of echo (TE) on magnetic resonance spectroscopy imaging (MRSI) of metabolites in maxillofacial carcinoma. 1.2. Methods: Twenty maxillofacial carcinoma patients and 10 healthy volunteers were recruited to undergo 1.5-Tesla high-resolution routine MRI and multi-voxel MRSI with a TE of 35 ms and 144 ms.
Background. Ionizing radiation could cause negative effects on DNA molecules, which leads mutation and tumorigenesis. Thyroid gland is one of the most radiosensitive organ due to the great oxidative process on their physiological condition. Medical workers have been exposed to radiation during medical image acquisition. The relation between radiation and the increase of thyroid cancer incidence have been studied before, the discussion mostly explain the acute effect of radiation. The aim of this study is to describe the incidence of thyroid nodule on radiation-exposed worker.
Methods. The study was performed in 40 radiation-exposed workers with at least has 5 years working period. We examined using thyroid ultrasonography and blood level of T3, fT4 and TSH.
Result. The incidence of thyroid nodule in radiation-exposed worker is 37.5%, which is higher among female (66%) than in male (29%). Based on the age distribution, most of the nodules were find in workers with age more than 35 years old. According to ultrasonography result and TIRADS scoring, 66.7% of the nodules were benign which categorize as TIRADS 1 and only 33% of the nodules were categorize as moderately suspicious or TIRADS 4.
Conclusion. Radiation-exposed workers have high risk to develop thyroid nodules. This study could be used as basic data to do further evaluation. It is important to perform thyroid screening periodically among them.
Medicinal Mushroom Preparations against Lung CancerNeven Jakopovic
In this cohort study, 13 patients with advanced small cell lung carcinoma and 52 with non-small cell lung carcinoma used medicinal mushroom extract (Dr Myko San company) from 2004 to 2007, and their status was assessed in 2009.
Using medicinal mushroom extracts with standard oncological therapy resulted in these significant dose-depended effects:
improved cancer survival and delayed mortality
decreases in tumor size
improved quality of life scores
when compared with standard therapy alone. Significant side effects or decreases in performance status, tolerance to therapy or outcome was not observed.
This work was presented by Dr. Ivan Jakopovic at the 5th International Medicinal Mushroom Conference in Nantong, China, in 2009.
Eurotox sep 2018 takala brussels new v2Jukka Takala
Succesful experiences of toxicology in occupational health. Items covered include classification and labelling of hazardous products, international regulations, global estimates of occupational accidents and work-related diseases, UN Sustainable Development Goals, Human Rights and occupational safety and health. Global asbestos disaster.
Effect of Time of Echo on 1H-magnetic Resonance Spectroscopy Imaging of Metab...submissionclinmedima
The aim of this study is to evaluate the effect of time of echo (TE) on magnetic resonance spectroscopy imaging (MRSI) of metabolites in maxillofacial carcinoma. 1.2. Methods: Twenty maxillofacial carcinoma patients and 10 healthy volunteers were recruited to undergo 1.5-Tesla high-resolution routine MRI and multi-voxel MRSI with a TE of 35 ms and 144 ms.
Keynote presentation on Current and Future Trends in Exposure Science Retired
Slides from my keynote at the ISES workshop in Bilthoven. I discuss the role of exposure science in improving population health, in the past and in the future. I cover lead poisoning and air pollution and show that we have solved these problems. The future will present new and different problems. We need to use the exposome paradigm to guide future research.
Exposure assessment for occupational epidemiology part 2Retired
The aim of this lecture is to provide an introduction to occupational exposures and the strategies used in epidemiological studies to assess exposure of subjects.
Exposure assessment for occupational epidemiology part 1Retired
The aim of this lecture is to provide an introduction to occupational exposures and the strategies used in epidemiological studies to assess exposure of subjects.
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Thyroid Gland- Gross Anatomy by Dr. Rabia Inam Gandapore.pptx
Cancer burden for BOHS Nov '11
1. Estimation of the Burden of Cancer in Great Britain due to Occupation L Rushton 1 , T. Brown 2 , R Bevan 3 , J W Cherrie 4 , G Evans 2 , L Fortunato 1 , S Bagga 3 , P Holmes 3 , S Hutchings 1 , R Slack 3 , M Van Tongeren 4 , C Young 2 1 Dept. of Epidemiology and Biostatistics, Imperial College London; 2 Health and Safety Laboratory, Buxton, Derbyshire 3 Institute of Environment and Health, Cranfield University 4 Institute of Occupational Medicine This study was funded by the Health and Safety Executive
15. Attributable Numbers of Cancer Registrations Scenarios All Base (1) Trend (2) (3) (4) (5) (6) Exposure Cancer Site 2010 2060 Exposure defined by agent; no appropriate exposure measurements ETS Lung 1465 0 0 67 156 Coal tars NMSC 489 800 877 602 475 433 402 Radon Lung 220 379 411 341 317 309 190 Solar radiation NMSC 1749 3069 3279 2552 2030 1503 163 Occupational circumstances, no specified carcinogen Painters Bladder, Lung, Stomach 461 640 639 481 383 347 321 Shift work Breast 1649 3062 3848 2134 1178 194 0 Welders Lung 189 140 63 105 83 76 70 Carcinogens for which exposure standards can be set Arsenic Lung 128 92 47 92 88 87 87 Asbestos Larynx, Lung Mesothelioma, Stomach 4281 2759 2864 2785 2689 2626 2307 Diesel Bladder, Lung 380 406 399 451 412 374 34 Silica Lung 837 794 442 102 49 21 10 Strong acids Larynx, Lung 122 39 7 19 12 10 12 TCDD (Dioxins) Lung, NHL, STS 286 123 30 22 8 5 6 Tetrachloro-ethylene Cervix, NHL, Oesophagus 139 135 119 123 118 117 119 Total 12050 12327 12938 9812 7944 6064 3705
16.
17. Uncertainties and the impact on the burden estimation Source of Uncertainty Potential impact on burden estimate Exclusion of IARC group 2B and unknown carcinogens e.g. for electrical workers and leukaemia ↓ Inappropriate choice of source study for risk estimate ↑↓ Imprecision in source risk estimate ↑↓ Source risk estimate from study of highly exposed workers applied to lower exposed target population ↑ Risk estimate biased down by healthy worker effect, exposure misclassification in both study and reference population ↓ Inaccurate latency/risk exposure period, e.g. most recent 20 years used for leukaemia, up to 50 years solid tumours ↓ Effect of unmeasured confounders ↑↓ Unknown proportion exposed at different levels ↑↓
18.
Editor's Notes
HSE is reviewing its priorities for chemicals including carcinogens. Wants to develop partnerships and practical measures to reduce occupational cancer in GB. May include better control, elimination and targeted enforcement To do this they need a sound evidence base including some baseline figures Doll and Peto’s analysis was focussed on the US mortality and their proportions (AFS) have been applied to the UK to give an estimation and used by the HSE. Our aim is to carry out an estimation of the current burden and to use a methodology that allows for some estimation for future burden to be predicted. The project will aid the HSE in prioritising some target occupation/industry/job/task and cancer type pairings that can then be focused on for intervention.
Studies could be: population or industry based single or pooled study meta-analysis Selected studies with comparable exposures to GB: Large sample size Clear case definition Appropriate comparison population Controlled for confounders where possible Adequate exposure assessment National data sources used to get the numbers ever exposed. CAREX – CARcinogen Exposure database – gives the estimated numbers exposed by country, carcinogen and industry. Included 139 agents evaluated by IARC as Groups 1,2A and some 2B across 55 industrial classes of the UN system ISIC. However, the prevalences were largely based on US and Finnish (FINJEM) rates and applied to numbers employed in the industry of other countries. LFS series of 2% household based samples from 1973 Census of employment etc employer based surveys from 1971 – gives numbers by sex/ full and part time/ 4 digit SIC code. Numbers ever worked from UK population of numbers of working age over the REP – gave denominator for the proportion. Adjusted for turnover, new workers and people retiring and dying + change in broad trends in employment patterns e.g. Service industries going up, manufacturing going down Three international workshops held during the project to discuss and develop the methodology. Helped to focus the assumptions we had to make to take account of inherent limitations in available data. These included: Pragmatic decision about REP and cancer latency Decision to assign industry sectors to ‘higher’ and ‘lower’ i.e. had proportions exposed over the REP at these two levels and then used published literature to select appropriate risk estimates for these levels Decision to use IARC group 1 and 2A. NB study carried out using classifications in place at end of 2008. In 2009 IARC reviewed all class 1 carcinogens so if we estimated burden now more cancer sites would be included e.g. asbestos and cervical cancer, colorectal cancer
Note nos do not always add up due to rounding. Ranked by total AF (column 3). AF tells us what proportions of the total numbers of that disease are due to occupation. So for mesothelioma, caused by asbestos, we estimate 95% (includes occupational and para-occupational). Looking at the bottom line we estimate that approximately 5.5% of all cancers are attributable to occupational carcinogens. Note the 95% confidence interval (random error). We have this for everything but this is the only slide I’m showing them due to lack of space. These AFs translate into considerable numbers of cancer deaths and registrations. Note these are annual. On the whole everything, AFs, deaths and registrations are greater for men. Overall 8.2% of all cancers in 2005 in men due to occupation. Similar figure to Doll and Peto’s top numbers. Female 2.3 similar to bottom of D&P’s range. Allows decisions to be made on a number of different measures e.g. Focus on cancers with high AFs i.e. for which most of the cancers are due to occupation (could be total, males, females) Focus on reducing cancers with large numbers of attributable deaths e.g. Lung cancer, mesothelioma breast cancer or Those with large numbers of attributable cancer registrations e.g. First 3 same as deaths but also NMSC which rarely kills but might incur considerable health costs
42 in total. Top 17 ranked on total registrations. From this slide we can see that several carcinogens affect multiple cancer sites, notably on this slide, lung cancer. Some affect as many as 4 cancer sites e.g. mineral oils. The ones in blue are those priority substances/occupations that we then went on to consider what would happen in future. Mineral oils not considered as thought that these have changes so much no longer going to be a problem in future. Cover 85.7% of all the exposures we looked at with a total of 11724 cancer registrations out of 13679. Also multiple carcinogens for each cancer site. Many had several carcinogens classified as 1 or 2A. Most complex was lung cancer with 32 carcinogenic agents or occupations classified as IARC 1 or 2A carcinogens – we estimated AFs separately for 21 – next slide.
Top industry is construction: 16 different lung carcinogens not all lead to any registrations. But other industry groups are also potentially exposed to several lung carcinogens e.g. manufacture of transport equipment (11, including chromium, nickel, radon, ETS), manufacture of machinery except electrical (notably nickel and chromium, plus silica and also radon) and seven each for land transport (especially diesel engine exhaust) and personal and household services (chromium in the lead plus diesel, PAHs and asbestos, and also ETS and radon and a small number exposed to cadmium . For men in the construction industry also are at risk of multiple cancer sites in this case 9 total registrations. By far the largest are meso, lung and NMSC but there also a few for stomach (47, 12 lead, 35 asbstos), bladder (41 DEE), Larynx ( 7 asbestos), Oesophagus (10 Tetra) Sinonsal (21 wood dust). Meso 1060 asbestos, NMSC 787 solar radiation and lung 2461 (painter 213, arsenic 15, asbestos 1221, cobalt 4, diesel 247, ETS 34, lead 19, silica 703, radon 5). Note personal and household services includes repair trades, laundries and dry cleaners, domestic services, hairdressing and beauty etc.
To predict future burden we extend the methods forward in time We make predictions every 10 years (could do this for more years or extend the methods for continuous forecast) Use the same REPs as for current burden. As we move forward we get less past exposure and more future exposure (show graph in next slide) Main extension is to increase the numbers of levels of exposure from H/L in current burden to H/M/L/B so reallocated industry sectors and found suitable RRs Forecast takes account of employment turnover and industry sector trends e.g. service sector is expected to rise in future Once we’ve estimated future AFs we apply these to forecast numbers of deaths and cancer registration based on demographic projections only i.e. assuming all non-occupational risk factors such as smoking stay the same as 2004/5. The forecast numbers of cancers go up because the population is forecast to go as is the proportion of the elderly and cancer is generally a disease of the elderly.
Example using silica. We know from exposure data that currently compliance to the current limit of 0.1mg/m 3 is only about 33%. Table shows the impact of improving compliance compared with lowering a standard. Could vary both of these and the timing of introducing the standard. Can also express this in terms of DALYs which can be fed into economic analyses Decisions can be made on the scenarios, the AFs, ANs, DALYs etc
Right hand graph shows the AFs for each scenario. No difference between them until after 2030 Left hand graph shows the same scenarios for each forecast year Shows no difference in attributable cancers between the scenarios up to 2030. Also because the total nos of lung cancers will rise anyway due to the rise population and rising proportion of the elderly the numbers of attributable cancers rises until after 2020. General conclusion is that whatever the intervention there is no impact until after 2030 because of the legacy of past exposures.
This example assumes we have halved the current limit and then tests how effective improving compliance is by workplace size. The most effective interventions are the last 2 when a) compliance improves in those companies employing less than 50 employees (200 more saved compared with previous intervention when compliance is improved in only those companies employing more than 50 employees) b) All workplaces have improved compliance including the self-employed (another 200). This is because silica exposure now occurs largely in the construction industry which is largely small companies and the self-employed.
Will rise to nearly 13,000 by 2060 given current trends in employment and exposure levels (>12,300 if current levels maintained). Aging population is a factor. No impact seen until 2030 because of general increase in cancers due to aging population With modest intervention (e.g. scenario 3) over 2,000 cancers can be avoided (including 376 lung, 928 breast cancers, 432 NMSC) With stronger interventions (e.g. scenario 6) nearly 8,500 can be avoided (including 1,732 lung, 3,062 breast and 3,287 NMSC) Effective interventions Silica - improve compliance DEE - need for v. low exposure limit indicated Shift work – If increasing risk with duration of exposure is valid then limiting years of night work reduces burden Intervention scenarios ETS: Compliance (3) 98% services 90% other (4) 95%/80% Radon: Reduce exposed numbers by 10% in (3) 2010, (4) 2020, (5) 2030, (6) 50% in 2010 Solar radiation: Move (3) 1/3, (4) 2/3, (5) all to next lower exposure category resp., (6) move all to lowest exposure category Shift Work: Restrictions on length of employment result in (3) 20% 30% 50%, (4) 10% 20% 70%, (5) 0% 10% 90%, at 15+ years, 5-14 years and <5 years resp. (6) 100% at <5 years For occupations (and coal tars), excess risk reduced to: (3) 75%, (4) 50%, (5) 25% of current risk in 2010, 2020, 2030 resp., (6) 50% of current risk in 2010 For chemicals: (3) = existing (asbestos, RCS) or proposed standard, 90% compliance (4) = half this standard (5) = quarter of standard (except asbestos, DEE where 10%) (6) = existing/proposed standard, 99% compliance (except asbestos, DEE where 1% of standard, 90% compliance) Intervention (3) for the chemical agents represents 90% compliance to an existing (RCS, asbestos) or possible standard, e.g. 0.1 mg/m**3 for DEE based on a standard used in Austria or our estimated H/L boundary exposure levels for arsenic, strong acids and tetrachloroethylene (L/B for TCDD). H/L was chosen as these carcinogens are either genotoxic or possibly genotoxic there is no recognised threshold below which excess risk can be assumed to be zero (background exposed). For the other agents it represents a 25% reduction in RR for the occupations and for coal tars and a modest limit on night shift work from 30% 40% 30% working 15+, 5-14 and <5 years respectively to 20% 30% 50% in these categories. For radon exposed numbers are reduced by 10%, and for solar radiation a third of workers are moved into the next lowest category of time spent outdoors. Together these interventions would avoid over 2,000 cancers a year by 2060, highlighted green are >100. Intervention (6) for the chemical agents represents 99% compliance to an existing (RCS) or possible standard, e.g. our estimated H/L boundary exposure levels for arsenic, strong acids and tetrachloroethylene (L/B for TCDD). For asbestos and DEE where it represents 90% compliance to a stringent 1/100 th of the current exposure standard . For the other agents it represents a 50% reduction in RR for the occupations and for coal tars and a limit on night shift work to <5 years duration. For radon exposed numbers are reduced by 50% immediately, and for solar radiation all workers are moved into the lowest category of time spent outdoors. Together these interventions would avoid over 8,000 cancers a year by 2060, highlighted blue are >100.
The method should be used for comparing the effect of alternative interventions, or comparing avoidable numbers of attributable cancers between exposures. NB don’t apply achieved AF to real 2030 cancer numbers as these will have increased because of the increasing proportions of the elderly. Note: there will probably have been many changes in the contribution of other environment and lifestyle risk factors.
Group 2B carcinogens or other carcinogens not yet considered; potential underestimation of the burden Time and resources did not allow for systematic review; epidemiological studies from which risk estimates taken have inherent biases; could be portability issues Estimates based on past exposures that may have been much higher than current Difference in distribution of confounders between source and target Most risk estimates were low (< 2); large proportions exposed at low levels (hence low RR) can give high AF Lack of information on numbers exposed to agents and at different levels of exposure; assignment to high/low assumed similarity of intensity and duration of exposures For very low/background levels RR = 1 used if no information; gives zero AF May not have accounted fully for overlapping/ multiple exposures 2 workshops held during the project. Advice was to first prioritise on IARC group 1 and 2A. Group 2B, often regulated as if human carcinogens not yet looked at. Also unknown occupational carcinogens which may not be detected using current epi methods e.g. promoters rather than early stage carcinogens Focused on meta-analyses, key studies etc. had to be pragmatic in choice of key studies including portability to GB situation. Many exposures will have been a lot higher than currently or may not exist now. Long latency means that numbers of cancers will carry on being high in the future for some exposures. For some exposure on going high levels of exposures e.g. wood dust. For occupations e.g. painting, welding multiple exposures. Difficult to attribute risk to single agent. E.g. in painting many toxic paints have been replaced. However, silica, asbestos etc may remain Good data in the UK on nos. employed in broad industry groups but little information on exactly who in these industries is exposed to carcinogens and at what levels of exposure. We have no UK JEM Exposure misclassification could have occurred in using the CAREX industry classifications to assign low/high categories. In situations where no risk estimate could be identified for very low/background/environmental levels of exposure, used RR = 1. Assumes threshold exists. Didn’t evaluate shape of the exposure-risk relationships Could not account fully for all interactions.
The patterns of our results are similar to those of other studies although the magnitude of the estimates may differ due to numbers of exposures included, methodology etc. Our estimates for only 6 cancers are overall higher than Doll and Peto with males at the higher end of their estimate and females at the lower end