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Elimination of occupational cancer from hazardous substances
1. WORKING FOR A HEALTHY FUTURE
Elimination of occupational cancer
from hazardous substances
John Cherrie
INSTITUTE OF OCCUPATIONAL MEDICINE . Edinburgh . UK www.iom-world.org
2. Jeffrey Lee
• 32-year ACGIH member, he gave
generously gave his time and talents to
various committees and to the Board of
Directors in 1987–88
• Helped establish the journal, Applied
Occupational and Environmental
Hygiene, and served as its Editor-in-
Chief from 1990–1993
3. Summary…
• Workplace cancers are a concern
• The current occupational cancer burden is mostly
caused by a small number of agents
• Exposures have been decreasing steadily over time
• Without any additional actions burden in the future
will be lower than now
• Focused effort could ensure the occupational
cancer burden becomes much less than 1% of all
cancers
• This would “eliminate” workplace cancer
4. 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
6. 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
7. President Richard Nixon started a war
• 23rd December 1971 he signed the National
Cancer Act
• The main focus was on trying to find a cure, but
there was a clear focus on prevention
• Strengthened the
role of NCI
• This was the
“War on Cancer”
8. 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
9. Typical US Low incidence
75% and 80% of all cancers are preventable
Connecticut Low incidence registry
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
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
24. What would “eliminate” really mean?
• 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. For some substances we are already there
• 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
26. Tracking progress…
• Periodic surveys of exposure by EU and
national authorities
• Intensity (including contextual information)
• Prevalence
• Updates of cancer burden estimates
• Routine reporting by occupational hygienists
through European occupational hygiene
associations
27. A challenge…
• Focus on the top ten causes of the occupational
cancer burden
• 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
28. 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)
29. Questions…
• You can contribute to the discussion at www.OH-
world.org
John.Cherrie@iom-world.org
Editor's Notes
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.