Eliminating occupational cancer

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1 Eliminating occupational cancer John Cherrie IOSH National Safety Symposium 2014 INSTITUTE OF OCCUPATIONAL MEDICINE. Edinburgh. UK

2 Summary Workplace cancer has been a problem for some time How many people die from occupational cancer in Britain? What are the main causes? What will the future hold? Can we really eliminate occupational cancer?

3 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

4 This was a coal carbonization plant

5 Mortality in the plant We carried out a mortality study in the plant in year follow-up 620 men included Increased cancer mortality Lung about 1.5x the expected numbers Stomach 1.6x Prostate 1.5x Bladder 2.7x Non-melanoma skin cancer commonly reported

6 Understanding the causes 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

7 Attributable fractions About 4% (2 8%)

8 Cancer burden in the UK Designed to update Doll and Peto s estimate for occupational cancer burden Current burden (2010) Future burden (to 2060+) Funded by HSE to inform policy 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.

9 Attributable fraction Men = blue Women = red 5.3% ( %)

10 Not all carcinogens are equally important 85% of the cancer cases come from the top ten chemical agents

11 Some good news Aerosols Creely KS et al. (2007) Trends in inhalation exposure--a review of the data in the published scientific literature. Ann Occup Hyg.; 51(8):

12 Some good news Gases and vapours Creely KS et al. (2007) Trends in inhalation exposure--a review of the data in the published scientific literature. Ann Occup Hyg.; 51(8):

13 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

14 So what does the future hold? We have estimated future cancer burden in Britain for a range of interventions for a number of workplace carcinogens AFs estimated for forecast years, e.g. 2010, Assume years latency for solid tumours e.g. lung cancer, 0-20 years for leukaemia Some past and some future exposure until 2060 Workers at the beginning (2010) assumed to be of all working ages Workers recruited through employment turnover are assumed to be only aged Hutchings, S., Cherrie, J., van Tongeren, M., & Rushton, L. (2012). Intervening to Reduce the Future Burden of Occupational Cancer in Britain: What Could Work? Cancer Prevention Research. doi: / capr

15 Crystalline silica Assessed baseline scenario Introduction of new limit values: 0.05 mg/m 3 and mg/m 3 Improved compliance with limits: From 33% to 90%

16 Silica Cancer incidence Baseline, 0.1 mg/m 3, 33% compliance OEL = 0.05 mg/m 3, 33% compliance OEL = mg/m 3, 33% compliance

17 Silica Cancer incidence OEL =0.1 mg/m 3, 90% compliance OEL = 0.05 mg/m 3, 90% compliance OEL = mg/m 3, 90% compliance

18 Silica cancer incidence

19 Silica cancer incidence

20 Successful interventions Agent Solar radiation Diesel engine exhaust Shift work Asbestos Welders Intervention Reduce time outdoors, wear suitable clothes, use sun screen 90% comply with an OEL of 1 mg/m 3 < 5-years night shift work for women 90% comply with an OEL of fibres/ml Improved ventilation, wear respiratory protection

21 Elimination Focus on the top-ten carcinogens Encourage more effective controls along with more stringent enforcement Elimination achieved when future occupational cancer burden less than 0.1% of all cancer registrations Monitor exposure and undertake an assessment of future burden as a leading indicator

22 Questions

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