Common workplace cancers

Transcription

1 Common workplace cancers Lin Fritschi

2 Case study A man born in 1950 presents with painless haematuria which has been present for about 4 weeks. You have been seeing him occasionally for 15 years and his past history includes borderline hypertension, mild intermittent rosacea, and occasional acute bronchitis. He has never smoked and drinks 3-4 standard drinks a week. On questioning he states that he has noticed that he has increased frequency of urination including nocturia for the past year. He has some slight back pain but no other symptoms. Physical examination is unremarkable.

3 Next steps

4 His wife is incapacitated with severe osteoarthritis in her hips and knees and he was her primary carer. They have no children. His death has severe ramifications for her, as she is unable to live at home alone, and they have virtually no savings and no assets. Would taking an occupational history have helped with early diagnosis and better outcome, or with compensation?

5 Occupational history Labourer on various building sites, mainly assisting carpenters and bricklayers Packer in chicken processing factory, wrapping, grinding and packing meat Worked in the vulcanization section of a rubber manufacturing plant Part time cleaner in office blocks Retired

6 Then the vulcanising processes begin their weird work. The distinctive feature of a rubber factory is that everything is finished with heat. The odours of brimstone and roasting rubber have a tang of their own, and are all-permeating but not unpleasant. Gillespie ON. Rubber goods. NZ Railways Magazine 1940;14:49-53

7 Occupational cancer A cancer which is caused wholly or partly by exposure to a carcinogen at work Easy to prove if The carcinogenic effect of an agent is very strong The cancer is rare Otherwise difficult to prove because No pathological or clinical features which distinguish occupational cancers Long delay between the time of exposure and the diagnosis of cancer Multiple exposures including lifestyle risk factors

8 What is a common occupational cancer? Largest number of cancers due to occupation Highest proportion of that type of cancer which are occupationally related Likelihood of a cancer being occupationally related if the person had a relevant exposure

9 Occupational cancer numbers Rushton et al, British Journal of Cancer 2012;107:Suppl 1 Requirements List of established carcinogen-cancer type combinations Proportion of population exposed to each carcinogen Number of each type of cancer occurring in the whole population Relative risk of cancer in the exposed subgroup for each carcinogen-cancer type combination Applied to Australia to give an approximation

10 Largest number of cancers due to occupation - Australia (approximate) Cancer N in males N in females Total occupational TOTAL Lung Leukaemia Melanoma Breast Mesothelioma Laryngeal Lip Stomach 110 <5 115 Bladder 80 <5 85 Sinonasal 50 <5 55

11 Highest proportion of each type of cancer which are occupationally related - approx AF m AF f Mesothelioma 75% 10% Sinonasal 70% 10% Laryngeal 30% 5% Pharyngeal 30% 5% Leukaemia 20% 10% Lung 25% <5% Lip 20% <5% Ocular melanoma 15% <5% Nasopharyngeal 10% <5% Stomach 10% <5% Melanoma 5% <5% Bladder 5% <5%

12 Likelihood of a cancer being occupationally related if the person had a relevant exposure Cancer Exposure RR-High Approximate Odds Mesothelioma Asbestos in every 42 Lung Asbestos in every 3 Agudo et al, Goodman et al, 1999

13 Mesothelioma in WA by exposure category and calendar period Olsen et al, MJA 2011;195:

14 Likelihood of a cancer being occupationally related if the person had a relevant exposure Cancer Exposure RR- High Ratio Nasal/paranasal Leather dust in every 12 Nickel 9 8 in every 9 Wood dust 6 5 in every 6 Chromium VI 5 4 in every 5 Formaldehyde 2 1 in every 2 Fu et al, Grimsrud and Peto, Demers et al Rosenman and Stanbury, t Mannetje et al, 1999.

15 Think about occupation in men for. AF n WA total occupational Mesothelioma 75% Sinonasal 70% 9 6 Laryngeal 30% 29 9 Pharyngeal 30% Lung 25% Leukaemia 20% Lip 20% Ocular melanoma 15% 9 1 Nasopharyngeal 10% 6 1 Stomach 10% Melanoma 5% Bladder 5%

16 Occupations for mesothelioma Occupations and exposures Mesothelioma Asbestos

17 Occupations for sinonasal and nasopharyngeal cancer Occupations and exposures Pathologists and laboratory Wood workers, leather workers Welding, metal cutting, plating, nickel refining en.ca/blogart ing_details/phoenix-australasia-pty-ltd

18 Occupations for lung cancer Occupations and exposures Asbestos. Stone cutting (silica). Ionizing radiation Heavy industry metals, soots, coal burning, firefighters, road paving, Metal workers, machinists, welders, plating Painting, printing, chemicals, dyes 5/02/24/free_air_carbon_capture_a_climate_ engineering_idea_worth_considering.html +Small+Dose+of+Solvents

19 Bladder cancer Occupations and exposures Production of: coal tar, coal gas, coke, metals, rubber, Road paving, firefighters, drivers, Metal workers, painters, chemical production

20 Think about an occupational cause in women AF n in WA total pa Mesothelioma 7% 14 1 Leukaemia 10% Lung 1% Breast 3%

21 Bladder cancer in the rubber industry Cancer Exposure RR-High (95% CI) Bladder Rubber industry >1 year PAHs, N-nitrosamines, solvents, naphthylamine ~5 Start screening 20 years after start of exposure How often 6 monthly Type of screen urinary cytology Clin B; "RecoCancerProf" Working Group, Pairon JC. Medical follow-up for workers exposed to bladder carcinogens: the French evidence-based and pragmatic statement. BMC Public Health Nov 6;14:1155.

22 Acknowledgements Renee Carey, Ellie Darcey, Alison Reid, Deborah Glass, Tim Driscoll, Geza Benke,