Transcript Paul A. Demers, PhD
Occupational Cancer in Canada: Current State of Knowledge and Data Gaps Paul A. Demers, PhD
Occupational and Environmental Medical Association of Canada Niagra-on-the-Lake October 4 th , 2011
Scrotal Cancer among Chimney Sweeps
• • • Percival Pott (1775) linked scrotal cancer in chimney sweeps to the nature of their work and their exposure to cancer causing agents in soot He was the first to identify an occupational carcinogen Finally in 1840’s laws were passed prohibiting young boys from performing the work
IARC
Monograph Evaluations
IARC Classification of Carcinogens
Group
1 2A 2B 3 4
Classification
Carcinogenic to Humans Probably Carcinogenic Possibly Carcinogenic Unclassifiable Probably Not Carcinogenic
Agents
107 59 267 508 1
• • • •
What do we Know about Occupational Carcinogens?
~ 60 definite or probable workplace carcinogens (IARC 1 and 2A) Over 100 additional workplace exposures are possible carcinogens (IARC 2B) Many other workplace exposures with a suspicion of human carcinogenicity Even greater number of workplace substances with little formal evaluation
CAREX Canada Priority Occupational Carcinogens (IARC Classification, cancers) Industrial Chemicals
Aromatic amines (1,
bladder
) 1,3-Butadiene (1, lymphatic/hemaetopoietic) TCDD (dioxins) (1, all cancers) Benzene (1, leukemia, multiple myeloma, non Hodgkin’s lymphoma) Formaldehyde (1, nasopharynx, leukemia,
sinonasal?
) Vinyl chloride monomer (1, liver) Ethylene oxide (1, lymphoid?, breast?) Polychlorinated Biphenyls (PCBs)(1/2A, ?) Acrylamide (2A), Epichlorohydrin (2A) 6
CAREX Canada Priority Occupational Carcinogens (IARC Classification, Cancers)
Metals
Arsenic & compounds (1, lung, bladder,
kidney?, liver?, prostate?
) Beryllium and compounds (1, lung) Cadmium & compounds (1, lung,
prostate?, kidney?
) Chromium, hexavalent (1, lung,
sinonasal?
) Nickel & compounds (1, lung, sinonasal) Lead & compounds (2A/2B), Antimony trioxide (2B), Cobalt (2A/2B) 7
CAREX Canada Priority Occupational Carcinogens (IARC Classification, Cancers)
Dust and Fibres
Asbestos (1, lung, mesothelioma, larynx, ovary, pharynx?,
colorectal?, stomach?
) Erionite (1, mesothelioma) Silica (1, lung) Wood Dust (1, sinonasal, nasopharynx) Leather Dust (1, sinonasal) 8
CAREX Canada Priority Occupational Carcinogens (IARC Classification, cancers)
Radiation
Radon decay products (1, lung) Plutonium (1, lung liver, bone) X-radiation, gamma-radiation (1, lung, breast, leukemia, many others) Solar radiation (1, skin squamous cell, basal cell, melanoma) UV Tanning Devices (1, skin & eye melanoma) Magnetic fields (ELF)(2B) 9
CAREX Canada Priority Occupational Carcinogens (IARC Classification, cancers)
Combustion Products and Others
Polycyclic aromatic hydrocarbon related exposures (mix of 1/2A/2B, lung, skin, bladder) Mineral oils (1, skin) Diesel Exhaust (2A,
lung?
) Environmental Tobacco Smoke (1, lung) Antineoplastic Agents (1/2A, leukemia, bladder) Shiftwork at Night (2A,
breast?
) 10
CAREX Canada Priority Occupational Carcinogens (IARC Classification) Chlorinated Solvents
Tetrachloroethylene (2A) Trichloroethylene (2A) 1,2 – Dichloroethane (2B) Dichloromethane (2B) Chloroform (2B) 11
CAREX Canada Priority Occupational Carcinogens (IARC Classification)
Pesticides
Chlorophenoxy Herbicides (2,4-D, MCPA, MCPP)(2B) Chlorothalonil (2B) Dichlorvos (2B) Lindane (2B) Pentachlorophenol (2B) Atrazine (3) 12
Estimated Burden of Occupational Cancer from Various Studies
Author and Location Nurminen et al (2001) Finland Steenland et al (2003) United States
Male Female Male Female Lung 29 5.3
8-19.2
2
Attributable Fraction (%) By Cancer Site and Gender
Leukemia 18.5
2.5
0.8-2.8
0.8-2.8
Bladder 14.2
0.7
5.6-19 5.6-19 Skin (NMSC) 13.1
3.8
1.2-6 Nasal 24 6.7
31-43 Total 13.8
2.2
3.3-7.3
0.8-1.0
Rushton et al (2010) United Kingdom Alberta Health Services, AHS (2010), Alberta
Male Female Male Female 21.1
5.3
6-33 1-5.5
0.9
0.5
1.8-18.5
0.5-3 7.1
1.9
1.2-27 0.4-19 7.1
1.1
1.2-13.1
3-3.8
46.0
20.1
2-18.4
8.2
2.3
24-64.3 3.3-13.8
0.1-2.2
CAREX Canada - OVERVIEW
• • The objectives of CAREX Canada are to: – develop estimates of the
number
of Canadians exposed to IARC carcinogens in their workplace & community environments, – – identify
how
&
where
people are exposed, and when possible, determine their
level
of exposure. Etimates are generated using existing Canadian exposure data, census population data & the best exposure estimation procedures available.
15
Potentially Exposed Workers: Initial Estimates Known or suspected carcinogen (IARC) Exposed
Shift work with circadian disruption (2A) Solar radiation (1) Diesel engine exhaust (2A) Silica (crystalline) (1) Other PAHs (2A/2B) Benzene (1) Wood dust (1) Lead (2A) Ionizing radiation (1) Asbestos (1) UV radiation (artificial sources)(1) Chromium (VI) compounds (1) Nickel compounds (1) Formaldehyde (1) 2,800,000 1,500,000 804,000 349,000 307,000 297,000 293,000 202,000 153,000 152,000 150,000 83,000 53,000 41,600
Industry sectors with potential over-exposure to carcinogens in Quebec: 2001-2005 Substance (IARC Category) PAHs (1/2A/2B) Crystalline silica (1) Wood Dust (1) Beryllium (1) Styrene (2B) Methylene chloride (2B) Lead (2B) Nickel (1) Cobalt (2B) Asbestos (1) Industries 70 27 25 12 11 11 9 7 4 4 * Institut de recherche Robert Sauvé en santé et en sécurité du travail (IRSST) Rapport R-485, 2007
Canadian Workplace Exposure Database (CWED)
18
Workplace Regulatory Agencies in Canada
19
Provincial Workplace Measurements
Wood dust Formaldehyde Lead Silica Perchloroethylene Benzene Cadmium Asbestos Beryllium
Ontario (81-96)
3,848 7,936 7,806 4,666 2,764 1,441 1,358 1,787 292
BC (81-04)
7,194 2,788 3,060* 1,640 2,148 658 851 4,718 128
Quebec (01-05)
4,588 4,629 3,459 3,373 882 1,240 662 1,385 17,864 * plus 5,200 blood-lead & 17,400 urine-lead biological measurements
8 9
Mean benzene exposure over time in BC and Ontario workplaces
7 6 5 4 3 2 1 0 80-84 85-89 90-94 * current ACGIH TLV is 0.5 ppm, NIOSH PEL is 0.1 ppm 95-02 BC Ontario
Mean Concentration by Sampling Year
2 1 4 3 7 6 5 0 1984 1985 1986 1987 1988 1989 1990
Year
1991 1992 1993 1994 1995 1996
Levels of Exposure to Benzene by Industry Sector, Ontario 1981-1996
Industry Sector (measurements) Gasoline stations (12) Iron and Steel Mills (29) Printing industry (38) Pharm. & Medicine Mfr. (128) Rubber Manufacture (192) Plastics Manufacture (137) Electrical Components Mfr. (21) Mean ppm (range) 13.0 (0.01-55.8) 2.3 (0.01-16.0) 0.9 (0.01-7.8) 0.7 (0.01-19.5) 0.1 (0.01-5.2) 0.05 (0.01-2.5) 0.03 (0.01-0.2)
Benzene exposure to service station attendants: Personal long-term samples Source
CPPI-PACE 1996 CPPI-PACE 1990 PACE Pilot 1987 Rappaport 1987 Halder 1986 Kearney 1986 Runion 1985 Weaver 1983 McDermott 1979
Location
Canada Canada Canada USA USA USA USA USA USA
Mean (ppm)
0.04
0.38
0.03
0.2
0.3
0.1
0.06
0.06
0.09
n samples
78 280 42 49 21 18 1478 14 84 Compiled from Verma et al., 2001. ‘Benzene and Total Hydrocarbon Exposures in the Downstream Petroleum Industries’, AIHAJ, 62:2, 176-194
Levels of Exposure to Crystalline Silica by Industry Sector, Ontario 1983-1996
Industrial Sector (# samples)
Mean* (range)
Construction (270) Mineral products mfg. (1147) Mining (277) Basic metal industries (1465) 1.8 (0-52.0) 0.2 (0-27.0) 0.1 (0-2.7) 0.2 (0-22.5) Metal products mfg. (577) 0.3 (0-66.5) Other manufacturing (340) 0.2 (0-5.6) Other industrial sectors (539) 0.2 (0-6.2) * mg/m 3 , current ACGIH TLV is 0.05 mg/m 3
Number of People Exposed to Ionizing Radiation by Industry in Ontario Industrial group
Nuclear power Medicine Professional, scientific services Uranium mining Public administration Other
Number monitored by NDR (2005)
18,600 27,700
Number exposed*
7,320 4,280 6,950 2,570 18 2,500 13,000 2 475 2,900 *Exposure is defined as having an annual ionizing radiation dose of >0 mSv 26
Night, Evening & Rotating Workers in Ontario Industries with the Highest Prevalence
27
28
Estimated Number of Farm Operators Potentially Exposed to Chlorothalonil
Estimated Number of Farm Workers Potentially Exposed to Chlorothalonil
Golf Course Pesticide Applicators by Province Province/Region
BC AB SK MB ON QC NFL PEI NB YT NT NU
Canada Total
1056 999 426 399 2493 1083 66 84 174 6 3 0
7017
32
• • • • •
Recent Reports Relevant to Setting Priorities
Report of the Advisory Group to Recommend Priorities for IARC Monographs during 2010–2014. IARC, Internal Report 08/001. Lyon, France, 2008 Ward EM, Schulte PA, Straif K, et al. Research Recommendations for Selected IARC-Classified Agents. Environmental Health Perspectives 2010:119(10):1355-1362.
Presidents Cancer Panel. Reducing environmental cancer risks. U.S. National Cancer Institute, April 2010.
Demers PA, Peters CE, Nicol AM. Priority Occupational Carcinogens for Surveillance in Canada: Preliminary Priority List. CAREX Canada, 2008.
Hohenadel K, Marrett L, Pichora E, Brown J, Harris S, Blair A. Occupational Cancer Research Centre Stakeholder Consultation Report. OCRC, November 2009.
All reports are available at: http://occupationalcancer.ca/topics/information-resources/reports/
IARC Evaluation Priorities 2010-2014
High Priorities (occupational) Medium priorities (occupational)
Asphalt & bitumen* Carbon-based nanoparticles Crystalline fibres other than asbestos Ultrafine particles Motor vehicle exhaust emissions Perfluorinated compounds (e.g. PFOA) Radiofrequency electromagnetic fields* Sedentary work Stress Iron & iron oxides Welding Atrazine Metalworking fluids & lubricants N-Nitrosamines* Polybrominated biphenyls (PBB) Polybrominated diphenyl ethers (PBDE) Polychlorinated biphenyls (PCB) DEHP and other phthalates* Styrene Trichloroethylene & other chlorinated solvents * IARC review already scheduled
NIOSH/IARC Top 20 Research Priorities
Ultrafine particles
Titanium dioxide Carbon black Diesel Engine Exhaust Welding fumes
Metals
Lead & lead compounds Indium phosphide Metallic cobalt
Pesticides
Atrazine
Shiftwork Chlorinated solvents
Trichloroethylene Perchloroethylene Methylene chloride Chloroform
Other Chemicals
Formaldehyde Styrene & Styrene-7,8-Oxide Acetaldehyde Propylene Oxide Polychlorinated Biphenyls (PCBs) Di (2-ethylhexyl) phthalate (DEHP)
Priorities for Etiologic Research versus Prevention?
• • • Both the IARC Monograph Program and the NIOSH priorities focus on contributing to the classification of suspected carcinogens Research on established carcinogens?
– Some are defined only by job or industry (e.g. painting & welding) and targets for prevention are needed – Some are poorly defined (e.g. wood dust)
Research on mixed exposures?
OCRC Stakeholder Needs Assessment Survey Most frequently identified exposures Exposure category
Chemicals Dusts and fibres Radiation Lifestyle factors Shiftwork Pesticides Nanomaterials Exhaust Metals Work environment Solvents Fossil fuels & oils Pharmaceuticals
Examples of commonly listed exposures
Formaldehyde, amines, PCB, sulphuric acid mists… Asbestos, fibreglass, silica, wood dust, carbon black Electromagnetic fields, nuclear, cell phone, solar, ionizing radiation, radiofrequency radiation, WIFI… Smoking, physical activity, stress, diet, alcohol - - - Diesel, gasoline Uranium, chromium, cobalt, gold, nickel, smelter fumes, tungsten, welding fumes, lead Indoor air, environmental tobacco smoke, mould Solvents (general), benzene, trichloroethylene… Metal working fluid, oil mists, coal tar, fuel, asphalt Antineoplastic drugs, cytotoxic drugs
Frequency
30 27 24 18 16 15 14 14 13 12 9 7 4
Creation of National Occupational Cancer Surveillance Cohort
• • •
1991 Long-Form Census
– Representative 20% sample of population
Linked to:
– Canadian Mortality Database • Vital statistics – Canadian Cancer Database • Cancer incidence registry – Tax Summary Files • Derived from personal tax returns
Follow-up: 1991 – 2003 (to be extended to 2005)
Canadian Census Cohort N = 2,734,800 Men N = 1,342,100 Women N = 1,392,700 Working N = 1,123,500 Working N = 953,600
• Insert screen shots for CAREX Canada site here (no worries for translation since available in both languages)