Transcript Slide 1

Why the UK stalled on occupational cancer prevention, where we
stand now internationally and what Scotland can do about it?”
Andrew Watterson, Tommy Gorman, Rory O’Neill
Occupational and Environmental Health Research Group
Centre for Public Health and Population Health Research
School of Health Sciences,
University of Stirling,
Scotland
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WHO estimate that
globally 7-19% of
all cancers are due
to toxic
environmental
exposures. 2009
15,764 people died from cancer in Scotland in 2013
If 10% of cancer deaths are work-related, an estimated 1576 deaths are
work-related = cost to Scotland of £3,862,200,000 (estimate of £2.45
million per cancer death DEFRA 2006)
Estimated 1 in 5 workers exposed to carcinogens
Occupational cancer prevention?
Ban/ Remove
carcinogens on the
basis of evidence
and precaution
Compensate and
support those
affected by
occupational cancers
Reduce exposure to
carcinogens and
measure them
Occupational
cancers
Treat people with occupational
cancers - and use data on cases
to focus on prevention strategies
in the future
Wear PPE
Screen workers
for occupational
carcinogens
Detect those
exposed to
carcinogens
Hueper’s occupational cancers some substance and Site Concerns 1942
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Asbestos
Benzidine
Diesel
Dyes, coal tar
Endocrine
disruptors linked
to breast cancer
Metal Dust
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‘Blood’ cancers
Brain cancers
Breast cancer (endocrine)
Lung cancers
Naso-pharyngeal cancers
Prostate cancer
(Oppenheimer 1926;
Henry et al 1931 6 of 46
occupations
Testicular cancer (Shimkin
1941 stilbestrol)
Andrew Watterson UoS Holyrood
March 2105
Global estimates of fatal work-related-diseases.
Hamalainen et al 2007 AJIM 50:28-41 (1)
In 2012, an EU Occupational
Health and Safety workshop
looked at occupationally-caused
and related cancers and
identified ‘hidden’ groups whose
occupational exposure to cancer
risks and carcinogenic processes
was under-represented in
exposure data and intervention
strategies (EASHW 2012). They
noted an unrecognised workrelated cancer burden in lower
socio-economic classes, women,
migrant workers, the precariat
and floated the concept of
‘socially discriminating cancers’
Andrew Watterson UoS Holyrood
March 2105
EU/Global Statistical picture. EASHW 2008
Region
Number of all cancer
deaths
Attributable
fraction
related to
work
Cancer
(total)
Men
Women
Men Women
EU 15
528,953
410,829
13.8
EU 25
600,508
464,757
EU 27
623,709
481,307
World
3,872,766 3,062,008
Number of
deaths
attributable
to work
Workrelated
cancer
Men
Women
Total
2.2
72,996
9,038
82,034
13.7
2.2
82,194
10,144
92,338
13.6
2.1
85,106
10,177
95,581
Andrew Watterson UoS Holyrood
March 2105
9.6%
665,738
Table: Estimate of the proportion of cancer deaths that will be
found to be attributable to various factors
Best Estimate
Range
Tobacco
30
25-40
Alcohol
3
2-4
Diet
35
10-70
Food additives
<1
5-2
1
1
Up to 6
0-12
Occupation
4
2-8
Pollution
2
1-5
<1
<1-2
Medicines and procedures
1
0.5-3
Geographical factors
3
2-4
10
1-?
Sexual behaviour
Yet to be discovered hormonal analogies
of reproductive factors
Industrial products
Infective processes
UK/ US Cancer Pattern, cited by Peter Boyle, Source: Doll & Peto (1981)
Scotland and some occupational cancer studies,
missed policy opportunities and developments
1875 The first case of paraffin
cancer in GB was described by Bell
in Scottish shale oil plants - ‘a well
known fact among the local
physicians’ (Hueper 1942:156)
1922. Scott described 19 cases of
paraffin cancer in the Scottish
industry. No effective action had
apparently followed Bell’s report
1990s: Old epidemics and endemics in occupational health – cancers listed
2006 The economic costs of health service treatments for occupational cancers. Annals New
York Academy Science, 1076; 871-881. OEHRG
2006. OEHRG met Scottish Minister of Public Health to discuss occupational cancer prevention
2006-2015 OEHRG held workshops and spoke at seminars on occupational cancer prevention
2008 OEHRG produced paper on ‘Burying the Evidence on occupational cancer’
2008 OEHRG held international conference in Stirling on occupational and environmental cancer
prevention
2008 OEHRG published paper in European Journal of Oncology on “occupational cancer
prevention in Scotland: a missing public health priority”.
2014 OEHRG worked for WHO on costs of occupational cancers
2014 APHA occupational breast cancer prevention policy initiative based on OEHRG
Major public health threats in Scotland? Skewing risk assessment, risk
reduction & risk management? (from 2006)
Murders
Road traffic fatalities
Suicides
Occupational cancer
2003 = 108
2004 = 306 (includes work link)
2004 = 835
2004 = 600 using 4% Doll/Peto estimates
1800 (12% Clapp estimate)
Alberta firefighters recognised
diseases = 14. UK = 0?
The ‘top’ 10 occupational carcinogens
and their related cancers and their
prescribed industrial disease status
(HSE 2012 and DWP):
Substance and related
Cancers
Related cancers
Prescribed industrial
disease status
Asbestos
Mesothelioma
Lung
Larynx
Stomach
Yes
Yes
No – rejected in 2008
No
Silica
Shift work
Welding
Painting
Lung
Breast
Lung
Lung
Bladder
Lung
Bladder
Non melanoma skin
cancer
Non melanoma skin
cancer
Yes
No
No
No
No
No
No
No
Cervix,
Non-Hodgkins
Lymphoma
Oesophagus
No
No
No
Lung
No
Diesel exhaust emissions
Solar radiation
Polycyclic aromatic
hydrocarbons (PAHs) –
coal tar and pitches
Tetrachlorethylene
Source: Watterson 2015
Radon
Yes
Simple solutions? The law on workplace carcinogens
COSHH and
related EU
Management
directives
REACH
EU
Carcinogen
Directive
2004
ECHA
IARC
protect “workers against risks to their
health and safety, including the prevention
of such risks, arising or likely to arise from
exposure to carcinogens or mutagens at
work” (Art. 1).
CLP Regulations 2010-2015 Hazard category – carcinogen
Specific regulations such as:
– Control of Asbestos Regulations 2012
- Ionising Radiations Regulations 1999 [1]
(IRR99) and The Radiation (Emergency
Preparedness and Public Information)
Regulations 2001[2] (REPPIR)
is a substance or mixture that induces or increases cancer
incidence with mechanisms relevant to humans
1A known human carcinogen – largely human evidence H350 eg-i
1B presumed human carcinogen – largely animal evidence H351
2. Suspect human carcinogen – evidence but not yet sufficiently
strong
CMR,toxicity, respiratory sensitiser
Global activity on cancer prevention
WHO/IARC and
Asturias 2011
PP
information
-regulation,
enforcement and
sunsetting
French
substitution
programme
2000s
Canada 2000s
The UK?
USA 1990s onwards
Scottish specific strategies and
opportunities – a more Nordic model?
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Scottish Government discussion/ focus, with cross-party initiatives, on
occupational and environmental diseases including cancer and using public and
community engagement
Prevention through public health and social and environmental justice - linking
NHS policy, plans and practice with enforcement and regulation by HSE and SEPA
and in the Scottish Government’s Better Cancer Care and Action Plans (2008>)
Prevention through incentives? Scottish Government benefits for enterprises that
adopt toxics use reduction/sunsetting/green jobs strategies on carcinogens?
Prevention through economic penalties? Scottish parliamentary action to recover
costs of occupational and environmental diseases, including occupational cancer,
from employers?
Greater governmental support for victims of occupational cancer through better
disease recognition and recording, welfare rights and social services. ?
Greater support, advice, information and use of existing regulation and
enforcement where needed from HSE/SEPA/EHOs on occupational and
environmental monitoring of industries and workplaces using and emitting
carcinogens. ? UK ACTS and WATCH vanishing?
Andrew Watterson UoS Holyrood March 2105
Reductions TURI (1990 - 2005)
Andrew Watterson UoS Holyrood
March 2105