Transcript South West Annual Public Health Scientific Conference

Occupation and Cancer
Richard Hancock
South West Public Health Observatory
South West Public Health Observatory
South West Regional
Public Health Group
Topics

Reasons occupation linked to cancer

Changes in occupation

Identifying occupational carcinogens

Burden of occupational cancer in South West

Examples - mesothelioma in the South West

Future
South West Public Health Observatory
South West Regional
Public Health Group
Occupation and Cancer
Carcinogens

e.g. scrotal cancer among chimney sweeps, mesothelioma
among shipyard workers

liver angiosarcoma from vinyl chloride monomer, bladder
cancer from benzidine, nasal cancers from wood dust
Lifestyle

Smoking

Lack of exercise, obesity
South West Public Health Observatory
South West Regional
Public Health Group
Changes in employment patterns
From
“production” to “service”
industries!
South West Public Health Observatory
South West Regional
Public Health Group
South West - 1971
South West Public Health Observatory
South West Regional
Public Health Group
South West - 2001
South West Public Health Observatory
South West Regional
Public Health Group
Occupations 2004 - England v South West
South West Public Health Observatory
South West Regional
Public Health Group
Occupational carcinogens and cancer

Important because of impact on individuals and
community, and potentially avoidable

Numbers of cancers probably small compared with
smoking

Equity
South West Public Health Observatory
South West Regional
Public Health Group
Carcinogenicity
Evidence

Epidemiological – elevated cancer numbers in
particular groups of workers

Experimental – e.g. cause cancer in mice
South West Public Health Observatory
South West Regional
Public Health Group
Listing occupational carcinogens is difficult*!

Not a simple “good guy” v “bad guy”

Many carcinogens also found in environment

Evidence usually fragmentary

Levels of exposure may change
*Siemiataycki et al 2004: Listing occupational carcinogens. Environmental
Health Perspectives 2004; 112: 1447-1459.
www.ehponline.org/members/2004/7047/7047.pdf
South West Public Health Observatory
South West Regional
Public Health Group
Sources of information
IARC

International Association for Research in Cancer
(IARC) Monographs - reviews
CAREX

European CARcinogen Exposure database
South West Public Health Observatory
South West Regional
Public Health Group
Ten commonest UK carcinogen exposures
83% of carcinogen exposed UK employees
Carcinogen
Cancer site
Crystalline silica
Radon
Passive tobacco smoke
Solar radiation
Diesel exhaust
Wood dust
Benzene
Chemicals used in
hairdressing
Inorganic lead
compounds
Ethylene dibromide
Lung
Lung
Lung
Skin
Lung, bladder
Nasal, paranasal sinuses
Leukaemia
Bladder, lung, NHL, ovary
Lack of human evidence
Lack of human evidence
South West Public Health Observatory
South West Regional
Public Health Group
Other common UK carcinogen exposures
14% of carcinogen exposed UK employees
Carcinogen
Cancer site
Decorating paints
Chromium IV compounds
Tetrachlorethylene
Coal tar products
Iron and steel foundries
Asbestos
Formaldehehyde
Nickel compounds
Acid mists
Cadmium compounds
Lung, bladder, stomach
Lung, nasal
Oesophagus, cervix, NHL
Skin, lung, bladder
Skin, lung, bladder
Lung, mesothelioma
Leukaemia, nasal sinuses
Lung, nasal cavity, sinuses
Larynx, lung
Lung
South West Public Health Observatory
South West Regional
Public Health Group
Relative risks of occupational carcinogens

Challenging area

Estimation of risks for particular compound(s)

Data on exposure

Interaction with e.g. smoking

“For most agents the information is
fragmentary”*
*Siemiataycki et al 2004: Listing occupational carcinogens.
Environmental Health Perspectives 2004; 112: 1447-1459.
www.ehponline.org/members/2004/7047/7047.pdf
South West Public Health Observatory
South West Regional
Public Health Group
Estimating numbers of occupational cancers

Doll & Peto - The causes of cancer – quantitative
estimates of avoidable risks of cancer in the United
States today. Oxford: Oxford University Press; 1981.

“Attributable fractions” - proportion of cancers
estimated to be due to occupational causes

4% (2 – 8%)

Specifically excluded some groups of “occupational
cancers”
South West Public Health Observatory
South West Regional
Public Health Group
Estimating numbers in UK

Multiply figures for incidence and mortality by “attributable
fractions” (http://hse.gov.uk/statistics/tables/can01.htm)

“Attributable fractions” derived from Doll and Peto, 1981,
American workers

Further work in progress HSE/Dr Lesley Rushton, Imperial
College
South West Public Health Observatory
South West Regional
Public Health Group
Estimates for South West - example

Male deaths from bladder cancer
in SW in 2004
293

Attributable fraction for bladder
cancer in males
0.1
Estimated number deaths
attributed to occupation 0.1 x 293
29

South West Public Health Observatory
South West Regional
Public Health Group
Estimates of cancer deaths in SW due to
occupational causes - 2004
Other
Leukaemia
Bladder
Prostate
Skin
Pleura
Lung
Larynx
Liver
Mesentery
Lymphoma
Brain
Kidney
Pancreas
Colon & rectum
Stomach
Oesophagus
0
50
100
150
200
250
300
South West Public Health Observatory
South West Regional
Public Health Group
Estimates of numbers of cancers in SW due to
occupational causes - 2004
Other
Leukaemia
Bladder
Prostate
Skin
Pleura
Lung
Larynx
Liver
Mesentery
Lymphoma
Brain
Kidney
Pancreas
Colon & rectum
Stomach
Oesophagus
0
200
400
600
800
1000
South West Public Health Observatory
South West Regional
Public Health Group
Estimates of deaths in South West



Total cancer deaths in SW
in 2004
Estimated cancer deaths
attributed to occupation
Attributed to smoking
12,111
565
8,300
South West Public Health Observatory
South West Regional
Public Health Group
Radon in the workplace

Some workplaces significant levels of radon (e.g. small
ground floor rooms, utility ducts)

90 – 280 UK lung cancer deaths per year related to
workplace exposure (+ smoking)

Majority of employers not undertaken risk assessments

HSE working with local stakeholders
[email protected]

Radon South West Committee
South West Public Health Observatory
South West Regional
Public Health Group
Mesothelioma & asbestos

Pleura of lungs (mostly)

More than 80% of mesothelioma cases related
to asbestos

20-60 years between exposure and symptoms

Survival is usually less than 2 years

Possible routes of exposure –
– Occupational
– Environmental
– Items in home
– Exposure from family member
South West Public Health Observatory
South West Regional
Public Health Group
Mesothelioma in the UK
 Female
cases approximately 12% of total
JT Hodgson et al, Brit. J. Can.
92, 587-593 (2005)
South West Public Health Observatory
South West Regional
Public Health Group
Industry in the South West of England
Shipyard
Other

Population based cancer
registry

6.6 million people
South West Public Health Observatory
South West Regional
Public Health Group
Mesothelioma – male 99.8% deviation by ward
Swindon

“Satscan” Clustering tool
RR
2.4

Deaths 1980-2005
n
38
Pop
13 000
p
0.01

Clear effect after 40+ years of
population mixing!
Plymouth
RR
2.6
n
432
Pop
147 000
p
<0.001
M. Kulldorff, Comm. Stat: Theo. & Meth. 26:1481-1496 (1997)
RR
2.2
n
763
Pop
311 000
p
<0.001
Portsmouth &
Southampton
South West Public Health Observatory
South West Regional
Public Health Group
Mesothelioma in the South West of England –
modelling the number of cases

1600
Predicted
1400
1200
Actual
1000
800
600
400
200
2045-2049
2040-2044
2035-2039
2030-2034
2025-2029
2020-2024
2015-2019
2010-2014
2005-2009
2000-2004
1995-1999
1990-1994
0
1985-1989
Number of cases per five years
1800
Age – period – cohort model gives good agreement to data.
South West Public Health Observatory
South West Regional
Public Health Group
Male and female rates
Direct ASR for female cases
12.0
10.0
8.0
6.0
4.0
2.0
0.0
Plymouth
Southampton
Age standardised rate per 100 000
Age standardised rate per 100 000
Direct ASR for male cases
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0.0
Plymouth
Southampton

29:1 male:female ratio in Plymouth, 12:1 in Southampton

Consultation with Trade Union Congress revealed that,
uniquely, the Devonport dockyard in Plymouth operated a
workers laundry service.
South West Public Health Observatory
South West Regional
Public Health Group
Mesothelioma

Clear link to occupational asbestos exposure

Local good practice reduced effects on family

Reductions in death rates expected with increased
regulation

Monitor
South West Public Health Observatory
South West Regional
Public Health Group
Passive smoking in the workplace

Increase in lung cancer risk of

Frequency of cancer in “never
smokers”


Increased frequency with
passive smoking
“Passive smoking” UK lung
cancer deaths/year
12 – 19%*
0.4%
0.45 – 0.48%
160**
*Tobacco smoke and involuntary smoking – IARC Monograph 83 – 2004
**Deaths attributable to passive smoking – Jamrozik, BMJ - 2005
South West Public Health Observatory
South West Regional
Public Health Group
Occupation and lifestyle
Smoking

Commoner in particular groups of workers

Linked to deprivation

Key area for “Choosing Health”
South West Public Health Observatory
South West Regional
Public Health Group
Future

Exposure to occupational carcinogens being reduced

Lack of exercise could cause more “work-related”
cancer than all the “traditional” carcinogens
(Pukkala in Burden of occupational cancer in Great Britain
http://www.hse.gov.uk/research/hsl_pdf/2005/hsl0533.pdf)

“Health and Safety” at work should include access by
walking and cycling - “active travel”?
South West Public Health Observatory
South West Regional
Public Health Group
“Active living” environment*

Many great public health interventions by planners,
architects, engineers.

Need to call on those sectors again

“Active living” friendly environment should be key
objective in town and transport planning
*Dr Harry Burns, Chief Medical Officer for Scotland
www.activetravel.org.uk
South West Public Health Observatory
South West Regional
Public Health Group
Acknowledgements
SWPHO
Julia Verne, Sean McPhail, Andy Pring, Annika
Evans, Helen Cooke, Mark Dancox, Matthew
Greenslade, Lynn Kirkham, Kate Lachowycz,
Pauline Masurel, Wendi Slater, Bob Muliss, Mary
Shaw, Ben Wheeler
HSE
Gareth Thomas, Damien McElvenny
HPA
Mike Studden, Daryl Dixon
South West Public Health Observatory
South West Regional
Public Health Group
Thank You!
More info – www.swpho.nhs.uk
South West Public Health Observatory
South West Regional
Public Health Group