From Coal to Carbon Nanotubes 19 June 2009 1 - IOM

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					IOM 40th Anniversary Seminar - From                                                    19 June 2009
Coal to Carbon Nanotubes




         Estimation of the burden of cancer in
           Great Britain due to occupation.


              L Rushton1, T. Brown2, R Bevan3, J Cherrie4, L
              Fortunato1, S Bagga3, P Holmes3, S Hutchings1, R
              Slack3, M Van Tongeren4, C Young2

              1 Dept. of Epidemiology and Public Health, Imperial College   London;
              2 Health and Safety Laboratory, Buxton, Derbyshire
              3 Institute of Environment and Health, Cranfield University
              4 Institute of Occupational Medicine




                            This study was funded by the Health and Safety Executive




                                Aims of the study
       • Aims of the study:
           – to develop and apply methodology to estimate current
             attributable risk and cancer numbers caused by work
           – to identify important cancer sites
           – to identify industries and occupations for targeting for reduction
             measures
           – To estimate the future occupational cancer burden in GB under
             different scenarios of changing exposure

       • Estimation for agents and occupations
           – classified by IARC as group 1 and 2A carcinogens
           – with strong or suggestive evidence of carcinogenicity in humans
           – 24 cancer sites; 41 carcinogenic agents or occupations; over
             100 industry sectors




                              Measure of burden
       • Measure of burden used is the AF - proportion of cases attributable
         to exposure; needs
          – risk of disease associated with the exposure of concern (e.g.
             relative risk (RR))
          – proportion exposed in the population

       • RR from published literature: meta-analyses, pooled studies,
         narrative reviews where available

       • Selected studies with comparable exposures to GB:
          – Large sample size
          – Clear case definition
          – Appropriate comparison population
          – Controlled for confounders where possible
          – Adequate exposure assessment

       • Risk estimates obtained for overall ‘higher’ level of exposure and
         lower/background exposure




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IOM 40th Anniversary Seminar - From                                                                 19 June 2009
Coal to Carbon Nanotubes




          Estimating the Proportion Exposed

          • To take into account latency - length of time before disease risk
            increases - we defined the risk exposure period (REP) when the
            exposure occurred

          • Solid tumours: 10-50 years; 1956-95

          • Leukaemia: up to 20 years; 1986-2005

          • Proportion exposed over the REP is:
                number ever exposed/number ever worked

          • Estimated using national data sources

          • Adjusted for turnover, change in numbers employed over REP




               Provisional results: AF, Deaths and Registrations

         Cancer Site                 AF (%)                Deaths (2005)     Registrations (2004)
         Mesothelioma                         95.0                  1937                     1937
         Sinonasal                            34.4                    40                      134
         Lung                                 15.2                  4993                     5727
         Nasopharynx                           8.3                     8                       17
         Bladder                               5.4                   248                      558
         Breast                                4.6                   555                     1971
         NMSC                                  4.6                    23                     2909
         Larynx                                2.6                    20                       56
         Oesophagus                            2.5                   185                      189
         STS                                   2.3                    16                       30
         Stomach                               2.0                   108                      159
         NHL                                   1.7                    71                      161
         Melanoma (eye)                        1.6                     1                        7

         Total                   5.51 (4.65, 6.61)     8290 (6993, 9940)      14109 (9424, 21316)




         Provisional results: AF, Deaths, Registrations for Males and Females

       Cancer Site             AF (%)         Deaths (2005)                Registrations (2004)
                           M     F    Total  M     F    Total               M        F      Total
       Mesothelioma       97.0 82.5    95.0 1699   238 1937                 1699      238    1937
       Sinonasal          46.0 20.1    34.4   29    10      40               102       32     134
       Lung               22.2 5.5     15.2 4236   757 4993                 4877      850    5727
       Nasopharynx        11.1 2,5      8.3    7     1       8                16        1      17
       Bladder             7.2     1.9     5.4       218    31    248        503      55     558
       Breast                      4.6     4.6             555    555               1971    1971
       NMSC                7.0     1.2     4.6       20      2     23       2542     367    2909
       Larynx              2.9     1.6     2.6        18     3     20         51       6      56
       Oesophagus          3.3     1.1     2.5       157    28    185        160      29     189
       STS                 3.4     1.1     2.3        12     4     16         25       6      30
       Stomach             3.0     0.3     2.0       102     6    108        150       9     159
       NHL                 2.1     1.1     1.7        49    23     71        110      51     161
       Melanoma (eye)      2.9     0.4     1.6        1      0      1          6       1       7

       Total            8.45      2.35    5.51 6588 1702         8290      10406    3703   14109




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IOM 40th Anniversary Seminar - From                                                                                           19 June 2009
Coal to Carbon Nanotubes




                  Provisional results: Registrations for Carcinogens and Occupations

               Carcinogen or Occupation                      Total Registrations   Cancer Sites
               Asbestos                                                    4215    Larynx, Lung, Mesothelioma,
               Shift work (+ Flight Personnel)                             1971    Breast
               Mineral oils                                                1690    Bladder, Lung, Sinonasal, NMSC
               Solar radiation                                             1549    NMSC
               Silica                                                       908    Lung
               Diesel engine exhaust                                        803    Bladder, Lung
               PAHs - Coal tars and pitches                                 545    NMSC
               Painters                                                     437    Bladder, Lung, Stomach
               Dioxins                                                      334    Lung, NHL, STS
               Environmental Tobacco                                               Lung
                                                                            284
               Smoke (non-smokers)
               Radon                                                        209    Lung
               Welders                                                      175    Lung, Melanoma (eye)
               Tetrachloroethylene                                          168    Cervix, NHL, Oesophagus
               Arsenic                                                      129    Lung
               Strong inorganic-acid mists                                  127    Larynx, Lung
               Chromium                                                      90    Lung, Sinonasal
               Non-arsenical insecticides                                    83    Brain, Leukaemia, Multiple myeloma, NHL




                                              Provisional result: Lung cancer AF by carcinogen/occupation


                                   Arsenic
                                 Asbestos
                                 Beryllium
                                Cadmium
                             Chromium IV
                                    Cobalt
            Diesel engine exhaust
                                      ETS
                            Inorganic lead
                        Ionising radiations
                               Mineral oils
                                    Nickel
                                     PAHs
                                  Painters
                                    Radon
                                     Silica
            Steel foundry workers
       Strong inorganic-acid mists
         Containing sulphuric acid
                                    TCCD
                               Tin miners
                                 Welders




                          Provisional result: Cancer Registrations Attributable to Work in the
                          Construction Industry - Men

                                   Arsenic
                                 Asbestos
                                Chromium
                                    Cobalt
                                    Diesel
                                      ETS                                                    Construction, inc painters and
           Carcinogen




                             Formaldehyde                                                    decorators; road surfacers,
                                     Lead                                                    roadmen, roofers & glazers,
                                  Painters                                                   paviours
                                     PAH                                                     Other Sectors
                            PAH - coal tars
                               and pitches
                                    Radon
                                    Silica
                            Solar Radiation
                        Tetrachloroethylene
                                Wood dust

                                                    0   500 1000150020002500300035004000
                                                           Number of Registrations




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IOM 40th Anniversary Seminar - From                                                                       19 June 2009
Coal to Carbon Nanotubes




                                   Provisional results: Attributable Registrations by Cancer Site for
                                   Work in the Construction Industry: Men



                       Stomach


                       Sinonasal

                   Oesophagus

                         NMSC
       Cancer




                   Nasopharynx

                  Mesothelioma

                           Lung

                         Larynx

                        Bladder

                                               500         1000          1500         2000         2500

                                                              Registrations




                Provisional results: Registrations by Industry Sector
                                                           Attributable Registrations        Exposures
            Industry Sector
                                                                 Male           Female
            Construction                                                4237         64             14
                 Painter + decorators                                     331         3              1
                 Roadmen + roofers                                        538         4              1
            Total construction                                          5102         71             16
            Metal workers                                               1224        164              1
            Personal + household services                                 450       375             10
            Mining (not coal)                                             640       161              4
            Land Transport                                                436        43              9
            Wholesale + retail trades                                     152       141              7
            Public admin. + defence                                       240        33              4
            Printing                                                      224        46              1
            Farming                                                       175        40              3
            Welders                                                       161        16              1
            Manufacture of transport equipment                            145        19             15
            Manufacture of machinery (not electrical)                      81        31             12
            Manufacture of chemical products                               95        16             15
            Non-ferrous metal industries                                   82        26             17




        Estimation of the burden of cancer in Great Britain due
              to occupation: Predicting Future Burden

       • AFs estimated for forecast years, e.g. 2010, 2020 … 2060

       • For lung cancer assume latency 10-50 years

       • Define the risk exposure period for each year e.g. for 2030, 1971 –
         2020

       • Some past and some future exposure.

       • Workers at the beginning assumed to be of all working ages

       • Workers recruited through employment turnover are assumed to be
         only aged 15-24.




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IOM 40th Anniversary Seminar - From                                                                    19 June 2009
Coal to Carbon Nanotubes




        Change in future exposure: Possible Scenarios

       • Estimates made for alternative scenarios of changes in exposure
         levels and proportions exposed

       • (1) No change in exposure levels or patterns

       • (2) ‘Forecast scenario’ based on pattern of past and current
         exposure, and on linear projections up to 20 years into the future,
         after which levels assumed constant due to prediction uncertainty.

       • (3) ‘Intervention scenarios’ also based on past and current
         exposures, and suitably chosen target exposure levels in the future

       • Intervention scenario results compared to the ‘forecast’ or a
         ‘baseline’ scenario to assess relative impact on reducing attributable
         numbers




           Example Intervention Scenarios for Silica

       • (3) Halve the exposure limit from 0.1 to 0.05 mg/m3 in all
          workplaces, in 2010, with the same proportion
          exposed above the new limit as above the old

       • (3a) the same in 2020

       • (4) successfully enforce the new limit in
         workplaces employing 50+ only, or

       • (5) amongst all employers




                                              Forecast Attributable Numbers for Lung cancer
                                                   and Crystalline Silica exposure - Men

                                            2,000
                                            1,800
                                            1,600
               Attributable registrations




                                            1,400                                               (1)
                                            1,200                                               (2)
                                                                                                (3)
                                            1,000
                                                                                                (3a)
                                             800                                                (4)
                                             600                                                (5)

                                             400
                                             200
                                               0
                                                    2010   2020   2030    2040    2050   2060
                                                                  Forecast year




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IOM 40th Anniversary Seminar - From                                            19 June 2009
Coal to Carbon Nanotubes




                                  Summary
        • Robust methodological approach developed for estimation of
          burden for all IARC 1, 2A occupational carcinogens

        • Estimate of total burden 8.5% males, 2.5% females, 5.5% total

        • Important agents/occupations; asbestos, shift work, mineral oils,
          solar radiation, silica, DEE, coal tars and pitches, diesel engine
          exhaust, arsenic, dioxins, radon, ETS, painter, welder

        • Methodology developed for predicting future trends burden under
          different exposure change scenarios: Applied to important
          cancers/agents/occupations/industries

        • On-going/planned work:
            – Quality of life indicators
            – Evaluation of impact of source of bias and uncertainty

        • Preliminary work on 6 cancer sites published:
          OEM 2008, 65, 789-800




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