Impact: the burden of occupational cancer

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Impact: the burden of occupational cancer

Australia

The Australian Work Exposures Study (AWES) estimated that in 2012, 3.6 million current workers, or 40% of the working population, were potentially exposed to carcinogens in the workplace[1]. The study found that men were more likely to be exposed than women with approximately 2,727,000 men (58% of the working population) and 877,000 women (21%) potentially exposed to at least one carcinogen at work[1].

A number of occupational groups were estimated to have 100% of workers exposed to at least one occupational carcinogen. These included farmers, drivers, transport workers and various tradespersons. Common exposures were diesel engine exhaust, solar ultraviolet radiation, silica and benzene. See Table 1 and Table 2 for occupational groups for men and women most likely to be exposed to at least one carcinogen in an occupational setting.

National exposure surveillance is not routinely carried out in Australia, meaning that population-based data concerning the prevalence and extent of exposure over time is not available[2].

Table 1. Top occupational groups in Australia potentially exposed to carcinogens - males[1]

Occupational group Most common exposures % exposed
Heavy vehicle drivers DEE, solar UVR, ETS 100
Farmers Solar UVR, DEE, PAHs 100
Plumbers Solar UVR, ETS, lead 100
Painters Solar UVR, lead, wood dust 100
Miners Silica, DEE, solar UVR 100
Carpenters Wood dust, solar UVR, formaldehyde 98.8
Animal and horticultural Solar UVR, benzene, DEE 98.5
Vehicle trades DEE, asbestos, lead 97.4
Handypersons Solar UVR, wood dust, silica 97.0
Passenger transport DEE, shiftwork, solar UVR 96.8
Automobile drivers DEE, solar UVR, ETS 95.4
Engineers Solar UVR, DEE, silica 92.9
Outdoor workers Solar UVR, DEE, benzene 92.3
Construction workers Silica, solar UVR, ETS 90.7
Electrical workers Solar UVR, ETS, lead 89.4
Emergency workers DEE, PAHs, lead 89.1
Metal workers Artificial UVR, chromium VI, nickel 87.1
Warehousing Solar UVR, DEE, ETS 86.2
Scientists Solar UVR, DEE, benzene 78.4
Other health professionals Ionising radiation, PAHs, solar UVR 73.6

DEE - diesel engine exhaust, UVR - ultraviolet radiation, ETS - environmental tobacco smoke, PAHs - polycyclic aromatic hydrocarbons

Table 2. Top occupational groups in Australia potentially exposed to carcinogens - females[1]

Occupational group Most common exposures % exposed
Farmers Solar UVR, DEE, benzene 100
Automobile drivers DEE, Solar UVR, benzene 100
Passenger transport Shiftwork, DEE, ETS 100
Heavy vehicle drivers DEE, solar UVR, ETS 100
Handypersons Solar UVR, ETS, DEE 100
Electrical workers Solar UVR, ETS, DEE 100
Vehicle trades DEE, asbestos, ETS 100
Metal workers Ionising radiation, DEE, formaldehyde 100
Construction workers Silica, ETS 100
Miners Silica, lead, nickel 100
Animal and horticultural Solar UVR, benzene, DEE 91.7
Engineers Solar UVR, DEE, benzene 85.7
Emergency workers Solar UVR, shiftwork, PAHs 83.3
Scientists Ionising radiation, DEE, solar UVR 69.1
Carpenters Wood dust, DEE 66.7
Hospitality ETS, solar UVR, PAHs 59.0
Nurses Shiftwork, ionising radiation, PAHs 52.1
Machine operators Solar UVR, DEE, ETS 46.2
Food service ETS, PAHs, shiftwork 44.4
Food factory Shiftwork 33.3

DEE - diesel engine exhaust, UVR - ultraviolet radiation, ETS - environmental tobacco smoke, PAHs - polycyclic aromatic hydrocarbons

Estimating cancer burden associated with occupation is challenging for a number of reasons, including: limited data on exposure; uncertainty about the strength of evidence on association and causation; and uncertainty about latency (time lag between exposure and diagnosis). These challenges may explain much of the variation in findings from different studies.

Due to the long latency between exposure and the occurrence of most cancers, occupational cancers identified today will reflect the effect of exposures several decades previously. Similarly, the burden of cancers resulting from current exposures will not be seen for several decades. Long latency and the fact that cancer incidence is more common means that occupational cancers mainly occur in older persons.


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Global impact

The World Health Organization assessed worldwide mortality and morbidity resulting from exposures to selected occupational hazards in 2000. The selected occupational risk factors were responsible for 9% of lung cancer cases, 2% of leukaemia cases, and close to 100% of mesothelioma cases worldwide[3]. In 2004, WHO estimated that 177,000 deaths from lung cancer, leukaemia and mesothelioma worldwide were attributed to occupational carcinogens, with the majority (137,000) occurring in males[4].

Various estimates of global burden have been made (WHO, 2009; Global Burden of Disease, 2013). The most recent estimates come from the Global Burden of Disease Study in 2013 which estimated that there were 314,000 occupational cancer deaths worldwide[5]. Lung cancer, mesothelioma, laryngeal cancer and leukaemia were the most common cancer types.

There are also a range of country-specific estimates such as a UK study which found that workplace exposures accounted for 4% of cancer cases (5.7% in men and 2.2% in women) and 5.3% of cancer deaths (8.2% in men, 2.3% in women) in Great Britain in 2005[6].

Estimating the cancer burden is challenging for a number of reasons including the lack of good quality data on exposure, uncertainty about the nature or strength of the association between the exposure and cancer incidence and uncertainty about latency. This explains much of the variation between the estimates arising from different studies.


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References

  1. 1.0 1.1 1.2 1.3 Carey RN, Driscoll TR, Peters S, Glass DC, Reid A, Benke G, et al. Estimated prevalence of exposure to occupational carcinogens in Australia (2011-2012). Occup Environ Med 2014 Jan;71(1):55-62 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/24158310.
  2. Driscoll T. Review of Australian and New Zealand workplace exposure surveillance systems. Canberra: Commonwealth of Australia; 2006.
  3. Fingerhut M, Nelson DI, Driscoll T, Concha-Barrientos M, Steenland K, Punnett L, et al. The contribution of occupational risks to the global burden of disease: summary and next steps. Med Lav 2006 Mar;97(2):313-21 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/17017364.
  4. World Health Organization. WHO global health risks. Mortality and burden of global health risks. Mortality and burden of disease attributable to selected major risks. Geneva, Switzerland: WHO; 2009 Available from: http://www.who.int/healthinfo/global_burden_disease/GlobalHealthRisks_report_full.pdf.
  5. GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015 Jan 10;385(9963):117-71 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/25530442.
  6. Rushton L, Bagga S, Bevan R, Brown TP, Cherrie JW, Holmes P, et al. Occupation and cancer in Britain. Br J Cancer 2010 Apr 27;102(9):1428-37 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/20424618.

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