What should we be doing to prevent occupational diseases from hazardous substances?

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What should we be doing to prevent occupational diseases from hazardous substances? John Cherrie

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Summary… Workplace disease The case of workplace cancers Two key observations that help us plan our approach Two examples: Vinyl chloride monomer Respirable crystalline silica Let’s be bold in our commitment for the future

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Accidents and disease around the world WHO regions AFRO AMRO EURO SEARO WPRO EMRO

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Fatal workplace disease/accident rates Hamalainen P, Saarela KL, Takala J. Global trend according to estimated number of occupational accidents and fatal work-related diseases at region and country level. Journal of Safety Research 2009;40:125–39.

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Ratio disease to accidents

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Workplace diseases and their causes… Pruss-Ustun A, Vickers C, Haefliger P, et al. Knowns and unknowns on burden of disease due to chemicals: a systematic review. Environmental Health 2011;10:9.

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Let’s get specific: workplace cancers In 1981 Richard Doll and Richard Peto were commissioned by the US government to assess the relative importance of the “environment” in causing cancer Their aim was to identify the proportion of cancer that is preventable Sir Richard Doll

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Attributable fractions…

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Cancer burden in the UK… Designed to update Doll and Peto’s estimate for occupational cancer burden Current burden (2010) Future burden (to 2060) Method based on: Risk of Disease (relative risk from published literature) Proportion of Population Exposed Estimation for IARC groups 1 (definite) and 2A (probable) carcinogens and occupational circumstances Rushton L, Hutchings SJ, Fortunato L, et al. Occupational cancer burden in Great Britain. Br J Cancer 2012;107:S3–S7.

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Attributable fraction… Men = blue Women = red

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Not all carcinogens are equally important 85% of the cancer cases come from the top ten chemical agents

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Some good news… Creely KS et al. (2007) Trends in inhalation exposure--a review of the data in the published scientific literature. Ann Occup Hyg.; 51(8): 665-678. Aerosols

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Some good news… Creely KS et al. (2007) Trends in inhalation exposure--a review of the data in the published scientific literature. Ann Occup Hyg.; 51(8): 665-678. Gases and vapours

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VCM levels in a English PVC plant 14

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Burden should be decreasing… If exposure is decreasing then it seems likely that the future burden will also be lower Assumes Risk is related to exposure Prevalence of exposure is not increasing The aging population is not distorting the picture

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So what does the future hold? We have estimated current and future cancer burden in Europe and socioeconomic costs of interventions for a number of workplace carcinogens Exposure levels reliant on stakeholder data or when unavailable published sources Risk assessment reliant on epidemiological studies or analogy Health impact carried out using carefully reviewed methodology developed for British cancer burden study Socioeconomic assessment based on EC guidance Hutchings S, Cherrie JW, van Tongeren M, et al. Intervening to Reduce the Future Burden of Occupational Cancer in Britain: What Could Work? Cancer Prevention Research Published Online First: 7 September 2012.

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Future burden estimates for VCM… Increased risks angiosarcoma of liver and possible hepatocellular carcinomas 19,000 people exposed in Europe Geometric mean exposure level 0.05 ppm, 5% exposed above 3 ppm Current burden - 14 liver cancers By 2060 we expect there to be no cancer deaths due to workplace VCM exposure

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Risk already eliminated for some substances In our assessment of current burden in Europe we estimate <20 cancers/year from past exposure for: Vinyl chloride monomer 14 cases 1, 3 Butadiene 2 cases Beryllium 7 cases Acrylamide 7 cases MbOCA 8 cases Ethylene oxide 0 cases Refractory ceramic fibre 2 cases 1, 2-Epoxypropane 0 cases Bromoethylene 0 cases 1,100,000

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Estimates of future burden for silica… Crystalline silica in Europe: 720,000 people exposed About 40% exposed above 0.05 mg/m3 Current burden 7,600 lung cancers 460,000 cases between 2010 and 2069 Cost of inaction between €190,000m to €490,000m

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Lung cancer registrations - baseline

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Lung cancer registrations - intervention

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The cost and benefits of intervention… Total net health benefits by 2069 from setting an OEL at 0.05 mg/m3 are €28,000m to €74,000m Costs of compliance estimated to be €34,000m About half of these costs arise in construction Most costs fall on small companies

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However, we could just wait…

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We could “eliminate” workplace cancer Elimination of the disease as a public health problem (i.e. reduction of cases below what is considered to be a public health risk) What might be “a public health risk” for occupational cancer? Reduction of incidence to <<1% of all cancers?

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A challenge… Focus on the top ten causes of the occupational cancer burden (and/or COPD) Ensure that exposures continue to fall by about 10% per annum We have eliminated the problem when an assessment of future burden from current exposure is <1% of all cancers

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Acknowledgements… The work was in part funded by the British Health and Safety Executive (HSE) and the European Commission (EC) However, the views presented here are my own Collaborators include: M Gorman Ng, A Shafrir, M van Tongeren, A Searl, J Crawford, A Sanchez-Jimenez, J Lamb (IOM) R Mistry, M Sobey, C Corden, O Warwick and M-H Bouhier (AMEC UK) L Rushton and S Hutchings (Imperial College) T Kaupinnen and P Heikkila (Finnish Institute of Occupational Health),H Kromhout (IRAS, University of Utrecht), L Levy (IEH, Cranfield University)

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Questions… You can contribute to the discussion at www.OH-world.org John.Cherrie@iom-world.org