Common workplace cancers Lin Fritschi Curtin University is a - PowerPoint PPT Presentation

Common workplace cancers Lin Fritschi Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J

Case study  A man born in 1950 presents with painless haematuria which has been present for about 4 weeks. You have been seeing him occasionally for 15 years and his past history includes borderline hypertension, mild intermittent rosacea, and occasional acute bronchitis. He has never smoked and drinks 3-4 standard drinks a week. On questioning he states that he has noticed that he has increased frequency of urination including nocturia for the past year. He has some slight back pain but no other symptoms. Physical examination is unremarkable. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J

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 His wife is incapacitated with severe osteoarthritis in her hips and knees and he was her primary carer. They have no children. His death has severe ramifications for her, as she is unable to live at home alone, and they have virtually no savings and no assets.  Would taking an occupational history have helped with early diagnosis and better outcome, or with compensation? Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J

Occupational history  1965 Labourer on various building sites, mainly assisting carpenters and bricklayers  1971 Packer in chicken processing factory, wrapping, grinding and packing meat  1978 Worked in the vulcanization section of a rubber manufacturing plant  2000 Part time cleaner in office blocks  2014 Retired Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J

“Then the vulcanising processes begin their weird work. The distinctive feature of a rubber factory is that everything is finished with heat. The odours of brimstone and roasting rubber have a tang of their own, and are all-permeating but not unpleasant .” Gillespie ON. Rubber goods. NZ Railways Magazine 1940;14:49-53

Occupational cancer  A cancer which is caused wholly or partly by exposure to a carcinogen at work  Easy to prove if • The carcinogenic effect of an agent is very strong • The cancer is rare  Otherwise difficult to prove because • No pathological or clinical features which distinguish occupational cancers • Long delay between the time of exposure and the diagnosis of cancer • Multiple exposures including lifestyle risk factors Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J

What is a “common” occupational cancer?  Largest number of cancers due to occupation  Highest proportion of that type of cancer which are occupationally related  Likelihood of a cancer being occupationally related if the person had a relevant exposure Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J

Occupational cancer numbers  Rushton et al, British Journal of Cancer 2012;107:Suppl 1  Requirements List of established carcinogen-cancer type combinations Proportion of population exposed to each carcinogen Number of each type of cancer occurring in the whole population Relative risk of cancer in the exposed subgroup for each carcinogen-cancer type combination  Applied to Australia to give an approximation Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J

Largest number of cancers due to occupation - Australia (approximate) Cancer Total N in males N in females occupational TOTAL 3400 710 4110 Lung 1430 50 1480 Leukaemia 440 130 570 Melanoma 470 30 500 Breast 0 460 460 Mesothelioma 400 10 410 Laryngeal 160 5 165 Lip 140 5 145 Stomach 110 <5 115 Bladder 80 <5 85 Sinonasal 50 <5 55 Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J

Highest proportion of each type of cancer which are occupationally related - approx AF m AF f Mesothelioma 75% 10% Sinonasal 70% 10% Laryngeal 30% 5% Pharyngeal 30% 5% Leukaemia 20% 10% Lung 25% <5% Lip 20% <5% Ocular melanoma 15% <5% Nasopharyngeal 10% <5% Stomach 10% <5% Melanoma 5% <5% Bladder 5% <5% Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J

Likelihood of a cancer being occupationally related if the person had a relevant exposure Approximate Cancer Exposure RR-High Odds Mesothelioma Asbestos 42 41 in every 42 Lung Asbestos 1.5 1 in every 3 Agudo et al, 2000. Goodman et al, 1999 Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J

Mesothelioma in WA by exposure category and calendar period Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Olsen et al, MJA 2011;195:271-274

Likelihood of a cancer being occupationally related if the person had a relevant exposure RR- Cancer Exposure High Ratio Nasal/paranasal Leather dust 12 11 in every 12 Nickel 9 8 in every 9 Wood dust 6 5 in every 6 Chromium VI 5 4 in every 5 Formaldehyde 2 1 in every 2 Fu et al, 1996. Grimsrud and Peto, 2006. Demers et al 1995. Rosenman and Stanbury, 1996. ‘t Mannetje et al, 1999. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J

Think about occupation in men for…. total AF n WA occupational 80 Mesothelioma 75% 60 Sinonasal 70% 9 6 Laryngeal 30% 29 9 Pharyngeal 30% 71 21 Lung 25% 578 132 Leukaemia 20% 169 31 105 Lip 20% 19 Ocular melanoma 15% 9 1 Nasopharyngeal 10% 6 1 Stomach 10% 143 12 734 Melanoma 5% 51 Bladder 5% 230 10 Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J

Occupations for mesothelioma Occupations and exposures Mesothelioma Asbestos http://www.abc.net.au/radionational/programs/scienceshow/the-search- http://theconversation.com/diy-renovators-now- for-asbestos-worker-jeremy-tear/4363568 most-at-risk-of-asbestos-cancers-3206 Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J

Occupations for sinonasal and nasopharyngeal cancer Occupations and exposures Pathologists and laboratory Wood workers, leather workers Welding, metal cutting, plating, nickel refining http://www.buddyskitch en.ca/blogart28 Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J http://www.wisegeek.org/what-is-particle-board.htm http://www.austandnzdefence.com/listings/list ing_details/phoenix-australasia-pty-ltd

Occupations for lung cancer Occupations and exposures Asbestos. Stone cutting (silica). Ionizing radiation Heavy industry metals, soots, coal burning, firefighters, road paving, Metal workers, machinists, welders, plating Painting, printing, chemicals, dyes http://www.atlenv.com/osha-proposes- http://www.slate.com/blogs/future_tense/201 stricter-crystalline-silica-dust-rule/ 5/02/24/free_air_carbon_capture_a_climate_ Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J engineering_idea_worth_considering.html http://www.toxipedia.org/display/toxipedia/A +Small+Dose+of+Solvents

Bladder cancer Occupations and exposures Production of: coal tar, coal gas, coke, metals, rubber, Road paving, firefighters, drivers, Metal workers, painters, chemical production http://www.keenovens.com/articles/steel-furnance.htm Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J http://www.geofftompkinson.com/gt_gallery/science-industry/ http://switchboard.nrdc.org/blogs/dbailey/diesel_truck_pollution_the_tru.html

Think about an occupational cause in women n in AF total pa WA 14 Mesothelioma 7% 1 Leukaemia 10% 120 12 Lung 1% 422 6 Breast 3% 1569 52 Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J

Bladder cancer in the rubber industry Cancer Exposure RR-High (95% CI) Rubber industry >1 year Bladder PAHs, N-nitrosamines, ~5 solvents, naphthylamine Start screening – 20 years after start of exposure How often – 6 monthly Type of screen – urinary cytology Clin B; "RecoCancerProf" Working Group, Pairon JC. Medical follow-up for workers exposed to bladder carcinogens: the French evidence-based and pragmatic statement. BMC Public Health. 2014 Nov 6;14:1155 . Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J

Acknowledgements Renee Carey, Ellie Darcey, Alison Reid, Deborah Glass, Tim Driscoll, Geza Benke, Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J