World Health Organization Collaborating Centre for Occupational Health Cancer Excess as a Marker of Disparity: The Case of Occupational and Environmental Cancer Melissa A. McDiarmid, MD, MPH, DABT University of Maryland School of Medicine Division of Occupational and Environmental Medicine World Health Organization Collaborating Centre for Occupational Health

World Health Organization Collaborating Centre for Occupational Health Health Disparity …definitions vary but most address differences in health status between one population in comparison to a more advantaged group. (Carter-Pokras & Baquet, 2002) …most address issues of equity

Too much of a bad thing regarding health status… Excess as Disparity Too much of a bad thing regarding health status…

Cancer Facts 1.5 million new cancer cases in 2013 (WHO) 70% increase in new cases over next 2 decades Majority of increase in LMICs ILO estimates ~70,000 occupational cancer deaths annually Occupational cancer is the biggest killer at work in High Income Countries (WHO Classification) https://goo.glo/fuUXsl August 2013

Preventing Disease Through Healthy Environments Annually about 19% of all cancers are attributed to environmental/occupational exposure Resulting in 1.3 million deaths Occupational exposures cause 5.3 – 8.4% of all cancers, and among men, up to 30% of all lung cancer deaths.

Environment Health Threats Arising from: Manufacturing Energy production Fossil fuel consumption Unsustainable resource use Agriculture These activities are associated with growing problems of: Hazardous waste Air and water pollution Occupational exposures Climate change Unequal capabilities in technology and infrastructure Slide shared by W. Suk

Distribution of Work-related illness by WHO regions https://www.wsh-institute.sg/files/wshi/upload/cms/file/Global%20Estimates%20of%20Occupational%20Accidents%20and%20Work-related%20Illness%202014.pdf

Most frequent carcinogens and exposures at work in the United States 85% of the cancer cases come from the top ten chemical agents

National Institutes of Health U.S. Department of Health and Human Services

Global Infections and Cancer ~16% of newly diagnosed cancers may be attributable to infections. Mechanisms of cancer induction: interactions between the environment, host genetics, and other factors. Less-developed countries had a higher percentage of infection-related cancers. Slide shared by W. Suk

No country can treat it’s way out of this problem... What is our response? No country can treat it’s way out of this problem... prevention is key. K. Straif, IARC/CR

Planning Policy and Advocacy Diagnosis and Treatment Prevention Early Detection Palliative Care

Bernardino Ramazzini

Scientific Session III: Cancer Disparities, Occupational and Environmental Risks and Prevention Strategies CT screening for lung cancer: an unprecedented opportunity to reduce occupational cancer mortality Steven Markowitz, USA Low dose chest CT in asbestos-exposed workers Laura Welch, USA Cancer excesses in Ramazzini Institute clinical cohort Angela Guaragna, Italy The role of general practitioners in contrasting cancer care disparities Pier Giorgi Natali, Italy