OCCUPATIONAL CANCER Funded by the Netherlands embassy, Ankara, Turkey

Learning Objectives Knowing about common hazards for occupational cancer in metal sector Be able to identify the cancer risks for metal sector workers 2

3 Introduction.. One of every two or three individuals in the industrialized world will develop some type of cancer during their lifetimes Approximately 3-10% of all human cancers are thought to be caused by occupational exposure to carcinogens It is estimated that approximately 20,000 cancer deaths and 40,000 new cases of cancer each year in the U.S. are attributable to occupation

4 Exposure to carcinogens at work place Environmental exposure to carcinogens Having certain medical conditions Diet and Personnel habits Personal characteristics Family History Risk of developing a particular cancer

Induction period 3-5 years for radiation or toxin induced Leukemia 40 or more asbestos-induced Mesothelioma For most tumors about years

The most common cancers associated with occupational exposure: lung and pleura bladder skin laryngeal nasal cavity leukemia throat lymphoma soft-tissue sarcomas liver

7 Most widespread carcinogens at work : Solar radiation Passive smoking Crystalline silica Diesel engine exhausts Radon Wood dust Lead and its inorganic compounds Benzene Asbestos Formaldehyde Chromium VI

Cancer Registry by Industry Nasopharyngeal: carpenters and other blue collar special trade construction Colorectal: machinery manufacturing, printing Liver: general construction and rubber and plastics Gallbladder: electrical equipment Lung: primary metals, shipbuilding, construction, and stone, clay, and glass Mesothelioma: shipbuilding and asbestos manufacturing Source : New Jersey cancer registration - USA

Cancer Registry by Industry Breast: (females) chemical and pharmaceutical Bladder: (males) apparel and textile industries. Non-Hodgkin's lymphoma: – (females) printing – (male) bakers and motor vehicle manufacturing Lymphocytic leukemia: chemical and construction Source : New Jersey cancer registration - USA

Lung cancer (Steenland, 1996) silica asbestos diesel engine exhaust radon progeny arsenic chromium, beryllium, nickel, and cadmium acrylonitrile

Cutting fluid exposure (Eisen, 1992) 85% increase of laryngeal cancer (also stomach)

International Agency of Research on Cancers IARC

IARC Evaluations Dimensions and Groups 13 Types of evidence Human Animal Other - mutagenicity - genotoxicity - metabolism - etc. Group 1Carcinogenic to humans 2AProbably carcinogenic to humans 2BPossibly carcinogenic to humans 3Not classifiable 4Not carcinogenic to humans

Numbers of occupational carcinogens and high risk occupations and industries designated by the IARC Monograph Programme, Siemiatycki et al, Environ Hlth Persp, 2004, MixturesOccupations Groups & Agents& Industries 1(definite) A(probable) B(possible) 113 4

Lung cancer (Exposures) Tobacco smoking is responsible for nearly 90% of all lung cancers. Second-hand smoke Byproducts of fossil fuel Air pollution Insufficient consumption of fruits and vegetables High doses of ionizing radiation Asbestos Radon chloromethyl ethers Polycyclic aromatic hydrocarbons Inorganic arsenic Chromium Nickel Mustard Gas Generalworkplaces

Mesothelioma (exposure) Asbestosis (trivial contact) Crocidolite: the most potent carcinogen

Mesothelioma (prevention) OSHA PEL (1970) :5 Fiber/cm3 (1986):2 fiber/cm3 now: 0.1 fiber/cm3 Asbestos ban : since 1989 by EPA

Asbestos Ban (1989)

Bladder cancer (exposure) The most important risk factor is cigarette smoking. Heavy coffee consumption (Possible risk factors ) Bladder infection with schistosoma Cyclophosphamide Long-term use of pain killers containing phenacetin, Urinary tract infections or low urine flow Genetic factors Benzidine 2-naphthylamine Occupations in the dye, leather or rubber industry Chlornaphazine 4 chlorotoluidine Phenacetine Generalworkplace

Bladder cancer (prevention) Avoidance of exposure Medical monitoring : Urinary cytology (75% Sen Spes.) Immunocytology

Liver cancer (hepatic angiosarcoma) (exposure) Vinyl chloride Arsenic Copper, Lead, Zinc Thorotrast (thorium dioxide)

Liver cancer (hepatic angiosarcoma) (prevention) Avoidance of exposure Medical monitoring (history, Ph/E, CBC, LFT, Ultrasonography)