1. South West Public Health Observatory South West Regional Public Health Group Occupation and Cancer Richard Hancock South West Public Health Observatory

2. South West Regional Public Health Group Topics Reasons occupation linked to cancer Changes in occupation Identifying occupational carcinogens Burden of occupational cancer in South West Examples - mesothelioma in the South West Future

3. South West Public Health Observatory South West Regional Public Health Group Occupation and Cancer Carcinogens e.g. scrotal cancer among chimney sweeps, mesothelioma among shipyard workers liver angiosarcoma from vinyl chloride monomer, bladder cancer from benzidine, nasal cancers from wood dust Lifestyle Smoking Lack of exercise, obesity

4. South West Public Health Observatory South West Regional Public Health Group Changes in employment patterns From “production” to “service” industries!

5. South West Public Health Observatory South West Regional Public Health Group South West - 1971

6. South West Public Health Observatory South West Regional Public Health Group South West - 2001

7. South West Public Health Observatory South West Regional Public Health Group Occupations 2004 - England v South West

8. South West Public Health Observatory South West Regional Public Health Group Occupational carcinogens and cancer Important because of impact on individuals and community, and potentially avoidable Numbers of cancers probably small compared with smoking Equity

9. South West Public Health Observatory South West Regional Public Health Group Carcinogenicity Evidence Epidemiological – elevated cancer numbers in particular groups of workers Experimental – e.g. cause cancer in mice

10. South West Public Health Observatory South West Regional Public Health Group Listing occupational carcinogens is difficult*! Not a simple “good guy” v “bad guy” Many carcinogens also found in environment Evidence usually fragmentary Levels of exposure may change * Siemiataycki et al 2004: Listing occupational carcinogens. Environmental Health Perspectives 2004; 112: 1447-1459. www.ehponline.org/members/2004/7047/7047.pdf

11. South West Public Health Observatory South West Regional Public Health Group Sources of information IARC International Association for Research in Cancer (IARC) Monographs - reviews CAREX European CARcinogen Exposure database

12. South West Public Health Observatory South West Regional Public Health Group Ten commonest UK carcinogen exposures 83% of carcinogen exposed UK employees

13. South West Public Health Observatory South West Regional Public Health Group Other common UK carcinogen exposures 14% of carcinogen exposed UK employees

14. South West Public Health Observatory South West Regional Public Health Group Relative risks of occupational carcinogens Challenging area Estimation of risks for particular compound(s) Data on exposure Interaction with e.g. smoking “For most agents the information is fragmentary”* * Siemiataycki et al 2004: Listing occupational carcinogens. Environmental Health Perspectives 2004; 112: 1447-1459. www.ehponline.org/members/2004/7047/7047.pdf

15. South West Public Health Observatory South West Regional Public Health Group Estimating numbers of occupational cancers Doll & Peto - The causes of cancer – quantitative estimates of avoidable risks of cancer in the United States today. Oxford: Oxford University Press; 1981. “Attributable fractions” - proportion of cancers estimated to be due to occupational causes 4% (2 – 8%) Specifically excluded some groups of “occupational cancers”

16. South West Public Health Observatory South West Regional Public Health Group Estimating numbers in UK Multiply figures for incidence and mortality by “attributable fractions” ( http://hse.gov.uk/statistics/tables/can01.htm ) http://hse.gov.uk/statistics/tables/can01.htm “Attributable fractions” derived from Doll and Peto, 1981, American workers Further work in progress HSE/Dr Lesley Rushton, Imperial College

17. South West Public Health Observatory South West Regional Public Health Group Estimates for South West - example Male deaths from bladder cancer in SW in 2004 293 Attributable fraction for bladder cancer in males 0.1 Estimated number deaths attributed to occupation - 0.1 x 293 29

18. South West Public Health Observatory South West Regional Public Health Group

19. South West Public Health Observatory South West Regional Public Health Group

20. South West Public Health Observatory South West Regional Public Health Group Estimates of deaths in South West Total cancer deaths in SW in 2004 12,111 Estimated cancer deaths attributed to occupation 565 Attributed to smoking 8,300

21. South West Public Health Observatory South West Regional Public Health Group Radon in the workplace Some workplaces significant levels of radon (e.g. small ground floor rooms, utility ducts) 90 – 280 UK lung cancer deaths per year related to workplace exposure (+ smoking) Majority of employers not undertaken risk assessments HSE working with local stakeholders Gareth.Thomas@hse.gsi.gov.uk Gareth.Thomas@hse.gsi.gov.uk Radon South West Committee

22. South West Public Health Observatory South West Regional Public Health Group Mesothelioma & asbestos Pleura of lungs (mostly) More than 80% of mesothelioma cases related to asbestos 20-60 years between exposure and symptoms Survival is usually less than 2 years Possible routes of exposure – –Occupational –Environmental –Items in home –Exposure from family member

23. South West Public Health Observatory South West Regional Public Health Group Mesothelioma in the UK JT Hodgson et al, Brit. J. Can. 92, 587-593 (2005) Female cases approximately 12% of total

24. South West Public Health Observatory South West Regional Public Health Group Industry in the South West of England Population based cancer registry 6.6 million people Shipyard Other

25. South West Public Health Observatory South West Regional Public Health Group Mesothelioma – male 99.8% deviation by ward 0.01p 13 000Pop 38n 2.4RR <0.001p 311 000Pop 763n 2.2RR <0.001p 147 000Pop 432n 2.6RR Plymouth Swindon Portsmouth & Southampton “Satscan” Clustering tool Deaths 1980-2005 Clear effect after 40+ years of population mixing! M. Kulldorff, Comm. Stat: Theo. & Meth. 26:1481-1496 (1997)

26. South West Public Health Observatory South West Regional Public Health Group Mesothelioma in the South West of England – modelling the number of cases Age – period – cohort model gives good agreement to data.

27. South West Public Health Observatory South West Regional Public Health Group Male and female rates 29:1 male:female ratio in Plymouth, 12:1 in Southampton Consultation with Trade Union Congress revealed that, uniquely, the Devonport dockyard in Plymouth operated a workers laundry service.

28. South West Public Health Observatory South West Regional Public Health Group Mesothelioma Clear link to occupational asbestos exposure Local good practice reduced effects on family Reductions in death rates expected with increased regulation Monitor HSE at work should include

29. South West Public Health Observatory South West Regional Public Health Group Passive smoking in the workplace Increase in lung cancer risk of 12 – 19%* Frequency of cancer in “never smokers” 0.4% Increased frequency with passive smoking 0.45 – 0.48% “Passive smoking” UK lung cancer deaths/year 160** * Tobacco smoke and involuntary smoking – IARC Monograph 83 – 2004 **Deaths attributable to passive smoking – Jamrozik, BMJ - 2005

30. South West Public Health Observatory South West Regional Public Health Group Occupation and lifestyle Smoking Commoner in particular groups of workers Linked to deprivation Key area for “Choosing Health”

31. South West Public Health Observatory South West Regional Public Health Group Future Exposure to occupational carcinogens being reduced Lack of exercise could cause more “work-related” cancer than all the “traditional” carcinogens (Pukkala in Burden of occupational cancer in Great Britain http://www.hse.gov.uk/research/hsl_pdf/2005/hsl0533.pdf) http://www.hse.gov.uk/research/hsl_pdf/2005/hsl0533.pdf “Health and Safety” at work should include access by walking and cycling - “active travel”?

32. South West Public Health Observatory South West Regional Public Health Group “Active living” environment* Many great public health interventions by planners, architects, engineers. Need to call on those sectors again “Active living” friendly environment should be key objective in town and transport planning *Dr Harry Burns, Chief Medical Officer for Scotland www.activetravel.org.uk

33. South West Public Health Observatory South West Regional Public Health Group Acknowledgements SWPHO Julia Verne, Sean McPhail, Andy Pring, Annika Evans, Helen Cooke, Mark Dancox, Matthew Greenslade, Lynn Kirkham, Kate Lachowycz, Pauline Masurel, Wendi Slater, Bob Muliss, Mary Shaw, Ben Wheeler HSE Gareth Thomas, Damien McElvenny HPA Mike Studden, Daryl Dixon

34. South West Public Health Observatory South West Regional Public Health Group Thank You! More info – www.swpho.nhs.uk