1. 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

2. 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

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

4. 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)
August 2013

5. 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.

6. 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

7. Distribution of Work-related illness by WHO regions

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

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

10. 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

11. 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

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

13. Bernardino Ramazzini

14. 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