1. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Renee N Carey 1 and the AWES-Cancer team 1-4 The lifetime risk of occupational lung cancer in Australia 1.School of Public Health, Curtin University 2.School of Public Health, University of Sydney 3.Department of Epidemiology and Preventive Medicine, Monash University 4.School of Population Health, University of Western Australia

2. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Lung Cancer  Malignant tumour in tissue of one or both lungs  Fifth most common cancer in Australia 10,511 new cases diagnosed in 2011 (9% of all cancers) Risk of diagnosis by age 85 is 1 in 16 (6%)  Leading cause of cancer death, accounting for 19% of all cancer deaths 8,137 deaths from lung cancer in 2012 5-year survival rate 14%  More common in men (61% cases) than women (39%)

3. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Lung Carcinogens  Number of carcinogens associated with lung cancer, including: Tobacco smoke (including passive) Air pollution Asbestos Diesel engine exhaust Ionising radiation Metals including arsenic, beryllium, cadmium, hexavalent chromium, nickel Silica

4. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Occupational Lung Carcinogens  Recent Australian study (AWES) investigated current prevalence of exposure to 13 occupational lung carcinogens  Overall 31% sample exposed to at least one lung carcinogen (45% males, 13% females) Diesel engine exhaust: 19% Environmental tobacco smoke: 14% Silica: 7% Other polycyclic aromatic hydrocarbons: 6%  Extrapolated to approximately 2.9 million workers

5. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Exposure by Occupation  Most commonly exposed occupational groups: Miners: 100% Heavy vehicle drivers: 99% Farmers: 98% Vehicle tradespeople (e.g. mechanics): 95% Automobile drivers (e.g. couriers): 93% Construction workers: 90%

6. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Link between Exposure and Cancer  AWES provides detailed information on: what lung carcinogens workers are exposed to; who is exposed; and how prevalent those exposures are.  However, contribution of these exposures to future burden of lung cancer not known

7. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Our Research Question What proportion of future lung cancers will occur in those people who were occupationally exposed to lung carcinogens in 2012, as a result of their exposure?

8. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J An Illustration Cohort of Australian working population Exposed population Baseline lung cancers Excess lung cancers in exposed

9. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Lifetime Risk Approach  Used to estimate proportion of future lung cancers due to exposure occurring in the proportion of the population who were exposed in 2012 19502094 Working age population in 2012 (including exposed cohort) Start cancer count End cancer count

10. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Lifetime Risk Approach – Required Input  4 required inputs: Estimate of proportion of population currently exposed to carcinogens of interest (obtained from AWES) Relative risk estimate for each exposure (obtained from literature) Estimate of future lung cancer rates (projected from current rates using Canproj) Estimate of future person years at risk (estimated using life table mortality rates and lung cancer incidence rates)

11. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Lifetime Risk of Lung Cancer in the 2012 Working Age Population (LR WP )

12. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Excess Lifetime Risk

13. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Future Excess Number (FEN) and Future Excess Fraction (FEF)

14. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Combining Exposures

15. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Results - Overall MaleFemaleTotal Total lung cancers in cohort 408,650319,700728,350 Excess lung cancers due to exposure 25,100142026,530 Overall Future Excess Fraction 6.1%0.4%3.6%

16. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Results by Exposure – FENs (>50 cancers) Future Excess Number (n) ExposureMFTotal Asbestos3515203535 Cadmium19116207 Chromium VI1322401362 Diesel Engine Exhaust 4242924334 ETS32386363874 Nickel49372485184 Other PAHs26972192916 Silica56411175758

17. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Results by Exposure – FEFs (>50 cancers) Future Excess Fraction (%) ExposureMFTotal Asbestos0.90.010.5 Cadmium0.050.010.03 Chromium VI0.30.010.2 Diesel Engine Exhaust 1.00.030.6 ETS0.80.20.5 Nickel1.20.10.7 Other PAHs0.70.10.4 Silica1.40.040.8

18. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Implications  Results can show us where greatest burden is coming from (what exposures are leading to the most cancers)  Also possible to look at this by occupation and/or industry (results not presented) Future Excess Number (n) ExposureMFTotal Asbestos3515203535 Cadmium19116207 Chromium VI1322401362 Diesel Engine Exhaust 4242924334 ETS32386363874 Nickel49372485185 Other PAHs26972192916 Silica56411175758

19. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Implications and Future Research  Can also see potential effect of various interventions to reduce exposure – e.g. Banning particular carcinogens Reducing exposure to particular carcinogens Closing high risk industries Changing tasks which may lead to high levels of exposure Increasing use of protective equipment

20. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Assumptions of Lifetime Risk Model  Use of current prevalence of exposure – assume a normal distribution around this prevalence  No latent period Because some people have been exposed for long time in past, may be getting their cancers now so no need for latent period  Use of modelled future cancer incidence rates rather than present rates 2012

21. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Conclusions  Used lifetime risk to estimate contribution of current exposure to future risk of lung cancer Estimated that 26,530 future cancers will occur in 2012 exposed population as result of exposure  Results can be used to show where greatest burden coming from (in terms of exposure, occupation, and/or industry)  Can also model potential effect of preventive interventions

22. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Acknowledgements  AWES Cancer team Lin FritschiTim Driscoll Deborah GlassSusan Peters Alison ReidGeza Benke Ellie DarceySi Si Sally HutchingsLesley Rushton Jayzii Chan  National Health and Medical Research Council; Cancer Council of Western Australia

23. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Email: renee.carey@curtin.edu.au