1. FIOH / Tampere Occupational cancer Tööga seotud kopsuhaigused Tartu, 8.-9. oktoober 2003 OCCUPATIONAL LUNG CANCER Panu Oksa Soome Töötervishoiu Instituut Tampere, Soome Finnish Institute of Occupational Health, Tampere, Finland

2. FIOH / Tampere Occupational cancer Yearly about 20 000 new cancer cases occur in Finland Men in year 1997 prostate 2857 LUNG1536 colon/rectum 973 urinary bladder 606 ventricle 473 kidney 422 Women in year 1997 breast 3329 colon/rectum1112 uterus 663 ovaries 622 LUNG 478 central nervous system 446

3. FIOH / Tampere Occupational cancer New lung cancer cases /year in Finland YEARMENWOMEN ______________________________________ 19571106118 19621422113 196717571154 19722099266 19822015298 19871870378 19921837429 19971536478

4. FIOH / Tampere Occupational cancer Number of occupational cancers percentage of occupational cancers is unknown epidemiological studies indicate 2-6% of all cancer cases In Finland latest estimate is 2%. For men 4% and for women less than 0.1% (Dreyer, Andersen & Pukkala, 1997)

5. FIOH / Tampere Occupational cancer Occupational cancers in Finland Finnish Register for Occupational Diseases 1964-2001 CANCER /CAUSENUMBER OF CASES Lung1021 asbestos1004 quartz 6 hydrocarbons 3 radon 2 other/unknown 6 Pleura 366 asbestos 364 other/unknown 2 Peritoneum 18 asbestos 18

6. FIOH / Tampere Occupational cancer

7. Why occupational cancer is not always detected? occupational exposure to carcinogen not known long latency period other etiology, multi-etiology occupational etiology has been detected, but cancer case has not been reported

8. FIOH / Tampere Occupational cancer Occupational cancers in Finland Finnish Register for Occupational Diseases 1964-2001 2 CANCER /CAUSENUMBER OF CASES Bladder 11 aromatic amines 6 other/unknown 6 Leukemia 8 ionizing radiation 4 benzene 2 other/unknown 2 Nose 7 nickel 3 wood dust 2 chromium compounds 2 Larynx 6 asbestos 2 other/unknown 4 Other cancers 26

9. FIOH / Tampere Occupational cancer Risk for lung cancer among asbestosis patients in different studies. ____________________________________________________________________________ Reference Number of patientsRisk for lung cancer SMR, OR or RR (95% CI) _______________________________________________________________________ Huuskonen, 1978 202RR 9.0 Liddell and McDonald, 1980SMR 3.5 (2.7-4.4) Berry, 1981 665SMR 9.1 (7.5-11) Finkelstein et al., 1981 172SMR 7.9 (3.9-14) Cookson et al., 1985 354SMR 5.1 (3.2-7.9) Coutts et al., 1987 155SMR 7.4 (4.7-11) Hughes and Weil, 1991 77SMR 4.3 (1.9-8.2) Sluis-Cremer, 1991 97RR 8.3 Waage et al., 1994 86OR 3.7 Hillerdal, 1994b 166RR 2.3 (1.1-4.4) Wilkinson et al., 1995 211OR 2.0 (1.0-4.1) Karjalainen et al., 19971287SIR 6.8 (5.7-8.0) Oksa et al., 1997 128SIR 10 (6.9-14) SMR 8 (5.2-12)

10. FIOH / Tampere Occupational cancer Occupational carcinogens Most common are: asbestos, silica, wood dust, diesel exhaust, benzene, chromates and nickel compounds International Agency for Research on Cancer, IARC, evaluates agents and classifies these into groups 1, 2A, 2B, 3 EU and different countries have their on lists

11. FIOH / Tampere Occupational cancer Carex is an international information system on occupational exposure to known and suspected carcinogens, (CARsinogen EXposure) includes data on 139 agents evaluated by IARC, groups 1 and 2A, selected agents in 2B, eg, Carex report of Estonia Rjazanov et al. 1997 SEE: www.ttl.fiwww.ttl.fi

12. FIOH / Tampere Occupational cancer Carex reports of Estonia and Finland in 1999-2000 about 180 000 workers (29% of the employed) exposed to agents covered by Carex in Estonia in 1997. Number of exposures is about 240 000 in 1990-1993 in Finland about 500 000 workers (24% of the employed) exposed to 139 agents covered by Carex, 650 000 exposures

13. FIOH / Tampere Occupational cancer Most common exposures Carex reports of Estonia and Finland Estonia solar radiation 62 000 wood dust 34 000 tobacco smoke 31 000 diesel exhaust 21 000 silica 19 000 radon 14 000 formaldehyde 9 000 Finland solar radiation 180 000 env. tobacco 110 000 silica 80 000 wood dust 65 000 radon 50 000 diesel exhaust 40 000 benzene 14 000

14. FIOH / Tampere Occupational cancer Asbestos and lung cancer -1- all different asbestos forms are carcinogenic latency period is usually over 20 years (10-40) (time lag from the beginning of the exposure to cancer diagnosis) 200 Finnish asbestos sprayers: risk for lung cancer SIR 17, 95% CI 8.2-31 Paakkilan asbestos quarry and enricher (1000 worker cohort) risk for lung cancer 2.9 times higher for all male workers; and for those at least 5 years in quarry 5 times higher in comparison to local male population

15. FIOH / Tampere Occupational cancer Asbestos and lung cancer -2- 17 000 Finnish male construction workers incidence for lung cancer 1990-2000: –all SIR 1.07 (95% CI 0.94-1.20) –insulators SIR 3.03 (95% CI 1.45-5.56) –those with thorax X- ray small opacities ILO 1/0 or more: SIR 2.4 (95% CI 1.88- 3.87) (Koskinen et al. 2002)

16. FIOH / Tampere Occupational cancer Risk for lung cancer

17. FIOH / Tampere Occupational cancer Occupational asbestos lung cancer Lung cancer is considered an occupational cancer if the risk is at least 2x (asbestos, asbestosis and cancer, the Helsinki criteria for diagnosis and attribution, SJWEH 1997:23:311-316) 2x risk with asbestos exposure means: –2-3 (5) million fibers/g dryed lung tissue –5-15 asbestos bodies AB/ml lavage fluid –1 year in heavy or 10 years in moderate exposure NOTE:it si not possible to calculate exposure to chrysotile from tissue samples or lavage fluid after a long latency period

18. FIOH / Tampere Occupational cancer Mesothelioma and work already slight exposure to asbestos can cause mesothelioma, even environmental exposure mesothelioma is considered an occupational disease if (any) occupational exposure has been detected (anamnesis is sufficient in most cases)

19. FIOH / Tampere Occupational cancer Mesothelioma -1- crocidolite (asbestos sprayng) creates a bigger risk than other asbestos forms and work tasks in the 1990s it was shown that also Finnish anthophyllite can cause mesothelioma latency period is usually 30-50 years exposure does not need to be long or heavy; already a few weeks' exposure at work can be enough in Finland all mesotheliomas are compensated as occupational disease if occupational exposure can be detected and if the latency period is over 10 years

20. FIOH / Tampere Occupational cancer Mesothelioma -2- 1990-2001 20-30 mesotheliomas were annually reported to the Register of Work Related Diseases 200 Finnish asbestos sprayers: mesothelioma incidence SIR 263, 95% CI 85-614 118 Finnish asbestosis patients: mesothelioma incidence SIR 65, 95% CI 13-188 17 000 Finnish construction workers 1990-2000: 13 mesotheliomas detected: insulators SIR 28,9 95% CI 5.97- 84.6 and electricians SIR 7,8 95% CI 2.66-25.0