European Code against Cancer 4th Edition: Environment, occupation and cancer

Our plain-English summary of European Code against Cancer 4th Edition: Environment, occupation and cancer, by C. Espina, K. Straif, S. Friis, et al (Cancer Epidemiology, 2015).

The study

• Authors: C. Espina, K. Straif, S. Friis, M. Kogevinas, R. Saracci, H. Vainio, J. Schüz
• Journal: Cancer Epidemiology
• Published: 2015;39 Suppl 1:S84-92
• Cited by: 42 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

People are exposed throughout life to a wide range of environmental and occupational pollutants from different sources at home, in the workplace or in the general environment - exposures that normally cannot be directly controlled by the individual. Several chemicals, metals, dusts, fibres, and occupations have been established to be causally associated with an increased risk of specific cancers, such as cancers of the lung, skin and urinary bladder, and mesothelioma. Significant amounts of air pollutants - mainly from road transport and industry - continue to be emitted in the European Union (EU); an increased occurrence of lung cancer has been attributed to air pollution even in areas below the EU limits for daily air pollution. Additionally, a wide range of pesticides as well as industrial and household chemicals may lead to widespread human exposure, mainly through food and water. For most environmental pollutants, the most effective measures are regulations and community actions aimed at reducing and eliminating the exposures. Thus, it is imperative to raise awareness about environmental and occupational carcinogens in order to motivate individuals to be proactive in advocating protection and supporting initiatives aimed at reducing pollution. Regulations are not homogeneous across EU countries, and protective measures in the workplace are not used consistently by all workers all the time; compliance with regulations needs to be continuously monitored and enforced. Therefore, the recommendation on Environment and Occupation of the 4th edition of the European Code against Cancer, focusing on what individuals can do to reduce their cancer risk, reads: "In the workplace, protect yourself against cancer-causing substances by following health and safety instructions."

Copyright © 2015 International Agency for Research on Cancer. Published by Elsevier Ltd. All rights reserved.

In plain English

This article was a review by a working group for the 4th edition of the European Code against Cancer. It summarised existing evidence, largely from International Agency for Research on Cancer (IARC) evaluations, on chemicals, metals, dusts, fibres and occupations that cause cancer and to which people in the European Union may still be exposed. The authors reported that all forms of asbestos are carcinogenic to humans and account for the largest share of occupational cancer in Europe. The evidence was sufficient for mesothelioma and cancers of the lung, larynx and ovary, and limited for colorectal, pharyngeal and stomach cancer. They noted that despite the EU ban, construction workers, electricians, carpenters and brake repair workers can still be exposed during renovation, repair and demolition. Citing a UK study by Rushton and colleagues, they reported that occupation was estimated to account for 8.2% of cancer deaths in men and 2.3% in women in 2005 (5.3% overall), with asbestos among the main agents. The authors issued the recommendation: "In the workplace, protect yourself against cancer-causing substances by following health and safety instructions." They noted that such estimates are likely to change.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Review of existing evidence (mainly IARC evaluations) written to justify a recommendation of the European Code against Cancer; no new data were collected
• Who was studied: No study population; the review concerned carcinogens to which citizens of the European Union may still be exposed
• Exposure: Chemicals and mixtures, metals, dusts and fibres (including asbestos of all forms, erionite and crystalline silica), outdoor air pollution, and occupations classified by IARC as carcinogenic to humans (Group 1)
• Main results:
  • The authors stated that all forms of asbestos are carcinogenic to humans and account for the largest proportion of occupational cancer in Europe
  • Citing IARC, the authors reported sufficient evidence that asbestos causes mesothelioma and cancers of the lung, larynx and ovary, and limited evidence for colorectal, pharyngeal and stomach cancer
  • Despite the EU ban, workers in construction trades, electricians and carpenters can still be exposed to high levels of asbestos through renovations, repairs and demolitions, as can workers handling asbestos-containing products such as in brake maintenance and repair
  • Because of the long latency, mesothelioma incidence has not yet peaked in many countries; a cited study predicted that mesothelioma deaths in Germany would peak in 2020
  • A cited UK study (Rushton et al.) estimated that occupation accounted for 8.2% of cancer deaths among men and 2.3% among women in 2005, an overall attributable fraction of 5.3%
  • In the same cited UK study, asbestos was among the agents responsible for most occupation-attributable cancers, and 56% of occupational cancers were attributed to men in the construction industry (mainly mesothelioma, cancers of the lung, bladder and stomach, and non-melanoma skin cancer)
  • A cited European pooled study (ESCAPE) reported an increased lung cancer risk associated with increments of PM10 air pollution (hazard ratio 1.22; 95% CI 1.03 to 1.45)
• The authors' conclusion: The authors' working group developed the recommendation that people in the workplace protect themselves against cancer-causing substances by following health and safety instructions
• Limitations the authors state:
  • The authors stated that cancer burden estimates are likely to change as more carcinogens and cancer sites are identified
  • The authors stated that dose-response relationships have not been established for many exposures, which makes it difficult to define safe levels
  • The authors stated that scientific knowledge of the carcinogenic potential of occupational and environmental chemicals is still incomplete

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Lung Cancer.

Related studies

• Low dose exposure to natural and man made fibres and the risk of cancer: towards a collaborative European epidemiology. Report of a workshop held in Paris , 10-12 June, 1991 — A.J. Valleron, J. Bignon, et al. (1992)
• Current controversies regarding the role of asbestos exposure in the causation of malignant mesothelioma: the need for an evidence-based approach to develop medicolegal guidelines — A.M. Marchevsky, M.R. Wick (2003)
• An air quality data analysis system for interrelating effects, standards, and needed source reductions: Part 13--Applying the EPA Proposed Guidelines for Carcinogen Risk Assessment to a set of asbestos lung cancer mortality data — R.I. Larsen (2003)
• Occupations and exposures in the work environment as determinants for rheumatoid arthritis — A.R. Olsson, T. Skogh, et al. (2004)
• 'Environment' in cancer causation and etiological fraction: limitations and ambiguities — P. Boffetta, J.K. McLaughlin, et al. (2007)
• 'Environment' in cancer causation and etiological fraction: limitations and ambiguities — D. Mirabelli, E. Merler (2008)

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