Occupation and cancer in Britain

Our plain-English summary of Occupation and cancer in Britain, by L. Rushton, S. Bagga, R. Bevan, et al (British Journal of Cancer, 2010).

The study

• Authors: L. Rushton, S. Bagga, R. Bevan, T.P. Brown, J.W. Cherrie, P. Holmes, L. Fortunato, R. Slack, M. Van Tongeren, C. Young, S.J. Hutchings
• Journal: British Journal of Cancer
• Published: 2010;102(9):1428-37
• Cited by: 143 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Prioritising control measures for occupationally related cancers should be evidence based. We estimated the current burden of cancer in Britain attributable to past occupational exposures for International Agency for Research on Cancer (IARC) group 1 (established) and 2A (probable) carcinogens.

Methods: We calculated attributable fractions and numbers for cancer mortality and incidence using risk estimates from the literature and national data sources to estimate proportions exposed.

Results: 5.3% (8019) cancer deaths were attributable to occupation in 2005 (men, 8.2% (6362); women, 2.3% (1657)). Attributable incidence estimates are 13 679 (4.0%) cancer registrations (men, 10 063 (5.7%); women, 3616 (2.2%)). Occupational attributable fractions are over 2% for mesothelioma, sinonasal, lung, nasopharynx, breast, non-melanoma skin cancer, bladder, oesophagus, soft tissue sarcoma, larynx and stomach cancers. Asbestos, shift work, mineral oils, solar radiation, silica, diesel engine exhaust, coal tars and pitches, occupation as a painter or welder, dioxins, environmental tobacco smoke, radon, tetrachloroethylene, arsenic and strong inorganic mists each contribute 100 or more registrations. Industries and occupations with high cancer registrations include construction, metal working, personal and household services, mining, land transport, printing/publishing, retail/hotels/restaurants, public administration/defence, farming and several manufacturing sectors. 56% of cancer registrations in men are attributable to work in the construction industry (mainly mesotheliomas, lung, stomach, bladder and non-melanoma skin cancers) and 54% of cancer registrations in women are attributable to shift work (breast cancer).

Conclusion: This project is the first to quantify in detail the burden of cancer and mortality due to occupation specifically for Britain. It highlights the impact of occupational exposures, together with the occupational circumstances and industrial areas where exposures to carcinogenic agents occurred in the past, on population cancer morbidity and mortality; this can be compared with the impact of other causes of cancer. Risk reduction strategies should focus on those workplaces where such exposures are still occurring.

In plain English

This study estimated Britain's cancer burden attributable to past occupational exposures. The authors combined published risk estimates with national exposure data, covering agents and occupations that the International Agency for Research on Cancer rates as established or probable carcinogens, where human evidence for that cancer site was strong or suggestive. They estimated 5.3% (95% confidence interval 4.6 to 6.6) of 2005 cancer deaths, or 8019 (6888 to 9977), were attributable to occupation: 8.2% (7.2 to 9.9) in men and 2.3% (1.7 to 3.2) in women. Asbestos contributed the most attributable registrations in 2004: 1937 mesotheliomas, 2223 lung cancers, 47 stomach and 8 laryngeal cancers. The authors stated asbestos accounted for 30% of occupationally related registrations and nearly half of deaths. The occupational share of mesothelioma was 97% (96 to 98) in men and 82.5% (75 to 90) in women, including paraoccupational or environmental exposure. Asbestos-related lung cancer deaths were estimated by assuming one per mesothelioma death. The authors noted possible biases not fully captured by their confidence intervals. They concluded risk reduction should focus on workplaces where exposures still occur.

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: Burden-of-disease estimation study: attributable fractions and attributable numbers calculated from published risk estimates combined with national data on proportions exposed (not a new study of individual patients)
• Who was studied: Cancer deaths (2005) and cancer registrations (2004) in Britain, from national statistics for England, Scotland and Wales; 150 124 cancer deaths and 343 583 registrations at ages 15 and over
• Exposure: Past occupational exposure to 41 agents and occupations. Each was classified by IARC as group 1 (established) or 2A (probable) and had strong or suggestive evidence of carcinogenicity in humans for the specific cancer site. They included asbestos (fiber types not specified), shift work, mineral oils, solar radiation, silica and diesel engine exhaust. The exposure period assumed for solid tumours was 1956 to 1995.
• Main results:
  • Cancer deaths in 2005 attributable to occupation: 5.3% (95% CI 4.6 to 6.6), 8019 deaths (6888 to 9977) overall; men 8.2% (7.2 to 9.9), 6362 (5646 to 7690); women 2.3% (1.7 to 3.2), 1657 (1249 to 2287)
  • Cancer registrations attributable to occupation: 13 679 (4.0%) overall; men 10 063 (5.7%); women 3616 (2.2%)
  • Asbestos was the largest contributor of attributable registrations: mesothelioma 1937, lung 2223, larynx 8 and stomach 47 (4216 in total)
  • The authors stated that asbestos contributed 30% of the occupationally related cancer registrations and nearly half of the deaths in the study
  • Attributable fraction for mesothelioma: men 97.0% (95% CI 96.0 to 98.0), women 82.5% (75.0 to 90.0), total 94.9% (93.0 to 96.9). These figures include cases described as due to paraoccupational or environmental asbestos exposure.
  • Asbestos-related lung cancer deaths were estimated using a ratio of one mesothelioma death to one lung cancer death, rather than the authors' standard method
  • 56% of attributable cancer registrations in men were attributed to work in the construction industry, mainly mesotheliomas and lung, stomach, bladder and non-melanoma skin cancers
• The authors' conclusion: The authors concluded that this was the first detailed quantification of the occupational cancer burden specifically for Britain, and that risk reduction strategies should focus on workplaces where such exposures are still occurring
• Limitations the authors state:
  • Assumptions in the methods and uncertainties and inaccuracies in the data may have introduced biases whose impact is not fully captured in the confidence intervals
  • The method used for asbestos-related lung cancer assumes that lung cancer has a similar latency pattern to mesothelioma
  • Estimates of average risk for the large number of workers with low exposures are unreliable
  • CAREX exposure data for Britain cover only 1990 to 1993, and Britain has no national job exposure matrix
  • In some cases separate risk estimates were lacking for women and/or for cancer incidence

Topics

Medical terms in this study, explained in our Lexicon: Occupational Exposure, IARC, Mesothelioma, Sarcoma, Stomach Cancer, Carcinogenic.

Related studies

• Occupational cancer burden in Great Britain — L. Rushton, S.J. Hutchings, et al. (2012)
• Women's occupation and cancer: preliminary analysis of cancer registrations in England and Wales, 1971-1990 — J. Simpson, E. Roman, et al. (1999)
• Feasibility of identifying high-risk occupations through tumor registries — M.D. Whorton, J. Schulman, et al. (1983)
• Incidence of mesothelioma and asbestosis by occupation in a diverse workforce — N.L. DeBono, H. Warden, et al. (2021)
• Incident chronic obstructive pulmonary disease associated with occupation, industry, and workplace exposures in the Health and Retirement Study — S.R. Silver, W.A. Alarcon, et al. (2021)
• Estimating the number of asbestos-related lung cancer deaths in Great Britain from 1980 to 2000 — A.J. Darnton, D.M. McElvenny, et al. (2006)

Browse more research in British Journal of Cancer, or return to medical research.