Occupational cancer burden in Great Britain

Our plain-English summary of Occupational cancer burden in Great Britain, by L. Rushton, S.J. Hutchings, L. Fortunato, et al (British Journal of Cancer, 2012).

The study

• Authors: L. Rushton, S.J. Hutchings, L. Fortunato, C. Young, G.S. Evans, T. Brown, R. Bevan, R. Slack, P. Holmes, S. Bagga, J.W. Cherrie, M. Van Tongeren
• Journal: British Journal of Cancer
• Published: 2012;107 Suppl 1(Suppl 1):S3-7
• Cited by: 166 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

A sound knowledge base is required to target resources to reduce workplace exposure to carcinogens. This project aimed to provide an objective estimate of the burden of cancer in Britain due to occupation. This volume presents extensive analyses for all carcinogens and occupational circumstances defined as definite or probable human occupational carcinogens by the International Agency for Research on Cancer. This article outlines the structure of the supplement - two methodological papers (statistical approach and exposure assessment), eight papers presenting the cancer-specific results grouped by broad anatomical site, a paper giving industry sector results and one discussing work-related cancer-prevention strategies. A brief summary of the methods and an overview of the updated overall results are given in this introductory paper. A general discussion of the overall strengths and limitations of the study is also presented. Overall, 8010 (5.3%) total cancer deaths in Britain and 13,598 cancer registrations were attributable to occupation in 2005 and 2004, respectively. The importance of cancer sites such as mesothelioma, sinonasal, lung, nasopharynx, breast, non-melanoma skin cancer, bladder, oesophagus, soft tissue sarcoma and stomach cancers are highlighted, as are carcinogens such as asbestos, mineral oils, solar radiation, silica, diesel engine exhaust, coal tars and pitches, dioxins, environmental tobacco smoke, radon, tetrachloroethylene, arsenic and strong inorganic mists, as well as occupational circumstances such as shift work and occupation as a painter or welder. The methods developed for this project are being adapted by other countries and extended to include social and economic impact evaluation.

In plain English

This article introduced a journal supplement estimating work-caused cancer in Great Britain, summarising its methods and updated overall results. The authors estimated attributable fractions: the share of cancers that would not have occurred without the workplace exposure. They covered agents and occupations that the International Agency for Research on Cancer had classed, by the end of 2008, as established or probable human carcinogens, where evidence of occupational exposure was strong or suggestive for the specific cancer site. Published risk estimates were combined with national exposure data. Overall, 5.3% of cancer deaths in 2005 (95% confidence interval 4.6 to 6.6%; 8010 deaths) and 4.0% of 2004 registrations (2.7 to 5.9%; 13,598) were attributed to occupation. Asbestos had the most attributable registrations of any agent, 4216, including 1937 mesotheliomas and 2223 lung cancers. For mesothelioma, 97.0% (96.0 to 98.0%) in men and 82.5% (75.0 to 90.0%) in women were attributed to occupation, including paraoccupational or environmental asbestos exposure. The authors concluded their estimates were almost certainly an underestimate, while noting assumptions that gave high estimates in some situations.

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 using attributable fractions. This is the introductory overview paper of a journal supplement and presents updated overall results of an earlier-published project.
• Who was studied: Cancer deaths in Great Britain in 2005 and cancer registrations in 2004. For solid tumours, exposure was assumed to have occurred in 1956 to 1995, based on an assumed latency of 10 to 50 years.
• Exposure: Agents and occupations classified by IARC as Group 1 (established) or Group 2A (probable) human carcinogens for which evidence of occupational exposure was strong or suggestive for the specific cancer site. These included asbestos (fiber types not specified), shift work, mineral oils, solar radiation, silica, diesel engine exhaust and others.
• Main results:
  • All cancers, based on deaths in 2005: the attributable fraction was 8.2% (95% CI 7.2 to 9.9) in men, or 6355 deaths, and 2.3% (1.7 to 3.2) in women, or 1655 deaths. Overall it was 5.3% (4.6 to 6.6), or 8010 deaths (6888 to 9977).
  • All cancers, based on registrations in 2004: the attributable fraction was 5.7% (4.0 to 8.4) in men, or 9988 registrations, and 2.1% (1.4 to 3.2) in women, or 3611. Overall it was 4.0% (2.7 to 5.9), or 13,598 registrations (9308 to 20,206).
  • Mesothelioma attributable fraction: 97.0% (96.0 to 98.0) in men, 82.5% (75.0 to 90.0) in women and 94.9% (93.0 to 96.9) overall. Attributable deaths were 1699 in men, 238 in women and 1937 in total.
  • The mesothelioma attributable fractions include cases described as due to paraoccupational or environmental exposure to asbestos.
  • Mesothelioma registration figures were based on deaths.
  • Asbestos had 4216 total attributable cancer registrations, the largest of any agent listed. These included 1937 mesotheliomas and 2223 lung cancers. Smaller numbers (8 and 47) at other sites cannot be reliably matched to a cancer site in the scanned table.
  • Lung cancer from all occupational causes combined (not only asbestos): the attributable fraction was 21.1% (19.2 to 24.7) in men, 5.3% (4.3 to 6.9) in women and 14.5% (13.0 to 17.2) overall, with 4745 attributable deaths in total.
  • The most important cancer sites for occupational attribution were mesothelioma, sinonasal, lung and bladder cancers and non-melanoma skin cancer in men. In women they were mesothelioma, sinonasal, lung, breast and nasopharyngeal cancers.
  • Asbestos was among the agents each responsible for over 100 attributable cancer registrations.
• The authors' conclusion: The authors concluded that the 5.3% estimate meant over 8000 cancer deaths in Great Britain, and that their estimates were almost certainly an underestimate of the true burden.
• Limitations the authors state:
  • Only agents classified by IARC by the end of 2008 were assessed.
  • IARC Group 2B carcinogens were not evaluated, so the estimates could be too low.
  • The results of IARC's 2009 review and update of all Group 1 carcinogens were not included.
  • Studies of British workforces were not always available for choosing risk estimates.
  • Risk estimates for women were scarce, and for many carcinogens the estimates for men were used for women.
  • Most risk estimates were for mortality rather than incidence.
  • The healthy worker effect and exposure misclassification in source studies could lead to underestimation.
  • Assumed risk estimates for low-exposure categories may have been inaccurate, either too large or too small.
  • Workers employed for less than one year were excluded. Including them would have increased the numbers exposed and the estimates.
  • Pragmatic assumptions about latency resulted in high estimates in some situations.

Topics

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

Related studies

• Occupation and cancer in Britain — L. Rushton, S. Bagga, et al. (2010)
• The expected burden of mesothelioma mortality in Great Britain from 2002 to 2050 — J.T. Hodgson, D.M. McElvenny, et al. (2005)
• The effect of smoking on the risk of lung cancer mortality for asbestos workers in Great Britain (1971-2005) — G. Frost, A. Darnton, et al. (2011)
• Chest physician-reported, work-related, long-latency respiratory disease in Great Britain — M. Carder, A. Darnton, et al. (2017)
• Simple benchmark for mesothelioma projection for Great Britain — M.D. Martínez-Miranda, B. Nielsen, et al. (2016)
• Mesothelioma mortality in Great Britain from 1968 to 2001 — D.M. McElvenny, A.J. Darnton, et al. (2005)

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