The burden of cancer at work: estimation as the first step to prevention

Our plain-English summary of The burden of cancer at work: estimation as the first step to prevention, by L. Rushton, S. Hutchings, T. Brown (Occupational and Environmental Medicine, 2008).

The study

• Authors: L. Rushton, S. Hutchings, T. Brown
• Journal: Occupational and Environmental Medicine
• Published: 2008;65(12):789-800
• Cited by: 93 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objectives: Work-related cancers are largely preventable. The overall aim of this project is to estimate the current burden of cancer in Great Britain attributable to occupational factors, and identify carcinogenic agents, industries and occupations for targeting risk prevention.

Methods: Attributable fractions and numbers were estimated for mortality and incidence for bladder, lung, non-melanoma skin, and sinonasal cancers, leukaemia and mesothelioma for agents and occupations classified as International Agency for Research on Cancer (IARC) Group 1 and 2A carcinogens with "strong" or "suggestive" evidence for carcinogenicity at the specific cancer site in humans. Risk estimates were obtained from published literature and national data sources used for estimating proportions exposed.

Results: In 2004, 78,237 men and 71,666 women died from cancer in Great Britain. Of these, 7317 (4.9%) deaths (men: 6259 (8%); women: 1058 (1.5%)) were estimated to be attributable to work-related carcinogens for the six cancers assessed. Incidence estimates were 13,338 (4.0%) registrations (men: 11,284 (6.7%); women 2054 (1.2%)). Asbestos contributed over half the occupational attributable deaths, followed by silica, diesel engine exhaust, radon, work as a painter, mineral oils in metal workers and in the printing industry, environmental tobacco smoke (non-smokers), work as a welder and dioxins. Occupational exposure to solar radiation, mineral oils and coal tars/pitches contributed 2557, 1867 and 550 skin cancer registrations, respectively. Industries/occupations with large numbers of deaths and/or registrations include construction, metal working, personal and household services, mining (not metals), land transport and services allied to transport, roofing, road repair/construction, printing, farming, the Armed Forces, some other service industry sectors and manufacture of transport equipment, fabricated metal products, machinery, non-ferrous metals and metal products, and chemicals.

Conclusions: Estimates for all but leukaemia are greater than those currently used in UK health and safety strategy planning and contrast with small numbers (200-240 annually) from occupational accidents. Sources of uncertainty in the estimates arise principally from approximate data and methodological issues. On balance, the estimates are likely to be a conservative estimate of the true risk. Long latency means that past high exposures will continue to give substantial numbers in the near future. Although levels of many exposures have reduced, recent measurements of others, such as wood dust and respirable quartz, show continuing high levels.

In plain English

This study estimated how many cancer deaths and new cases in Great Britain were attributable to past work exposures. The authors combined published risk estimates with national exposure data. They covered six cancers, including mesothelioma and lung cancer, using 2004 deaths and 2003 cancer registrations. For mesothelioma, they used earlier estimates that 85% to 90% of cases in men (from UK studies) and 20% to 30% in women (from UK and other studies) were due to occupational exposure. Their broader estimate also counted cases from paraoccupational or environmental asbestos exposure. They assumed one asbestos-related lung cancer death for each mesothelioma death. Of the 78 237 men and 71 666 women who died of cancer in Great Britain in 2004, 7317 deaths (4.9%) were estimated to be due to work-related carcinogens for the six cancers: 6259 (8.0%) in men and 1058 (1.5%) in women. Asbestos contributed the most: an estimated 1650 mesothelioma and 1650 lung cancer deaths in men, and 270 of each in women. Construction accounted for 1012 of each in men. No confidence intervals were given. The authors concluded the estimates were likely conservative.

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 calculated from published risk estimates and national exposure data
• Who was studied: All cancer deaths in Great Britain in 2004 (78 237 men, 71 666 women) and cancer registrations in 2003, for six cancers: bladder, leukaemia, lung, mesothelioma, non-melanoma skin and sinonasal
• Exposure: Occupational agents and occupations classified by IARC as Group 1 or 2A carcinogens, including asbestos. For the 'established plus uncertain' estimate, mesothelioma cases attributed to paraoccupational or environmental asbestos exposure were also counted. Asbestos-related lung cancer deaths were set equal to mesothelioma deaths.
• Main results:
  • The attributable fraction for mesothelioma in men was taken from several studies of UK mesothelioma cases suggesting that 85% to 90% of male cases are due to occupational exposure
  • For women, studies reporting female results separately, from the UK (a personal communication) and elsewhere, gave estimates of 20% to 30%
  • Of all cancer deaths in Great Britain in 2004 (78 237 men and 71 666 women), 7317 (4.9%) were estimated to be attributable to work-related carcinogens for the six cancers assessed: 6259 (8%) of male cancer deaths and 1058 (1.5%) of female cancer deaths
  • Asbestos exposure contributed the largest number of occupation-attributed deaths, from mesothelioma and lung cancer
  • Asbestos-attributed deaths in the 'established plus uncertain' estimate: 1650 mesothelioma and 1650 lung cancer deaths in men (3300 total); 270 of each in women (540 total)
  • In the construction industry, asbestos gave an estimated 1012 lung cancer deaths and 1012 mesothelioma deaths in men
  • In mining (excluding coal mining), over 65 000 workers were potentially exposed to asbestos in the relevant exposure period, giving an estimated 305 lung cancer deaths and 305 mesothelioma deaths in men
  • In personal and household services, an estimated 362 lung cancer deaths and 362 mesothelioma deaths were attributed to asbestos, of which 221 of each were in women
• The authors' conclusion: The authors concluded that their estimates are likely to be conservative. Because of long latency, deaths and registrations from past high exposures, particularly asbestos-related cancers, will continue to be substantial in the near future.
• Limitations the authors state:
  • Confidence intervals were not calculated or presented
  • IARC Group 2B carcinogens were not evaluated, so the estimates could be too low
  • Risk estimates from studies of men were used for women, and mortality risk estimates were used for incidence, which may have biased the results
  • Where no risk estimate was available for low or background exposure, a risk of one was assigned, giving zero attributable burden and possibly underestimating it
  • Information on cancer latency was generally lacking
  • The healthy worker effect in source studies could lead to underestimation

Topics

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

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