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

FIOH / Tampere Occupational cancer

Tööga seotud kopsuhaigusedTartu, 8.-9. oktoober 2003

OCCUPATIONAL LUNG CANCER

Panu OksaSoome Töötervishoiu Instituut

Tampere, Soome Finnish Institute of Occupational Health,

Tampere, Finland


Yearly about 20 000 new cancer cases occur in Finland

• Men in year 1997• prostate 2857• LUNG 1536• colon/rectum 973• urinary bladder 606• ventricle 473• kidney 422

• Women in year 1997

• breast 3329

• colon/rectum 1112

• uterus 663

• ovaries 622

• LUNG 478

• central nervous

system 446


New lung cancer cases /year in Finland

YEAR MEN WOMEN______________________________________1957 1106 1181962 1422 1131967 1757 11541972 2099 266

1982 2015 2981987 1870 3781992 1837 4291997 1536 478


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)


Occupational cancers in FinlandFinnish Register for Occupational Diseases 1964-2001

• CANCER /CAUSE NUMBER OF CASESLung 1021 asbestos 1004 quartz 6 hydrocarbons 3 radon 2 other/unknown 6Pleura 366 asbestos 364 other/unknown 2Peritoneum 18 asbestos 18


Occupational cancers in 1990-2001

0

30

60

90

120

150

90 91 92 93 94 95 96 97 98 99 00 01

Lung cancer

Mesothelioma

Others

Number of cases

Lea AaltoFinnish Register of Occupational Diseases FIOH


Why occupational canceris 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


Occupational cancers in FinlandFinnish Register for Occupational Diseases 1964-2001 2

• CANCER /CAUSE NUMBER OF CASESBladder 11 aromatic amines 6 other/unknown 6Leukemia 8 ionizing radiation 4 benzene 2 other/unknown 2Nose 7 nickel 3 wood dust 2 chromium compounds 2Larynx 6 asbestos 2 other/unknown 4Other cancers 26


Risk for lung cancer among asbestosis patients in different studies.

• ____________________________________________________________________________Reference Number of patients Risk for lung cancer

SMR, OR or RR (95% CI)_______________________________________________________________________Huuskonen, 1978 202 RR 9.0 Liddell and McDonald, 1980 SMR 3.5 (2.7-4.4)Berry, 1981 665 SMR 9.1 (7.5-11)Finkelstein et al., 1981 172 SMR 7.9 (3.9-14)Cookson et al., 1985 354 SMR 5.1 (3.2-7.9)Coutts et al., 1987 155 SMR 7.4 (4.7-11)Hughes and Weil, 1991 77 SMR 4.3 (1.9-8.2)Sluis-Cremer, 1991 97 RR 8.3Waage et al., 1994 86 OR 3.7Hillerdal, 1994b 166 RR 2.3 (1.1-4.4)Wilkinson et al., 1995 211 OR 2.0 (1.0-4.1)Karjalainen et al., 1997 1287 SIR 6.8 (5.7-8.0)Oksa et al., 1997 128 SIR 10 (6.9-14)

SMR 8 (5.2-12)


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


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.fi

http://www.ttl.fi/

http://www.ttl.fi/


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


Most common exposuresCarex 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


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


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)


Risk for lung cancer

0

5

10

15

20

25

30

35

40

no s, no a asbestos smoking s and a

RR


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


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)


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


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

Documents

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