Common workplace cancers Lin Fritschi Curtin University is a - - PowerPoint PPT Presentation

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Common workplace cancers Lin Fritschi Curtin University is a - - PowerPoint PPT Presentation

Jun 27, 2023 356 likes •592 views

Common workplace cancers Lin Fritschi Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Case study A man born in 1950 presents with painless haematuria which has been present for about 4 weeks.

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Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J

Lin Fritschi

Common workplace cancers

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Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J

Case study

  • A man born in 1950 presents with painless haematuria

which has been present for about 4 weeks. You have been seeing him occasionally for 15 years and his past history includes borderline hypertension, mild intermittent rosacea, and occasional acute bronchitis. He has never smoked and drinks 3-4 standard drinks a week. On questioning he states that he has noticed that he has increased frequency of urination including nocturia for the past year. He has some slight back pain but no other

  • symptoms. Physical examination is unremarkable.
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Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J

Next steps

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Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J

  • His wife is incapacitated with severe osteoarthritis in her

hips and knees and he was her primary carer. They have no children. His death has severe ramifications for her, as she is unable to live at home alone, and they have virtually no savings and no assets.

  • Would taking an occupational history have helped with

early diagnosis and better outcome, or with compensation?

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Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J

Occupational history

  • 1965 Labourer on various building sites, mainly

assisting carpenters and bricklayers

  • 1971

Packer in chicken processing factory, wrapping, grinding and packing meat

  • 1978

Worked in the vulcanization section of a rubber manufacturing plant

  • 2000

Part time cleaner in office blocks

  • 2014

Retired

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Gillespie ON. Rubber goods. NZ Railways Magazine 1940;14:49-53

“Then the vulcanising processes begin their weird work. The distinctive feature of a rubber factory is that everything is finished with heat. The

  • dours of brimstone and roasting rubber have a tang of their own, and are

all-permeating but not unpleasant.”

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Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J

Occupational cancer

  • A cancer which is caused wholly or partly by exposure to a

carcinogen at work

  • Easy to prove if
  • The carcinogenic effect of an agent is very strong
  • The cancer is rare
  • Otherwise difficult to prove because
  • No pathological or clinical features which distinguish occupational

cancers

  • Long delay between the time of exposure and the diagnosis of cancer
  • Multiple exposures including lifestyle risk factors
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Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J

What is a “common” occupational cancer?

  • Largest number of cancers due to occupation
  • Highest proportion of that type of cancer which are
  • ccupationally related
  • Likelihood of a cancer being occupationally related if the

person had a relevant exposure

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Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J

Occupational cancer numbers

  • Rushton et al, British Journal of Cancer 2012;107:Suppl 1
  • Requirements

List of established carcinogen-cancer type combinations Proportion of population exposed to each carcinogen Number of each type of cancer occurring in the whole population Relative risk of cancer in the exposed subgroup for each carcinogen-cancer type combination

  • Applied to Australia to give an approximation
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Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J

Largest number of cancers due to occupation

  • Australia (approximate)

Cancer

N in males N in females Total

  • ccupational

TOTAL 3400 710 4110 Lung 1430 50 1480 Leukaemia 440 130 570 Melanoma 470 30 500 Breast 460 460 Mesothelioma 400 10 410 Laryngeal 160 5 165 Lip 140 5 145 Stomach 110 <5 115 Bladder 80 <5 85 Sinonasal 50 <5 55

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Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J

Highest proportion of each type of cancer which are occupationally related - approx

AF m AF f Mesothelioma 75% 10% Sinonasal 70% 10% Laryngeal 30% 5% Pharyngeal 30% 5% Leukaemia 20% 10% Lung 25% <5% Lip 20% <5% Ocular melanoma 15% <5% Nasopharyngeal 10% <5% Stomach 10% <5% Melanoma 5% <5% Bladder 5% <5%

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Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J

Likelihood of a cancer being occupationally related if the person had a relevant exposure

Cancer Exposure RR-High Approximate Odds Mesothelioma Asbestos 42 41 in every 42 Lung Asbestos 1.5 1 in every 3

Agudo et al, 2000. Goodman et al, 1999

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Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J

Mesothelioma in WA by exposure category and calendar period

Olsen et al, MJA 2011;195:271-274

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Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J

Likelihood of a cancer being occupationally related if the person had a relevant exposure

Cancer Exposure RR- High Ratio Nasal/paranasal Leather dust 12 11 in every 12 Nickel 9 8 in every 9 Wood dust 6 5 in every 6 Chromium VI 5 4 in every 5 Formaldehyde 2 1 in every 2

Fu et al, 1996. Grimsrud and Peto, 2006. Demers et al 1995. Rosenman and Stanbury, 1996. ‘t Mannetje et al, 1999.

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Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J

Think about occupation in men for….

AF n WA total

  • ccupational

Mesothelioma 75% 80 60 Sinonasal 70% 9 6 Laryngeal 30% 29 9 Pharyngeal 30% 71 21 Lung 25% 578 132 Leukaemia 20% 169 31 Lip 20% 105 19 Ocular melanoma 15% 9 1 Nasopharyngeal 10% 6 1 Stomach 10% 143 12 Melanoma 5% 734 51 Bladder 5% 230 10

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Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J

Occupations for mesothelioma

Occupations and exposures Mesothelioma Asbestos

http://theconversation.com/diy-renovators-now- most-at-risk-of-asbestos-cancers-3206 http://www.abc.net.au/radionational/programs/scienceshow/the-search- for-asbestos-worker-jeremy-tear/4363568

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Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J

Occupations for sinonasal and nasopharyngeal cancer Occupations and exposures Pathologists and laboratory Wood workers, leather workers Welding, metal cutting, plating, nickel refining

http://www.buddyskitch en.ca/blogart28 http://www.wisegeek.org/what-is-particle-board.htm http://www.austandnzdefence.com/listings/list ing_details/phoenix-australasia-pty-ltd

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Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J

Occupations for lung cancer

Occupations and exposures

  • Asbestos. Stone cutting (silica). Ionizing radiation

Heavy industry metals, soots, coal burning, firefighters, road paving, Metal workers, machinists, welders, plating Painting, printing, chemicals, dyes

http://www.atlenv.com/osha-proposes- stricter-crystalline-silica-dust-rule/ http://www.slate.com/blogs/future_tense/201 5/02/24/free_air_carbon_capture_a_climate_ engineering_idea_worth_considering.html http://www.toxipedia.org/display/toxipedia/A +Small+Dose+of+Solvents

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Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J

Bladder cancer

Occupations and exposures Production of: coal tar, coal gas, coke, metals, rubber, Road paving, firefighters, drivers, Metal workers, painters, chemical production

http://www.keenovens.com/articles/steel-furnance.htm http://www.geofftompkinson.com/gt_gallery/science-industry/ http://switchboard.nrdc.org/blogs/dbailey/diesel_truck_pollution_the_tru.html

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Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J

Think about an occupational cause in women

AF n in WA total pa Mesothelioma 7% 14 1 Leukaemia 10% 120 12 Lung 1% 422 6 Breast 3% 1569 52

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Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J

Bladder cancer in the rubber industry

Cancer Exposure RR-High (95% CI) Bladder Rubber industry >1 year PAHs, N-nitrosamines, solvents, naphthylamine ~5 Start screening – 20 years after start of exposure How often – 6 monthly Type of screen – urinary cytology

Clin B; "RecoCancerProf" Working Group, Pairon JC. Medical follow-up for workers exposed to bladder carcinogens: the French evidence-based and pragmatic statement. BMC Public Health. 2014 Nov 6;14:1155.

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Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J

Acknowledgements

Renee Carey, Ellie Darcey, Alison Reid, Deborah Glass, Tim Driscoll, Geza Benke,