Asbestos related cancers

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1 New cancer cases in Finland, Men Pukkala et al. 26 Asbestos related cancers Panu Oksa, MD, docent Course on asbestos-related diseases Tartu Asbestos related cancer / FIOH / PO / New cancer cases in Finland , Women Pukkala et al. 26 New lung cancer cases /year in Finland YEAR MEN WOMEN Asbestos related cancer / FIOH / PO / Asbestos related cancer / FIOH / PO / Number of occupational cancers Occupational cancers in epidemiological studies indicate 2-6% of all cancer cases Number of cases In Finland latest estimate is 2%. For men 4% and for women less than.1% (Dreyer, Andersen & Pukkala, 1997) = 5-8/ year Lung cancer Mesothelioma Others Lea Aalto Finnish Register of Occupational Diseases FIOH Asbestos related cancer / FIOH / PO / Asbestos related cancer / FIOH / PO /

2 Occupational cancers and causes in Finland Finnish Register for Occupational Diseases Occupational cancers and causes in Finland Finnish Register for Occupational Diseases CANCER /CAUSE NUMBER OF CASES Lung 121 asbestos 14 quartz 6 hydrocarbons 3 radon 2 other/unknown 6 Pleura 366 asbestos 364 other/unknown 2 Peritoneum 18 asbestos 18 CANCER /CAUSE NUMBER OF CASES/ 2 Bladder 11 aromatic amines 6 other/unknown 6 Leukemia 8 ionizing radiation 4 benzene 2 other/unknown 2 Nose 7 nickel 3 wood dust 2 chromium compounds 2 Larynx 6 asbestos 2 other/unknown 4 Other cancers 26 Asbestos related cancer / FIOH / PO / Asbestos related cancer / FIOH / PO / Asbestos related cancers are common Asbestos exposure and risk for cancers IARC monographs, volume 7, 1987 Occupational exposures to asbestos dust are widespread in all industrial countries. In Western Europe, North America, Japan and Australia the use of asbestos peaked in the 197's Currently about 1 mesotheliomas and 2 asbestos-induced lung cancers are estimated to occur annually in the population of 8 million people. Lung RR asbestos exposure 2-5 asbestosis patients 9. Pleura 3-15 Larynx 2-3 Gastro -intestinal canal 2 Colon 2 Ovaries + Lymfatic tissue, bone marrow + Bile ducts + Asbestos related cancer / FIOH / PO / Asbestos related cancer / FIOH / PO / The history of asbestos- related cancers WORK HISTORY AND RISK OF LUNG CANCER (Ahrens et al 1996) 1935 Lunch&Smith, Lung cancer in asbestotic lung parenchyma Homburger, Asbestosis and lung cancer Doll. large epidemilogic study based on autopsies of asbestos mine workers. Working time of 2 years caused tenfold lung cancer risk 1931 Klemperer & Rabin, case report pleural mesothelioma 1947 Mallory et al., case report pleural and pericardial mesotheliomas of an asbestos worker 196 Wagner et al., 33 mesotheliomas of South-African crocidolite workers 1964 Selikoff et al. a large epidemiologic study on asbestos exposure and lung cancer 1979 Selikoff & Hammond, risk for lung cancer: asbestos 4x, asbestos and smoking together 53x. N = 839 male lung cancers, 839 controls High exposure (over 24 lifetime hours) Odds ratio Insulation work 4.39 ( ) Machining of asbestos 2.37 ( ) cement products Asbestos industry 2.21 ( ) Bystander at shipyards 1.47 ( ) Wearing heat protective 1.37 ( ) asbestos clothing Work with brake and 1.25 ( ) clutch linings Asbestos related cancer / FIOH / PO / Asbestos related cancer / FIOH / PO /

3 Asbestos consumption and occupational diseases with financial compensation due to asbestos in FRG (Hagemeyer et al. 26) Asbestos import and occupational diseases due to asbestos in GDR (Hauptverband der gewerblichen Berufsgenossenschaften (ed) 1995; Bundesanstalt für Arbeitsmedizin (ed) 1996) (Hagemeyer et al. 26) Asbestos related cancer / FIOH / PO / Asbestos related cancer / FIOH / PO / Estimated asbestos-related cancer mortality per 1, by exposure level for a 2-year working period (1) Occupation and asbestos related lung cancer All types of asbestos can cause lung cancer Latency time from the beginning of the exposure is usually over 2 years 2 Finnish asbestos sprayers: incidence of lung cancer 17- fold (SIR 17, 95% CI ) 17 male construction workers: incidence of lung cancer 199-2: all: SIR 1.7 (95% CI ) insulators: SIR 3.3 (95% CI ) those with x-ray classification ILO 1/ or more: SIR 2.4 (95% CI ) Paakkila asbestos mine, minimum 5 years at work (1 workers) lung cancer incidence 2.9-fold Asbestos related cancer / FIOH / PO / Asbestos related cancer / FIOH / PO / Risk for lung cancer among asbestosis patients in different studies. Progression of asbestosis predicts lung cancer Oksa 1998 Reference Number of patients Risk for lung cancer SMR, OR or RR (95% CI) Huuskonen, RR 9. Liddell and McDonald, 198? SMR 3.5 ( ) Berry, SMR 9.1 (7.5-11) Finkelstein et al., SMR 7.9 (3.9-14) Cookson et al., SMR 5.1 ( ) Coutts et al., SMR 7.4 (4.7-11) Hughes and Weil, SMR 4.3 ( ) Sluis-Cremer, RR 8.3 Waage et al., OR 3.7 Hillerdal, 1994b 166 RR 2.3 ( ) Wilkinson et al., OR 2. (1.-4.1) Karjalainen et al., SIR 6.8 (5.7-8.) Oksa et al., SIR 1 (6.9-14) SMR 8 (5.2-12) Asbestosis patients with and without radiographic evidence of asbestosis progression by cancer status Asbestosis Lung Other No Total patient group cancer cancer cancer % % % % Progressors (N=24) Nonprogressors (N=61) Asbestos related cancer / FIOH / PO / Asbestos related cancer / FIOH / PO /

4 Fifteen years of follow-up for asbestosis patients, predictors of lung cancer Oksa 1998 Risk for lung cancer interaction pattern between progression of small opacities in the radiographs (progression) and central nervous system abnormalities with unknown ethiology (CNS-NUD) Progression of asbestosis/ CNS-NUD findings None Only one Both Cancer status No cancer 3 (88%) 17 (56%) 2 (22%) Cancer 4 (12%) 14 (45%) 7 (78%) Total 34 (1%) 31 (1%) 9 (1%) no s, no a asbestos smoking s and a RR Asbestos related cancer / FIOH / PO / Asbestos related cancer / FIOH / PO / Compensation of lung cancer Lung cancer screening In Finland lung cancer is compensated as an occupational disease with asbestos exposure: Allways when asbestosis is present and otherwise if: Exposure has been moderate or heavy (twofolded risk) Latency time from beginning of exposure is over 1 y Regardless from smoking habits Survival of patients with stage I lung cancer detected on CT screening. The international Early Lung Cancer Action Program. N Engl J Med Oct 26, 26 31,567 asymptomatic persons were screened using lowdose CT from 1993 to 25 lung cancer was diagnosed in 484 participants of these 412 (85%) had clinical stage I estimated 1-year survival rate was 88% in this subgroup those 32 with clinical stage I cancer who underwent surgical resection within 1 month after diagnosis, the survival rate was 92% Annual spiral CT can detect lung cancer that is curable Asbestos related cancer / FIOH / PO / Asbestos related cancer / FIOH / PO / Asbestos and mesothelioma Crocidolite exposure gives a greater risk for mesothelioma than other types of asbestos Latency time is usually 3-5 years Exposure needs not to be heavy or long. Even exposure of some weeks can cause mesothelioma In Finland the mesothelioma is compensated as occupational disease, if the person has been exposed at work and the latency time is at least 1 years Asbestos related cancer / FIOH / PO / Asbestos related cancer / FIOH / PO /

5 Mesothelioma incidence Use of asbestos, tons/year 12 FINLAND Mesothelioma cases 8 2 Finnish asbestos sprayers: mesothelioma incidence 263-folded (SIR 263, 95% CI ) 118 Finnish asbestosis patients: mesothelioma incidence 65-folded (SIR 65, 95% CI ) Finnish construction workers 199-2: 13 mesotheliomas. SIR for insulators (28,9 95% CI ) and electricians (SIR 7,8 95% CI ) Asbestos related cancer / FIOH / PO / Asbestos related cancer / FIOH / PO / Asbestos related cancer / FIOH / PO / Asbestos related cancer / FIOH / PO / Mortality from Malignant Tumors of the Pleura in Italy, (Reference population: Italy 1991) (Di Paola M, et al. 2) Peto J et al. The European mesothelioma epidemic. Br J Cancer 1999 In six countries in Western Europe (Great Britain, France, Italy, Germany, The Netherlands, and Schwitzerland) male annual deaths from mesothelioma will increase from 5, in 1998 to 9, in 218, after which a decline is predicted. Asbestos related cancer / FIOH / PO / Asbestos related cancer / FIOH / PO /

6 Why occupational cancer is not always detected? Ask about asbestos exposure if: occupational exposure to carcinogen is not known long latency period other etiology, multi-etiology occupational etiology has been detected, but cancer case has not been reported Lung cancer patient has been working over 1 years in asbestos product industry in shipyards in construction Same with larynx cancer patient Mesothelioma patient allways Asbestos related cancer / FIOH / PO / Asbestos related cancer / FIOH / PO / Clinic bus FIOH Tampere Asbestos related cancer / FIOH / PO /

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