Epidemiological insight into occupational causes of respiratory cancers

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1 Epidemiological insight into occupational causes of respiratory cancers Fraser Brims Epidemiological insight into occupational causes of respiratory cancers The following relevant disclosures, conflicts of interest and/ or financial relationships exist related to this presentation: I have received honoraria, payment and support from: Australian Communities Foundation Slater & Gordon Turner & Freeman Vojakovic Fellowship 1

2 Introduction Occupational exposures & risk for lung cancer About 15% of lung cancer cases are attributable to occupational exposures Rushton, 2012 Mesothelioma Wittenoom to Libby, Montana 2

3 Relative risk of lung cancer Smoker >20/d Smoker 10-19/d Smoker <10/d All smokers High workplace ETS Workplace ETS overall Family history ETS = environmental tobacco smoke Cancer Australia,

4 Radon* Aresenic* PAH Cadmium Asbestos* Silica* Iron & Steel* Nickel* Beryllium Painting Chromium VI Diesel Occupational exposures relative risk of lung cancer *dose dependent risk; raised risk with tobacco smoke Cancer Australia, 2014 Other recent reports... Welders Canada; Vallieres, 2012; SYNERGY - adj OR 1.44 ( ), increased with longer duration; Kendzia, 2013 Night shift workers adjusted for smoking in current smokers; Schernhammer, 2013 Bricklayers (silica? asbestos?); Consunni, 2015 Lead exposure Wynant, 2013 NO; Chowdhury, 2014 YES! Fire fighters lung cancer SMR 1.1 ( ) Daniels, 2014 Formaldehyde workers; Mahboubi,

5 Other recent reports... And Hairdressers (?!) Olsson, 2013 Bakers, Pastry cooks and Confectionary workers OR 1.1 ( ); Behrens, 2013 Diesel engine exhaust 2012 IARC classified DEE as class 1 carcinogen Strongest evidence is in highly exposed workers Complex composition: gas, particulate, PAH, VOCs Proxy measure: respirable elemental carbon (REC) Variable risk estimates Benbrahim-Tallaa, Lancet Oncology

6 Diesel engine exhaust 2012 IARC classified DEE as class 1 carcinogen Strongest evidence is in highly exposed workers Complex composition: gas, particulate, PAH, VOCs Proxy measure: respirable elemental carbon (REC) Variable risk estimates Miners, rail road, truckers 2-3 fold increased risk Railroad workers 40% increased risk Truckers, dockyard workers 15-40% increased risk Benbrahim-Tallaa, Lancet Oncology 2012 How relevant is DEE to Australia? 6

7 DEE in Australia Cross sectional survey >5000 current workers in Australia (2011) 13.4% respondents substantial DEE exposure Highest in WA (17.0%) Agricultural, mining, transport, construction, mechanics. Males > females DEE in Australia Cross sectional survey >5000 current workers in Australia (2011) 13.4% respondents substantial DEE exposure Highest in WA (17.0%) Agricultural, mining, transport, construction, mechanics. Males > females Extrapolation: 1.2 million Australians currently exposed in the workplace 7

8 Asbestos Classic occupations exposed: Carpenters, boiler makers, laggers, ship & railway construction, ship breaking, armed services, builders, plumbers Risk of developing LC increases after >10 years exposure, lag time between 20-40yrs Valik, 2002 Increases with increasing duration of exposure Chrysotile - longer time to develop? Wang, 2012; Yano, 2010 Asbestos fibre type Healthy worker effect Underestimate of risk Naimi, 2013; Naimi, 2014 Risk of different fibre type(s) is unclear Hodgson, 2000, Lenters, 2011, van der Bij, 2013 Mixed fibre exposures 8

9 Low dose (mixed fibre) exposure Importance for wider population 9

10 Low dose (mixed fibre) exposure Importance for wider population Use of JEMs AsbJEM specific for >220 Australian jobs van Oyen, 2015 JEM for ~58,000 Netherlands Offermans, 2014 Low dose exposure may be associated with increased risk MPM, lung and laryngeal cancer Dependent on exposure duration 10

11 Relative Risk of lung cancer Asbestos exposed, never smoker: No asbestos, smoker: Asbestos exposed, smoker Multiplicative risk Lee, PN, 2001 Low dose CT for asbestos exposed? USPSTF (NLST lung cancer) Brims, AJRCCM

12 Low dose CT for asbestos exposed? USPSTF (NLST) 7 lung cancer cases in 906 (0.78%) 36% never smokers, mean age 68.9 yrs 3.6% eligible under NLST, 29.7% NCCN Brims, AJRCCM 2015 Low dose CT for asbestos exposed? USPTF (NLST) 7 lung cancer cases in 906 (0.78%) 36% never smokers, mean age 68.9 yrs 3.6% eligible under NLST, 29.7% NCCN Current risk prediction models probably do not account adequately for occupational exposures Brims, AJRCCM

13 Occupational exposures and lung cancer Numerous occupational exposures associated with increased risk of lung cancer Tobacco smoke exposure Strongest risk Interacts with other exposures to increase risk Majority of the exposures discussed are relevant to Australia 13

14 As of Thus 25 th March ,138 people (8,973 men) followed up 6,918 former Wittenoom workers (6,497 men) and 5,220 were former Wittenoom residents. 14

15 As of Thus 25 th March ,138 people (8,973 men) followed up 6,918 former Wittenoom workers (6,497 men) and 5,220 were former Wittenoom residents. 612 lung cancers 472 pleural and 58 peritoneal cases of MM 5,182 deaths from all causes Western Australia Mesothelioma Register

16 Mesothelioma in WA Olsen, MJA

17 From WA to the USA. Canada Libby, Montana United States Vermiculite Mine 6 Miles from Libby Slides courtesy of Dr Brad Black 17

18 Massive Mine Tailings 18

19 Vermiculite Rock at Mine Site Libby Amphibole Composition Winchite 85% Richterite 10% Tremolite 5 % Based on the classification criteria of Leake et al, 1997 Meeker et al, 2003, The composition and morphology of amphiboles from the Rainy Creek complex, near Libby, Montana.. SEM/EDS <3 um diameter 19

20 Libby Amphibole within vermiculite attic insulation Baseball field Vermiculite processing City of Libby 20

21 Baseball Field Surface with Vermiculite Ore Storage Bins and Processing Plant Adjacent Playing in Vermiculite Ore Was Popular (Up to 26% Libby Amphibole) 21

22 Traditional ARDs Libby Pleural abnormalities: 50% mine workers, 23% household contacts, 14% residents Peipins, 2003 SMR lung cancer 1.7 Sullivan, 2007 SMR MPM 15.1 to 23.3 Sullivan, 2007, Amtao, 2012 Also other diseases Libby Strong associations with Autoimmune disease Noonan, 2006, Noonan, 2014 New (?) clinical-radiographic appearances 22

23 23

24 In summary Numerous occupational exposures associated with lung cancer Tobacco smoke exposure Mesothelioma Industrial disasters Occupational and Respiratory Health Unit, Sir Charles Gairdner Hospital, Perth, Australia 24

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