1 Asbestos and Cancer in Ontario and The Occupational Cancer Research Centre March A Presentation to the Asbestos Surveillance & Disease Compensation Think Tank, Toronto Dr. Loraine Marrett Associate Director, OCRC Sr Scientist, Cancer Care Ontario
2 Outline Mesothelioma & asbestos in Ontario Workers compensation & asbestos in Ontario Ontario s new Occupational Cancer Research Centre (OCRC) OCRC s current and future work re asbestos-related cancers
3 Mesothelioma & asbestos in Ontario
4 Crude estimates of Ontario workers exposed to occupational carcinogens Source: CAREX Canada, 2008.
5 Mesothelioma in the Ontario Cancer Registry (OCR) Still a relatively difficult disease to diagnose accurately Effective surveillance requires accurate data CCO has applied enhanced logic to best available data to ensure capture of all mesothelioma cases (resulted in increased counts for recent years)
6 Estimated Asbtestos Consumption (Metric tonnes) Number of Cases Asbestos use in Canada and Mesothelioma in Ontario Asbestos consumption (5-yr moving average) Mesothelioma cases diagnosed in Ontario Sources: Natural Resources Canada, Canadian Minerals Yearbook ; Ontario Cancer Registry (2009) Year
7 Age standardized rate per 100,000 (3-year moving average) Rates of Mesothelioma in Ontario, Men Women Age Source: Ontario Cancer Registry (2009)
8 Compensation and asbestos, Ontario: Analysis of Occupational Disease Database (ODISS), WSIB
9 1. Descriptive Study of Cancer Compensation Claims using WSIB s ODISS ODISS claim records listing a neoplasm ICD-9: n = 6564 Restrict to compensated cancer claims n = 3126 Time trends ( ) - overall - by industry - by cancer Restrict to filed n = 1564 Demographics Claim administration Work exposure
10 Cancer distribution, allowed claims, Ontario, (N=1564) N = 1564 Lung cancer Mesothelioma Skin Colorectal Leukemia Larynx Bladder Kidney NH-Lymphoma Nasal Cavities Brain Esophagus Stomach Prostate 3% 4% 2% 1% Mesothelioma 37% Lung cancer, 42% Source: ODISS, WSIB. Pichora E, Payne JI. Am J Ind Med 2007; 50:
11 Occupational exposure, allowed claims, all cancers, Ontario, (N=1564) Primary Causal Agent Asbestos Sintering plants Gold mining U.V. radiation 2% 3% 1% 8% Silica Uranium Combustion residues 3% 3% Foundry dust & emissions Benzene & other A.H.* Coke oven emissions Nickel 3% 4% Asbestos 63% Chemical exposure Radon 5% Other & unknown * Aromatic Hydrocarbons Source: ODISS, WSIB. Pichora E, Payne JI. Am J Ind Med 2007; 50:
12 Occupational exposures, allowed claims, mesothelioma, Ontario, (N = 582) Occupations with n >10 Natural sciences, engineering & mathematics Crafts & 3% equipment operating 4% Machining & related 11% Other 10% Construction 45% Causal agent ~ 100% = asbestos Processing 13% Product fabricating, assembling & repairing 14% Source: ODISS, WSIB. Pichora E, Payne JI. Am J Ind Med 2007; 50:
13 Occupational exposures, allowed claims, lung cancer, Ontario, (N = 652) Occupations with n >10 Nickel Coke oven 2% emissions 3% Foundry emissions & dust 3% Uranium 7% Radon 2% Other & unknow n 10% Asbestos 45% Silica 8% Gold mining 10% Sintering plants 10% Source: ODISS, WSIB. Pichora E, Payne JI. Am J Ind Med 2007; 50:
14 Filing rates for lung cancer & asbestos Ratio of lung cancer to mesothelioma compensated claims where causal agent is asbestos is 298:582 ~ 1:2 Cohort studies of workers exposed to asbestos report a 2:1 ratio for lung cancer to mesothelioma cases Suggests that number of claims for lung cancer attributable to asbestos should be four times what it currently is Source: ODISS, WSIB. Pichora E, Payne JI. Am J Ind Med 2007; 50:
15 2. ODISS-Ontario Cancer Registry Linkage Probabilistic linkage: -personal identifiers: first and last name, date of birth, sex -claims filed (ODISS) -cancers diagnosed (OCR) 6564 WSIB-ODISS claim records listing a neoplasm were linked to the Ontario Cancer Registry Analyses restricted to cancers diagnosed in due to OCR data quality (e.g., pathology completeness) Source: Payne J, Pichora E. Filing for workers compensation among Ontario cases of mesothelioma. Cdn Respiratory J 2009; 16:
16 Filing for workers compensation, Ontario mesothelioma* cases, * WSIB schedule 4 disease as of May 1992 Source: Payne J, Pichora E. Filing for workers compensation among Ontario cases of mesothelioma. Cdn Respiratory J 2009; 16:
17 Percentage of cases that filed a claim (%) % Filing by Age at Diagnosis, Mesothelioma, Ontario, % % 20 14% Age at diagnosis Source: Payne J, Pichora E. Filing for workers compensation among Ontario cases of mesothelioma. Cdn Respiratory J 2009; 16:
18 Ontario s new Occupational Cancer Research Centre (OCRC)
19 OCRC Partners Workplace Safety & Insurance Board (WSIB) funder Canadian Cancer Society, Ontario Division (CCS) - funder Cancer Care Ontario (CCO) funder/home United Steelworkers - partner
20 OCRC Vision The prevention of occupational cancer through the identification and elimination of exposures to carcinogens in the workplace.
21 OCRC Research Foci Surveillance of occupational cancers and workplace exposures Research into the causes of cancer in the workplace Intervention research to reduce exposures and prevent cancer Capacity-building for occupational cancer research Knowledge transfer and exchange to ensure relevance of research and effective use of research findings
22 OCRC s current & future work in asbestos-related cancers
23 Surveillance: Projected mesothelioma burden What is the future burden of mesothelioma in Ontario? -When will the annual # of mesothelioma cases begin to decline? -Mark Clements (Australian National University) has projected # of new cases to 2060 for Australia -Dr. Clements has mesothelioma data (Ontario and Canada) and asbestos data (Canada) and will use to project meso cases through 2060 Important for forecasting compensation Useful as a marker of asbestos exposure for predicting other asbestos-related diseases
24 Surveillance: Refinement of CAREX for Ontario Estimate numbers of workers who continue to be exposed to asbestos by industry Validate estimates Ultimately, reduce exposures
25 Research: Increasing physician awareness of asbestos-related cancers Pilot project submitted to WSIB with Centre for Research Expertise in Occupational Disease (CREOD) (Linn Holness) Physicians in one Ontario lung cancer clinic will distribute exposure questionnaire (asbestos only) to lung/mesothelioma patients Physicians of mesothelioma patients elsewhere will distribute same questionnaire to their mesothelioma patients Patients who indicate asbestos exposure will be offered assistance in reviewing exposure as regards filing a claim OHCOW clinic cooperating Ultimate purposes: To increase physician awareness of asbestos as a workplace carcinogen for lung cancer and mesothelioma To increase filing for compensation where appropriate
26 Thank you! Questions?
27 Age-standardized incidence rate per 100,000 Ontario Mesothelioma Incidence Rate by County of diagnosis, County* of diagnosis Source: Ontario Cancer Registry, (SEER, 2004) *Counties where N<20 not shown
28 Number of compensated claims (5-year moving average) Compensated Cancer Claims by Cancer, Lung cancer (n = 1569) Mesothelioma (n = 800) 60 Other cancers (n = 527) Filing date Source: ODISS, WSIB. Pichora E, Payne JI. Am J Ind Med 2007; 50:
29 Mesothelioma Claim Characteristics, Of the 643 claims filed for mesothelioma cases diagnosed : 15% filed by dependants after worker s death no time limit for filing an occupational disease claim in Ontario 87% of claims filed were compensated Reasons for not compensating: - Ontario worker is not WSIB-insured (self-employed, etc) - asbestos exposure occurred while working out of province - asbestos exposure not occupational - claim was abandoned by the worker or by his/her dependants Source: Payne J, Pichora E. Filing for workers compensation among Ontario cases of mesothelioma. Cdn Respiratory J 2009; 16:
30 Percentage of cases that filed a claim (%) % Filing by County of Diagnosis, Mesothelioma, Ontario, % % TORONTO OTTAWA-CARLETON PEEL LAMBTON NIAGARA HAMILTON-WENTWORTH 14% DURHAM ESSEX YORK MIDDLESEX SIMCOE WATERLOO HALTON GLENGARRY County of diagnosis PETERBOROUGH FRONTENAC GRENVILLE ALGOMA THUNDER BAY VICTORIA HASTINGS NORTHUMBERLAND WELLINGTON Source: Payne J, Pichora E. Filing for workers compensation among Ontario cases of mesothelioma. Cdn Respiratory J 2009; 16:
31 OCRC Guiding Principles Produce and transfer new knowledge to support community action, public education, prevention, legislation, and policy development. Conduct research that adheres to the highest standards research integrity. Involve the partners and key stakeholders in its research agenda. Guided by the precautionary principle. The Centre will operate independently of its funders constraints.
32 OCRC Mandate & Scope Mandate Scope Conduct research on occupational cancer and carcinogens Bridge occupational, environmental, and public health Build research capacity Ontario-wide focus Nationally/internationally networked Multi-disciplinary approach Applied research
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