Tga seotud kopsuhaigused Tartu, 8'9' oktoober 2003

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Tööga seotud kopsuhaigusedTartu, 8.-9. oktoober
2003

• OCCUPATIONAL LUNG CANCER
• Panu Oksa
• Soome Töötervishoiu Instituut
• Tampere, Soome
• Finnish Institute of Occupational Health,
  Tampere, Finland

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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

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New lung cancer cases /year in Finland
YEAR MEN WOMEN________________________________
______1957 1106 1181962 1422 1131967 175
7 11541972 2099 2661982 2015 2981987
1870 3781992 1837 4291997 1536 478
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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)

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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

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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

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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

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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)

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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

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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

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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

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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

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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

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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)

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Risk for lung cancer
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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 199723311-316)
• 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
• NOTEit si not possible to calculate exposure to
  chrysotile from tissue samples or lavage fluid
  after a long latency period

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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)

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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

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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